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The Department came into being on 1st November 1993 when the founding head of the Department, Prof Msamati, took appointment. However, it was not until Monday 19th September 1994 that the doors of the Department were opened to the first cohort of locally trained undergraduate medical students.
Of this first group of 21 medical students, 18 graduated in July 1999.
Teaching is centred on training undergraduate medical students at the moment but we are on the verge of recruiting BSc Intercalated students, Masters students and those for PhD programmes coupled with our contributions to the Masters of Medicine (MMed.) Degree programmes in Clinical Departments when these come into being.
The main thrust of research has been to obtain baseline anthropometric data for Malawians as this is lacking. To this end 18 papers have now been published in refereed journals while 7 are under review. Collaborative research with clinical departments is also taking place while other areas of research in sleeping sickness, gut endocrine system, albumin levels and nutritional studies wait funding.
Clinical practice has been limited because of the heavy teaching workload as we are very few, but with the opening of the College of Medicine Clinic, more input will be expected from the Department.
Embalming services
Embalming service to the general public started in July 1998. The driving force behind this venture was financial constraints. The College of Medicine budget was increasingly getting smaller and smaller as years went by. Admittedly the constraints in the budget affected not only the University as a whole but also our staff in particular. When we realised that most of the rural hospitals have no cold rooms to keep their dead, the Department conceived a course for Mortuary Attendants to answer to the need of Malawians living in the rural areas.
The first embalming course was successfully launched in November 1999 with 6 Mortuary Attendants. To the best of our knowledge, this is the first course of its kind in Sub-Saharan Africa. Because of the success of that programme, more courses will be organised every year.
Developments underway
In order to address the staffing constraints, the Department is launching an Intercalated BSc (Hons.) Degree from January 2002.
The idea is to build an academic base of upcoming young men and women, who will not necessarily be Medical Scientists, but rather to prepare a large pool of young doctors capable of holding academic and clinical positions in all areas of medicine.
However, experience has shown that such candidates tend to gravitate to Basic Medical Science departments as well. Currently, we are preparing the syllabus for an MSc. Degree Course, which again we hope to launch next year. In order to realise these developments the department is intending to recruit more staff to support both the staff development programme (Intercalated BSc and MSc Courses) and to consolidate the research base in the fields of Forensic and Physical Anthropology.
The Department of Biochemistry came into existence in 1994, having been established along with the Anatomy and Physiology Departments to teach Biochemistry in an integrated Basic Medical Science programme. The Department is also responsible for teaching clinical biochemistry to the third year students in the Division of Pathology.
Biochemistry is an ever growing subject which covers not only the needs of all the medical disciplines such as medicine, dentistry, pharmacology, pharmacy, physiotherapy etc. but all other biological disciplines. It is in this context that the programmes and future expansion of the Department of Biochemistry should be viewed.
The quality and aspiration of an academic department as a centre of excellence must focus on the postgraduate programme which ideally must contribute to the quality of the graduating products and research capability of the department. The Department has designed a curriculum for higher degrees such as MSc and PhD. It is also envisaged that the Department will be able to produce first degree (BSc) holders who can be useful in a range of medical and non-medical disciplines.
Clinical chemistry that is at present being taught by the Department, would normally be taught by clinical scientists. The future growth of the Department of Biochemistry is expected to have a sub-department of clinical biochemistry (chemical pathology) which is hospital based. Forensic medicine should also taught in the future. It could be in form of a short course for law officers who are to be trained in aspects of crime investigation.
The BSc programme is to be linked with income generation from industries and other entrepreneurs. The research capabilities and dividends should normally start from the BSc programme up to PhD level. Having BSc honours students brings some dynamics to the discipline. Thus, BSc and other programmes (MSc and PhD) will enable the discipline of Biochemistry to be relevant to modern scientific trends. The programmes will contribute to the economic and industrial growth of Malawi.
Since its opening in 1991, the College of Medicine has had a community orientation, and this orientation finds expression in every aspect of the undergraduate teaching. Community Health teaching spans the whole five years of the College's undergraduate medical education and takes up 25% of curriculum time. Orientation is designed to achieve vertical integration within the subject and the horizontal integration with other basic medical and clinical disciplines.
It is important that the teaching of every aspect of Community Health is in relationship to direct on-going experiences of the needs of the people. Community health teaching takes place in Blantyre and the surrounding areas, as well as in Mangochi, where the College has a satellite unit with full teaching facilities and hostel accommodation for staff and students. There is also a teaching site at Lungwena Health Centre, 23 kilometres east of Mangochi. Our ethos is to impart an appreciation of community issues in our medical students. Subsequently our first years spend two weeks in a village “Learning by living”. We have a dynamic teaching staff specializing in various disciplines such as Psychology, Nutrition, Demography, Occupational Health, Public Health, Biostatistics, Bioethics and Health Economics.
Our vision of the department is that within the next 5 years, the Community Health department will be a self-sustaining division, training leaders for Malawi and the Sub-Saharan region at both undergraduate and postgraduate levels. The division will promote and maintain services to the community in the spirit of uMunthu (African philosophy of community). The division will also encourage a vibrant international collaborative environment.
The Department of Haematology became operational in April 1991 when the College of Medicine was, for the first time, established on the ground in Malawi. At its inception, the department's establishment was one professor and one secretary operating from a tiny room in the Department of Medicine teaching annex. To date its establishment is: two professors, one senior lecturer, one lecturer, two staff associates, one secretary, one chief technician and two senior technicians housed in the new haematology block at Mahatma Ghandi road campus. Staffing at academic level has been difficult and practically only one haematologist at professorial level has hitherto serviced the department.
Haematology is taught in a vertically and horizontally integrated fashion to years 1 to 5 of the MBBS programme to give students an understanding of the causes, presentation and management of blood disorders. The bulk of teaching is done in year 3 at the end of which a barrier final professional pathology (haematology inclusive) examination with external examinership is held. For the moment, there is no haematology postgraduate training for stall development but two local eligible candidates have been selected for training abroad and will form the nucleus of future haematologists. Other major academic achievements and community activities have included:
Research into haematological and oncological disease commonly seen in Malawi and the southern African region resulting in several local, regional and international conference presentations and publication of ten papers mostly in reputable journal.
Providing laboratory and clinical service at Queen Elizabeth Teaching Hospital with the establishment of haematological and oncological in-patient and out-patient services for patients with blood diseases.
External examinership at undergraduate and postgraduate levels in haematology at the Universities of Makerere, Nairobi, Dar-es-Salaam and Zimbabwe.
Completion of the new ultra-modern haematology block at the Mahatma Ghandi road campus in preparation for setting up high-technology haematology and oncology teaching and research laboratories.
The field of haematology is still virgin. There is a vast number of blood disorders that need intensive research to provide the necessary answers. For the haematology department, the foundation has been laid and the essential infrastructure fully established. As for the future of the department, the sky will not be the limit but the beginning.
I was appointed College Librarian for the new College of Medicine in May 1990. In July 1990, I left for the United Kingdom where I was attached to the Medical School Library of the University College London until October. Whilst there I visited several medical school libraries in the London area as well as the Medical Audio Visual materials specialists and medical book suppliers. At the Book AID International, I selected books and periodicals for the new College Library. In 1991, I visited African Medical Libraries at Makerere University, University of Zimbabwe, Medical University of Southern Africa (MEDUNSA) University of Witwatersrand and University of Cape Town. In Europe, I went to the University of Limburg Medical School, which has a community-oriented curriculum. These visits helped me plan a medical Library suitable for the new College.
Accommodation and Staffing
The first problem to be tackled was that of accommodation for the new Library since the new College had no such facility. Arrangements were made with the polytechnic Library to lend us the ground floor on the eastern side of the building. The initial plan was for this to provide us with space for three years, after which our own building would have been constructed. After arranging the spaces; the Library had sitting capacity of 60 readers and shelving space for 15000 volumes display shelves for 450 periodicals, room for up to 15 computers, photocopies and a loans counter. These spaces are now almost full. Should the Library remain at the Polytechnic for another two or three years, the problem of space will become serious.
The new Library had initially been allocated one position of College Librarian, one Senior/Chief Library Assistant and one Library Assistant. By the end of 1991, the number was increased to allow for the appointment of an A/V technician and a secretary.
As soon as I returned from the attachment in the UK, I embarked on the acquisition of books and audio visual materials with K1,500,000 which the Medical School Project had set aside for that. Whilst in the UK, I contacted some of the key medical booksellers and suppliers of medical audio-visual materials who provided me with a variety of catalogues. Orders were prepared and sent to the suppliers mainly in the UK and soon books started coming in. Within the first three years of the Libraryís existence, the stock grew to 6,838 volumes of books. What was more pleasing was that external examiners and visiting professors were satisfied with the Collection as being very supportive of what was taught in the College.
In the second year of the existence of the College, the Library subscribed to journals, which were mostly of interest to clinical studies, since the basic medical sciences had not yet started. It was only in 1995 that periodicals subscriptions relevant to basic medical studies were ordered. At our peak the Library subscribed to 140 titles of periodicals, which in recent years have dropped tremendously due to inadequate financing.
Information and Communicaton Technology (ICT)
Realising the importance of ICT in medical education, the Library took a decision to introduce Information and Communication Technology into its services right from the onset. An IBM PC 386 computer with two CD drives was procured. Subscription was entered for Medline and Popline databases to enable staff and students to search through these most popular databases since then the Library has acquired more electronic data bases which amount to over 50 at present.
Recently the Library has acquired a digital projector for computers, which is used mainly during College workshops and seminars.
Electronic Mail
In 1993, the University of Malawi electronic mail known as “UNIMA” system was introduced The Library was one of the first institutions to be connected to it. Later, Healthnet Malawi was established in April 1995 with its node in the College of Medicine Library. Its services quickly spread to district and rural hospitals in the country, but due to technical problems the service broke down in 1999. By that time, full Internet public service known as Malawinet had already come to Malawi. The Library applied for a connection, which has since revolutionalised the information searching habits in the Library. To date, the Library has 10 Internet stations all using Pentium computers. The service has recently received a boost when Malawinet increased its band width resulting in increased speed and better service.
Audio visual materials
The Library has a very rich collection of audio-visual materials relevant to the work of the College.
These include videocassettes, sound cassettes, films, colour slides, pictures, microfiche, microfilms and several others - together with their accompanying equipment, such as video equipment, viewing boxes and slide projectors. Realising that the stock of the Library is small and that some of the materials are not allowed out on loan, the Library has acquired adequate photocopying facilities to enable users to make photocopies whenever necessary.
Health information services are under developed in Malawi and the College is the only medical school in the land. The College of Medicine Library therefore undertook a number of measures aimed at sharing its meagre resources with less provided for neighbours in the health sector in Malawi. It provides free reference services, free literature searches in its several electronic databases. It provides current awareness service to district and rural hospitals by sending them contents pages of journals of their choice from the Library's list of periodicals received. The extent to which these services are offered depends on the availability of adequate finances in the College. In addition, the Library has in the past solicited books from donors such as Book Aid International and THET in the UK which it has distributed to district and rural hospitals.
Problems
In spite of the successes, the Library has met several problems. It has no building of its own. Where it is located, the space is inadequate/making it impossible for innovations in services to be introduced: The Polytechnic is also expanding and would like to lake back the space the Library is occupying. The other problem is under financing which has led to fewer books than expected being bought and failure to renew periodicals subscriptions in certain years. There is a need to have two more professionally qualified staff added to the Library. Developments in ICT applications require stall well trained and competent in the new technologies to be able to provide services the future users will demand.
The Future
Successful medical libraries will be those that will invest a lot in information and communication technologies. The College of Medicine Library will have to expand its services to increase access to Internet electronic databases. These facilities must be supported adequately with books, periodicals and audiovisual materials. The services to be offered will require adequate number of appropriately trained staff capable of harnessing the new technologies and a modern building equipped adequately with all the necessary paraphernalia.
Conclusion
As a young Library, the College of Medicine Library has done well despite financial inadequacies and lack of its own building. This has been confirmed by international visitors such a visiting professors and external examiners. However, the Library needs more resources to be able to meet future demands.
The Department of Medicine was established in 1991 by Professor Tony Harries. It has grown since then to a current full-time staff of 2 Associate Professors, 1 lecturer and 3 assistant lecturers; as well as 3 part-time members of staff: 1 professor, 1 senior clinical specialist and 1 lecturer.
Postgraduate teaching: is being developed in the formal of a Master of Medicine part I (in Malawi) and part II (now; abroad; in the future: in Malawi)
Diploma in Tropical Medicine course: a DTM&H (Malawi) course will be developed to attract candidates from Malawi and other countries in the region. The course will be built on an ideal combination of locally available expertise (supplemented with lecturers from abroad) as well as clinical material
The Department organizes teaching sessions for clinical officer trainees, who do their internship in the Department.
Research
The overall departmental research strategy can be described as follows:
“Clinical research on topics of major local relevance”
Planned/ongoing research includes:
prophylaxis of opportunistic infections in HIV infected patients with smear-positive tuberculosis
prevalence of Cryptosporidium parvum and Isospora belli infection among medical in-patients at QECH
study on the contribution of Schistosoma infection in non-traumatic spinal cord disorders as seen in medical inpatients at QECH
randomised trial of (a) dexamethasone against placebo (double blind) (b) intravenous versus intramuscular ceftriaxone (open label) in bacterial meningitis in an area of high HIV prevalence
modulation of human alveolar macrophage function during Mycobacterium tuberculosis and HIV co-infections
investigation of the humoral immune response to pneumococcal polysaccharides and the role of a conjugate pneumoccal vaccine in secondary prevention of invasive pneumococcal disease in HIV-infected Malawian adults
study of Salmonella disease
pulmonary defence and susceptibility to infection with Streptococcus pneumoniae in HIV-infected Malawian adults
Clinical duties
The Department is responsible for the clinical service in QECH for internal medicine by running the in-patient wards (200 beds) and a number of outpatient clinics. Daily admissions are ∼30–40 with a total of over 9000 admissions yearly. Patterns of disease mainly include HIV related illness (70% of in-patients are HIV positive); tuberculosis, respiratory tract infections, bacteraemia and malaria are the most common diagnoses. Other conditions include diabetes mellitus, heart disease, asthma and poisoning.
The tenth anniversary of the College of Medicine comes not long after the departure of the foundation Professor of Surgery, Adelola Adeloye. At his farewell symposium earlier this year, the history of the department was held up to the light. At its inception, the College found a strong clinical department at QECH with a number of Ministry of Health consultants responsible for a high level of clinical care. The pendulum has swung with the passage of time and now all clinicians are full-time members of the academic department.
There was always the feeling in the past that the demands of service commitment out-weighed that of teaching activities. Only in recent years has this changed with the arrival of middle grade staff. To be able to teach surgery in any other than a dry theoretical sense requires an active and functional department with a continuous throughput of a wide variety of patients. This particularly applies to the learning of practical procedures that must be part of the armamentarium of every graduate. Of all the surgical specialties, only orthopaedics has had reasonable representation over the years. Ophthalmology, plastic, paediatric and minor surgery have all had single consultants. The absence of an ENT specialist is still a significant gap in the program.
Despite such difficulties, undergraduate teaching has flourished. The curriculum has developed over the years in a way appropriate to the needs of the graduate in the context of future district hospital appointment. Research has a clinical bias with a particular emphasis on audit and on the study of common sepsis and HIV related problems which are major problems faced in daily patient care.
Postgraduate training has combined clinical training within the department and formal continuation of training abroad. The department is recognised for the clinical preparation for the MRCS (Ed) exam and one of our lecturers, Dr Kumiponjera, has successfully negotiated this hurdle. A second candidate is currently sitting the exam and two other registrars are preparing for the first part later this year. In addition, there are two post-graduates undergoing training in South Africa. The first fully-trained orthopaedic surgeon, Dr Mkandawire, returned from UK over a year ago and is a lecturer in the department.
The advent of the College of Surgeons of East and Central Africa (COSECA) is eagerly awaited and will hopefully set the standards for surgical training in the region. The Department is developing an M Med programme that will be closely linked to this regional initiative.
Microbial diseases remain, despite the inputs of antibiotics, vaccinations and public health, the major causes of human morbidity and mortality on a global scale. In sub-Saharan Africa including Malawi, over 70% of all the infections are of microbial origin and this immediately catapults diagnostic microbiological services to the centre stage of any planned health care delivery system.
The Department of Microbiology, established in September 1994, became functional with the joining of Dr V R Subramanyam from the Indian Institute of Medical Research. However, lack of independent laboratory facilities and being a lone member became the major constraints in the development of the department. Fortunately, with the help of funds from the departments of Paediatrics and Medicine and a grant from the Beit Trust, a laboratory was built and set up in the department which even till now remains the only functional microbiology laboratory, as the new laboratory building complex is yet to be completed. The number of clinical specimens referred to it has continued to increase, not only from QECH which it primarily serves, but from other hospitals, clinics and individuals within and outside the City of Blantyre. Our laboratory is particularly renowned for its activities in the area of mycobacteriology especially tuberculosis.
Although our mission in the department is “serving to improve the overall health care of the community,” we specifically aspire to be a centre of excellence in the areas of HIV/AIDS/STD, tuberculosis and onchocerciasis research. The recent confirmation in our laboratory of the first cases of Buruli ulcer (Mycobacterium ulcerans infection) in Malawi is an attestation of our resolve to change the public health landscape of the country for the better.
Furthermore, the department while initiating its own research activities continues to provide technical support for researches based in other departments and also collaborating with others initiated from outside the college. Some completed and on-going researches include:
Completed Research
Effect of essential oils on the viability and morphology of Escherichia coli (SP-11).
Antibacterial activity of essential oils from cymbopogon; inter- and intra- specific differences.
Parental filariasis as a risk factor for filariasis in children.
Number of sputum smears for diagnosis of smear-positive pulmonary tuberculosis.
Chloramphenicol-resistant bacterial meningitis in Malawi.
Cryptococcal meningitis in African children.
Bacteriology and demographic characteristics of chronic wounds/ulcers at the QECH.
Sexually transmitted diseases at the QECH.
Children as outpatients at the STD Clinic, QECH, Blantyre.
Bacteriology of burns at the QECH (with the Dept. of Surgery)
Epidemiology and mortality of burns at the QECH (with the Dept. of Surgery).
Mycobacterium ulcerans infection in Malawi.
Bacteriology and clinical course of crocodile bite wound infections at the lower Shire, Malawi.
The prevalence of tuberculosis among inmates at Chichiri Prisons, Blantyre.
Evaluation of the antimicrobial properties of garlic.
Mycobacteraemia and bacteraemia in febrile adult medical patients at the QECH, Blantyre (with the department of Medicine).
Knowledge, attitudes and practices on tuberculosis in Blantyre schools.
AIDS-related knowledge, attitude and practices among residents in rural Malawi.
Research in progress
Influence of HIV on burns outcome. (with the departments of Surgery & Medicine).
Drug susceptibility/resistance patterns of Neisseria gonococcus isolates at the QECH, Blantyre.
Immunological and viral load changes in a co-infection of HIV with Malaria.
Presently, with a staff strength of six and an array of equipment yet to be installed, the issue of space still remains the departmentís major problem. The department is involved in a number of collaborative research projects within and outside the College and there have been offers of collaboration from several international research institutions which are prepared to provide every other requirement but laboratory space. This issue of space is our major constraint and a serious impediment to our capacity building. The department therefore wishes to appeal to the government through the College Management to provide funds to complete the Microbiology laboratory building to enable the department attain its full potential.
The paediatric department was founded in 1991. The current staff include a professor, a senior lecturer and 2 assistant lecturers. There are also 2 honorary senior lecturers, 2 part time senior lecturers and a part time assistant lecturer. The founding Head of Department, Professor Broadhead, has recently been appointed as College Principal.
Teaching
Undergraduate: First and second year medical students are introduced to the clinical aspect of some of the basic science subjects in their curriculum. Third and fifth year students do 7 week clinical attachments in the department.
Postgraduate: Postgraduate courses leading to a Postgraduate Diploma are being developed. Meanwhile seminars and teaching sessions are aimed at encouraging and helping middle grade staff to acquire postgraduate diplomas from overseas. Seven postgraduates have obtained the MRCPCH and 3 more are in the process of acquiring it.
Clinical Officers: Clinical officers do 3 months internship in the department. Paediatric staff members also examine clinical officers in their final examinations both in Lilongwe and Malamulo.
Elective students: Students from many other countries do electives in the department.
Research
The department has been active in research. The research is clinically driven and relevant to local problems and perceived needs.
On going research includes:
The long term prognosis of twins both with and without HIV infection
Measles immunisation and measles antibody titres in children who are HIV positive
Rotavirus as a cause of acute diarrhoea and the role of HIV in rotavirus clearance and mortality
Chest infections in infants: the clinical presentation, cause and outcome
Bacteraemia in inpatients - causative agents, clinical presentation, associated findings and outcome
The role of steroids in the management of acute bacterial meningitis
Five versus 10 days treatment of ceftriaxone for meningitis
TB drug pharmacokinetics in children and the relevance of malnutrition or HIV to therapeutic dosages
Clinical
All the staff work and teach in the Queen Elizabeth Central Hospital. The paediatric department has 110 beds and 60 neonatal cots. There are 12,000 admissions each year. Each day 200 – 600 children are seen in the new accident and emergency unit of whom approximately 10% are admitted. Trauma cases are also cared for in A&E. Common causes of admission are malaria, gastro-enteritis, pneumonia, TB, meningitis and malnutrition. AIDS is an increasing problem. Malnourished children are looked after in a separate nutrition unit. Children with malignant disease are referred from the Southern Region and cared for on a separate oncology ward. The department hopes to introduce and develop a palliative care programme in the near future.
The Department of Physiology has been in existence since 1993. Despite its small size, inadequate premises and lack of essential laboratory equipment, it effectively provides qualitative tuition in Physiological Sciences to the undergraduate medical students.
From 1993 to 1999 staffing at the department was very critical with only one permanent qualified Physiologist. In addition, more than ten Physiologists from abroad visited the department to help in teaching and course development. However, staffing situation has improved considerably over the past two years and at the moment we have five academic members of staff, i.e. one Professor, one Senior Lecturer, one Lecturer and two Staff Associates.
Academic activities of the Department revolve essentially around teaching of first and second year medical students. This involves approximately 150 contact hours in the classroom and 50 hours of practical and tutorials plus 4 three-week projects for small groups of students.
There is an urgent need to start postgraduate programme in Physiology at the College but inadequate staffing situation and laboratory basis are limiting factors in developing and implementing this programme and therefore sending of local staff abroad for postgraduate training is the only way of staff development at the moment. Mr M H Mipando recently obtained a MSc degree in Physiology from the University of Liverpool and he is currently reading for a PhD degree in South Africa. Two other Staff Associates secured places in South Africa and will start their programmes next year.
Despite of lack of modern research equipment and qualified technical staff as well as overloading of academic staff, the department has been able to conduct research. Six papers were published over the last two years, four papers are in print and seven articles were submitted for publication. Members of the department attended several local and international conferences and served as external examiners in Zambia, Zimbabwe and Ethiopia.
The history of the department of Psychiatry at the College of Medicine is very brief. The department was created in August 1999. There are 3 established posts, viz: Senior Lecturer (1), Lecturer (2). Only one post of Lecturer is filled by an expartriate on a 2 year contract. There are no immediate prospects of Malawian psychiatrists filling the posts since there is only one Malawian training to become a psychiatrist. He will complete his training at the earliest 3 years from today.
There are possibly 2 main reasons why psychiatry faces an uncertain future. The main reason, in my opinion is that psychiatry has not yet made it to the list of priorities for the Ministry of Health and Population in Malawi. The second reason is that the stigma of mental illness has rubbed off into the discipline of psychiatry.
Why is psychiatry not a priority?
To answer this question one has to consider the public health concepts that all governments use - the incidences, prevalences, mortalities of priority conditions; the level of public concern and the availability of preventive and treatment measures. Mental disorders are generally non-communicable, are chronic, require long-drawn out treatments. A new way of deciding on priority conditions uses the burden of disease due to specific conditions. When this approach was used mood disorders were found to rank number 4 in 1990 on the top ten conditions that cause disability and the projections are that mood disorders will have moved to position number one in 2020 (WHO report; 1997).
Stigma and the future of psychiatry
Many people including health professionals fear and avoid people with severe mental disorders. The facilities and environment in which the severely mentally ill are managed are often neglected and therefore are unattractive. These matters deter young doctors from joining psychiatry. We in the department of psychiatry will over the next 4 years endeavour to:
raise the profile of psychiatry within the curriculum
create and nurture interest in psychiatry among students and the medical fraternity.
complete and publish research work on postnatal depression in selected communities in Malawi
recruit at least 2 young graduate doctors into the staff development programme
establish by 2004 an inter-university link with a university in the African region to enable the college to train the required academic staff.
In conclusion let me take this opportunity to invite young graduate doctors and medical students to consider psychiatry in their persuit of professional growth and development. There is more than meets the eye in psychiatry.
The Department of Obstetrics and Gynaecology was established by Professor Mtimivalye in 1991 as one of the first departments of the College of Medicine. The Department aims to provide quality medical education in reproductive health to undergraduate medical students in Malawi and contributes to teaching in all years, particularly Years 3, 4 and 5.
The department aims at establishing a fully fledged and internationally recognisable and acceptable specialist postgraduate training in Obstetrics and Gynaecology, so as to produce lecturers for the College of Medicine as well as specialists to work in various capacities within Malawi. To date, there are two post-graduates from the Department who have completed their specialist training and four who are in the process.
The department recognises the essential role that operational research plays in academic professional advancement, improvement of the quality of education offered to students and health care service provision as well as to assist the government in formulating national policies and guidelines in reproductive health. To this end, the Department has been involved in a wide range of research activity that includes management of sexually transmitted diseases, family planning, mother-to-child transmission of HIV infection, maternal anaemia, malaria in pregnancy, ectopic pregnancy, twin pregnancy and adolescent health. This research has resulted in many publications in international peer-reviewed journals.
Being a clinical discipline, the Department is committed to providing high quality reproductive health care services to people of Malawi, through outpatient services, inpatient care and operative obstetrics and gynaecological services. The department provides care and supervision within the maternity wing at QECH where there are more than 10,000 deliveries each year. It also supports local NGO's by participating in various community-based activities.
In 1986, the Ministry of Health identified “severe malaria in children” as priority for clinical research, and the “Malaria Research Project” began. From 1986 until 1991, the research was carried out under the aegis of the Queen Elizabeth Central Hospital. Dr Ankie Borgstein provided critical support. When the College of Medicine began in 1991, the Department of Paediatrics, headed by Professor Robin Broadhead, provided an academic home. A very productive symbiosis has developed, in which the research activities provide a diagnostic service as well as clinical care for critically ill patients, and over the years, a variety of studies have been earned out.
In July 1995, both the Wellcome Trust (WT) in UK, and the National Institutes of Health (NIH), in USA, began to provide significant amounts of support for this research. Two research groups have emerged from the original ‘Malaria Research Project’. These two groups are closely linked by several joint activities, and both are affiliated to COM. They are the BMP (Blantyre Malaria Project) - largely but not exclusively funded by NIH - and MLW (Malawi-Liverpool-Wellcome Trust Clinical Research Programme), funded by WT. While each group works independently, they do also collaborate st on several research studies.
The BMP and MLW programmes both operate on the following principles:
Projects are conducted within Departments of COM and in collaboration with COM staff
Topics studied are important clinical problems in Malawi
Research is coupled with training of staff, in Malawi and elsewhere
Collaborations with other universities and agencies are promoted
The research is conducted within Malawi whenever possible, or is linked to training of Malawi staff
Her face is wet and chilled. In awe look on, apprehensive. The tender leaf, the rose, the grass blade Are covered in tears. Mother Earth in tears? In great awe I wonder as I wander: In tears, but why? In tears cold and crystal clear, for whom? In tears this early? How come?
Has she been tear-gassed and harassed? Has she been robbed at gun-point? Has she been raped or divorced? Is she displaced, starved, diseased and without a blanket? Has she lost her spouse and children to war, famine and AIDS? Has she been retrenched of denied pay rise and discriminated against? Has she been bitten by Winter in her wrath? The earth is weeping and mourning. Sleep-lovers wonít notice her tears.
Her tears are shed for moral poverty and destitution, for the environment polluted and degraded, rusting, currency and cost-driven living. Very early in the morning her frozen teardrops fall. Tears for illiteracy, morbidity and the iron-reign of death. As I wander in her winter tears I wonder why?
