I
I
STUDENT VOICE/ LETTERTO THE EDITOR
An Elective Experieqce With the University of Oklahoma' AT Msusa Universitt:of Malawi Collegeof Medicine(Yaar V) Introduction -l was given the honour of being the first med_19a1 stuclentfiom the Universityof Malawi Collegeof Medicine(UNIMA-COM)
'partof'the teamand benefitedtiom thern. A varietyof conditionswere seenwith the difl'erence thatnot as many infectiousconditionsareseen,as is the casein Malarvi-At St. John's,alcoholabuse,cartliacproblems,agerelateddegenerative conditionsare commonlyseen.It was an and real lif'eexpositionof what herein eye openingexperience Malawi we consider"text-bookstutf'. Working in a hospital with all necessarydiagnostictools and computerizedfilling systemwas like a dreamto me. Healthinfbrmationsystemwas ': so elaborateand quick to access.
to be the scholarshiprecipientof the International Srudiesin -of Medlcine (ISML the Univdrsity of Oklahoma College of r Medicine (OU-COM). The broad objectivesof the elective Experience at St Francis Hospital -Warren Clinic Diabetic were fbr me to be ableto compareandcontrastmedicalservices Center.
providedto patientswith diabetesmellitusin USA and Malawi OU-COM also utilizes St, Francis Hospital as a teaching Centeris within this institution and to explore and describe e.lementsof diabetes mellitus hospital.WarrenClinic Diabrites good has program a lbr diabetes education.Oklahomais a ,ipatientsin USA. The objectives.of the elective were to be *and ' ofdiabetesandso wasjusttheright achievedthroughparticipationin morningmeetingdiscussions, statevriiha highprevalence place learn to DM management. ward rounds, clinics, lectures,case conferencesand iournal \club meetings. What a clffirence! i Warren Clinic caters for adult and paediatric . I arrived in Oklahomaon January 15, 2001. The conditionswith 3 and 2 doctorsrespectively. lt electiveprogramincludedattachmentto the AdvancedInternal endocrinology also has a diabetic educator and nutritionist. My -general main area of Medicine (AIM) unir at Sr John Medical Center for two wggks,then threeweekswith the AlM-Endociinology ynit focus was ,adult endocrinologywith an emphasisin DM of Dr at St FrancisHospital.This seemedfeasiblesinceI wasresiding management:I was doing my,electiveunder supei"vision at St JohnMedicalCenter.
ChristinaBratcher,an adultendocrinologist. Workingwith her mademy electivemore interesting and experiential. I managed
to be .exposedto several presentationsand managementof Experience at St John Medical Center difflcult diabeticand otherendocrineconditions. What differencefrom homefacilities? i At {e end of it all, I was sarisfiedrhar my objectives I was fascinatedto seea tremendousarray'of over 5 buildings were met. It was a good elective, learning abouti diabetes of up to 14 storiesmaking up the St John Medical genter.The environmentwas smartin cornparisonto facilities4t home.This educatilcn,out-patient rnanagement,in-patient management. 630-bedhospitalwas having its 75th anniversarybut did,not diabetes.complication.srianagement,current therapeuticsin DM and other endocrine disorders management.I enjoyed look old and was technicallynp-to-date. beingpart of diabeteseducationand aboutcurrenttherapeutics -How internal Medicine department ii is clon/ Dr Bratcherwas like a motherro me I was surprisedby the conceptof working in teams.Each team in DiabetesManagemenq had an allocatednumber of patientswhom they concentrated consideringthatl was thEtnly studerttdoing an electiveat the on. There may be two internalmedicinepatientsin the ward but c l i n i c . Psychosocialaspectsof the experienceat Oklahoma tfie team I was working with may have only managedone The UnitedStatesis a countrythat enjoysan advancedsociopatient.This is different trom home where wardsdivide work, with over60 patientsandteamsseeeverybodyin thework.This
economicstatus.Health facilities are more technicalcompared ts Malawiis. Allowing a Malawian medical studentto do an
allowedme to experience. the teamspirit in medibatcareand the importance of spending adequatetime on the patientsi elective is psychosociallybeneticial becauseit broadensthe problems.Surely bettercare is ppovidedin this setting.The horizonsof one's life experience,Another featureof Oklahoma structure of each team comprir.J on attending(consultant). is that it is America's Bibld belt with many churchesand senior resident (registrar),junior resident (intern), medical Christians,goodfbrg4eis spiritualdevelopment.I had a tasteof studentand othersusuallya nurse,socialworkerand a clinical it evenfiom someof the patients![ alsoenjoyedthe varietyof tasty foods i-e. Oklahomangrills, Mexican tbod and the typical pharmacist. AmericanJunk'food. Mixing with peoplein socialplaceslike Being'part of the team games,movietheatres enlighrened me furtheron the The two weeksat St John Medical Centerwas an excellent basketball learning experience.I will rememberDr R. Saizow, Dr S.L. peoples'lif'estyles. Sanders(attendingiDr S Ahmed.Dr Tram (SeniorResident), Dr Wan, Dr Kha'n(unior resident)and Wendy and Tory (rhird Conclusion Year Medi&al Students).One common thing experiencedby
The Universityof'OklahomaInternationalStudiesin Medicine
working with thesepeople,was rheteamspirit. I very much f'elt
is one otrtheuniqu!,programsI found beneficialand Universitv
Malawi Medical Journal
fla
STUDENT VOICE training of educatorssuch as nursesand the productionof leafletsmay enhancethis. opportunity.I f'eelthat the overall objectivesof the elective educational I am confidentthatOU is willing to allow a Malawian were met. Having beenthroughthe elective,I arn confidentof student everyyear to do an electivetherejust as they being able to providedataon practicalnranagenrent of DIr{ is medical USA and to relateit to Malawi. I may also be able to make a r et o c o n t i n u es e n d i n gt h e i rs t u d e n ttso M a l a w i . . Ib e l i e v ei t i s o f M a l a w i C o l l e g eo f M e d i c i n eh a st o c o n t i n u et o u t i l i z et h e
on DM managementon areas that need the generalobjectiveof OklahomaandCOM thatone broadens recommendations unilsociallyby beingbe able acaclemically improvement.One immediaterecommendation I would make one'slif'eexperience duringone'0sstudy. differences i s t h a te m p h a s issh o u l db e p u t o n h e a l t he d u c a t i osnt r e s s i ntgh a t to observethe cross-cultural DM is a disorderand not a diseasethat can be curedand that glycaemiacontrolis necessary to avoidconrplications. The
LETTERTO THE EDITOR
of Medicine. YearV student. College AT Msusa,
The cost of congenitalheart disease
caremay be requiredafterthe anda f'ewdaysin intensive expensive fbr just one operation.The totalcostcouldbe at leastUS$20,fiX1 childto betreated- clftenmore.Thiscostis well beyondthemeansof
It is importantto remember trom timeto tirne(or be rerninded aswe
mostfiimilies. be prepared WouldMalawians(viatiuesandgovemment)
were)that thereare many othercausesof chronic,severediseirsein Malawi aparl fiom HIV/AIDS. Congenitalhealt disearse is one of
to shareand shoulderthe costs'/Maybe,maybenot...but consider ofticialsandtheirfantilies) this.Many Malawians(oftengovemment
them. Common causesof congenitalheiut diseasein those that go to SouthAf icaat thetaxpayer's expense to undergoinvestigations survive beyond infancy iu'e septaldef'ectsaurdtetralogyof Fallot. or ffeatmentfbr conditionsfbr which thereis no cure.If we werc kr Thesecan causesignificantdisability- fbr example,hequentchest considerhom a cost-benefitviewpoint,thereare very f'ew chronic inf'ections,inabilityto play or exercisenormally,persistentdiiliculty conditions like congenital heiutdiseisewherethecostis a onceonly with breathing, poor growth - and n'rany children with these paymentandtlrcbenefltis t()talandlif-e-long. raise Suchcomparisons conditionsdie beforeadulthood.Chronicdebilityandearlydeathare
ln theperf'ect world,everyindividualdeserves difticultethicalissues. typical of many chronic diseasesincluding HIV/AIDS, renal the bestpossiblecarewhetherhe or sheis middle-agedanddying of insulliciencyor cerebralpalsy.However,unliketheseotherproblems, AIDS or a youngchildwith a heartproblern.However,decisions to what is almostuniqueaboutthe coffrmontypesof congenitalheart allocateresources aremadeeveryday and everywherebirsedon the diseirseis that they are curableby a single operation.This heart extentof potential Thesechildrenalsohavea rightto a normal benefit. operationis availablein SouthAlrica hasa low operativemortality lif'easwell andmightgrow to repaythenation'sgenerosity. Kanuis in experienced handsandifdonewhenindicated, thechildcanexpect a memberof theNigeriantbotballteamtlrathasrecentlyqualifiedfbr to returnto a normallif-elree of disability.
theWorld Cup.
Malawianchildrenwith congenitalheiutdiseaseregularly Like thechildrenI metatQueenElizabeth CentralHospital attenda clinic at QueensElizabethCentralHospiral(QECH)run by (QECH),Kanu was born with congenitalheartdisease- but he w,irs Dr Ankie Borgstein.They usuallycome trom Blantyredistrictand ffeated. theremustbe many moresuchchildrenstrugglingin the villages.As We believethat the Malawianchildrenwith surgically medicalstudents,we attendedthis clinic to learnaboutheartdisease corectablecongenital heartdiseirse shouldbegiventhatopporrunity. in children. From discussionof n.ranagement issuesfbr childrenwith They shouldbe sentto SouthAf ica on taxpirvers'expense on a congenitalheartdisease,it beciuneclearthat the medicalfteatment regulerbasisi$ a lesponseto the clinicalsitultionradrertlian leii thatthesechildrenreceiveis inadequate.Most suchchildrenin other waitingon a long anduncerlainlist.Alternatively, a cardiacsurgery pars of theworld havealreadyhadan operationandhaveretumedto
teamshouldbe encouraged to conleto QECH annuallyto do such
a normallifb. Many of thechildrenthatwe sawweredoomedto die
operations overthedurationof a coupleof weeks,iu huppns rvith
and would do so within the next f'ew years.Althoughthereis a mechanismin placefbr thesechildrento be considered fbr transt'er to SouthAhica fbr surgery, thisprocess is encountering bng delays.In
in the Paciflcregion.T'hislatteroptionhasthe teamstrom Ausn"alia advantage of irlproving our educationof crdiology and cardia.^
suryery.More inrporlantly, thechild stayscloseto homeandfiunily the meantirne,childrenwith Tetralogyof Fallot ale increir-singlyduringa ver] traurnatic tin1e. cyanosedand polycythaemic(haernatcrcris of greaterthan707oare common) and thosewith septaldef'ectsare developingpulmonary Sincerely, hypertension, renderingtheminoperable. Oftentherealitiesof livingin a resource-purr countryhave Leo Masamba,Yamikani Chinralizeni.Petros Kayangeand to be enduredif not alwaysaccepted. Thereiue other problernsthat Amosi Nyaka deseryeattentionsuchas rnalariaandtuberculosis because theyare very commonandcurablewith low-costtherapy- ttregreatest goul YearIll stuclents,Collegeo.fMadicirrc,Blatttvre fbr the greatestnuntber.The surgerythatthesechildrenneedis
I
STUDENT VOICE/ LETTERTO THE EDITOR
An Elective Experieqce With the University of Oklahoma' AT Msusa Universitt:of Malawi Collegeof Medicine(Yaar V) Introduction -l was given the honour of being the first med_19a1 stuclentfiom the Universityof Malawi Collegeof Medicine(UNIMA-COM)
'partof'the teamand benefitedtiom thern. A varietyof conditionswere seenwith the difl'erence thatnot as many infectiousconditionsareseen,as is the casein Malarvi-At St. John's,alcoholabuse,cartliacproblems,agerelateddegenerative conditionsare commonlyseen.It was an and real lif'eexpositionof what herein eye openingexperience Malawi we consider"text-bookstutf'. Working in a hospital with all necessarydiagnostictools and computerizedfilling systemwas like a dreamto me. Healthinfbrmationsystemwas ': so elaborateand quick to access.
to be the scholarshiprecipientof the International Srudiesin -of Medlcine (ISML the Univdrsity of Oklahoma College of r Medicine (OU-COM). The broad objectivesof the elective Experience at St Francis Hospital -Warren Clinic Diabetic were fbr me to be ableto compareandcontrastmedicalservices Center.
providedto patientswith diabetesmellitusin USA and Malawi OU-COM also utilizes St, Francis Hospital as a teaching Centeris within this institution and to explore and describe e.lementsof diabetes mellitus hospital.WarrenClinic Diabrites good has program a lbr diabetes education.Oklahomais a ,ipatientsin USA. The objectives.of the elective were to be *and ' ofdiabetesandso wasjusttheright achievedthroughparticipationin morningmeetingdiscussions, statevriiha highprevalence place learn to DM management. ward rounds, clinics, lectures,case conferencesand iournal \club meetings. What a clffirence! i Warren Clinic caters for adult and paediatric . I arrived in Oklahomaon January 15, 2001. The conditionswith 3 and 2 doctorsrespectively. lt electiveprogramincludedattachmentto the AdvancedInternal endocrinology also has a diabetic educator and nutritionist. My -general main area of Medicine (AIM) unir at Sr John Medical Center for two wggks,then threeweekswith the AlM-Endociinology ynit focus was ,adult endocrinologywith an emphasisin DM of Dr at St FrancisHospital.This seemedfeasiblesinceI wasresiding management:I was doing my,electiveunder supei"vision at St JohnMedicalCenter.
ChristinaBratcher,an adultendocrinologist. Workingwith her mademy electivemore interesting and experiential. I managed
to be .exposedto several presentationsand managementof Experience at St John Medical Center difflcult diabeticand otherendocrineconditions. What differencefrom homefacilities? i At {e end of it all, I was sarisfiedrhar my objectives I was fascinatedto seea tremendousarray'of over 5 buildings were met. It was a good elective, learning abouti diabetes of up to 14 storiesmaking up the St John Medical genter.The environmentwas smartin cornparisonto facilities4t home.This educatilcn,out-patient rnanagement,in-patient management. 630-bedhospitalwas having its 75th anniversarybut did,not diabetes.complication.srianagement,current therapeuticsin DM and other endocrine disorders management.I enjoyed look old and was technicallynp-to-date. beingpart of diabeteseducationand aboutcurrenttherapeutics -How internal Medicine department ii is clon/ Dr Bratcherwas like a motherro me I was surprisedby the conceptof working in teams.Each team in DiabetesManagemenq had an allocatednumber of patientswhom they concentrated consideringthatl was thEtnly studerttdoing an electiveat the on. There may be two internalmedicinepatientsin the ward but c l i n i c . Psychosocialaspectsof the experienceat Oklahoma tfie team I was working with may have only managedone The UnitedStatesis a countrythat enjoysan advancedsociopatient.This is different trom home where wardsdivide work, with over60 patientsandteamsseeeverybodyin thework.This
economicstatus.Health facilities are more technicalcompared ts Malawiis. Allowing a Malawian medical studentto do an
allowedme to experience. the teamspirit in medibatcareand the importance of spending adequatetime on the patientsi elective is psychosociallybeneticial becauseit broadensthe problems.Surely bettercare is ppovidedin this setting.The horizonsof one's life experience,Another featureof Oklahoma structure of each team comprir.J on attending(consultant). is that it is America's Bibld belt with many churchesand senior resident (registrar),junior resident (intern), medical Christians,goodfbrg4eis spiritualdevelopment.I had a tasteof studentand othersusuallya nurse,socialworkerand a clinical it evenfiom someof the patients![ alsoenjoyedthe varietyof tasty foods i-e. Oklahomangrills, Mexican tbod and the typical pharmacist. AmericanJunk'food. Mixing with peoplein socialplaceslike Being'part of the team games,movietheatres enlighrened me furtheron the The two weeksat St John Medical Centerwas an excellent basketball learning experience.I will rememberDr R. Saizow, Dr S.L. peoples'lif'estyles. Sanders(attendingiDr S Ahmed.Dr Tram (SeniorResident), Dr Wan, Dr Kha'n(unior resident)and Wendy and Tory (rhird Conclusion Year Medi&al Students).One common thing experiencedby
The Universityof'OklahomaInternationalStudiesin Medicine
working with thesepeople,was rheteamspirit. I very much f'elt
is one otrtheuniqu!,programsI found beneficialand Universitv
Malawi Medical Journal
fla
STUDENT VOICE training of educatorssuch as nursesand the productionof leafletsmay enhancethis. opportunity.I f'eelthat the overall objectivesof the elective educational I am confidentthatOU is willing to allow a Malawian were met. Having beenthroughthe elective,I arn confidentof student everyyear to do an electivetherejust as they being able to providedataon practicalnranagenrent of DIr{ is medical USA and to relateit to Malawi. I may also be able to make a r et o c o n t i n u es e n d i n gt h e i rs t u d e n ttso M a l a w i . . Ib e l i e v ei t i s o f M a l a w i C o l l e g eo f M e d i c i n eh a st o c o n t i n u et o u t i l i z et h e
on DM managementon areas that need the generalobjectiveof OklahomaandCOM thatone broadens recommendations unilsociallyby beingbe able acaclemically improvement.One immediaterecommendation I would make one'slif'eexperience duringone'0sstudy. differences i s t h a te m p h a s issh o u l db e p u t o n h e a l t he d u c a t i osnt r e s s i ntgh a t to observethe cross-cultural DM is a disorderand not a diseasethat can be curedand that glycaemiacontrolis necessary to avoidconrplications. The
LETTERTO THE EDITOR
of Medicine. YearV student. College AT Msusa,
The cost of congenitalheart disease
caremay be requiredafterthe anda f'ewdaysin intensive expensive fbr just one operation.The totalcostcouldbe at leastUS$20,fiX1 childto betreated- clftenmore.Thiscostis well beyondthemeansof
It is importantto remember trom timeto tirne(or be rerninded aswe
mostfiimilies. be prepared WouldMalawians(viatiuesandgovemment)
were)that thereare many othercausesof chronic,severediseirsein Malawi aparl fiom HIV/AIDS. Congenitalhealt disearse is one of
to shareand shoulderthe costs'/Maybe,maybenot...but consider ofticialsandtheirfantilies) this.Many Malawians(oftengovemment
them. Common causesof congenitalheiut diseasein those that go to SouthAf icaat thetaxpayer's expense to undergoinvestigations survive beyond infancy iu'e septaldef'ectsaurdtetralogyof Fallot. or ffeatmentfbr conditionsfbr which thereis no cure.If we werc kr Thesecan causesignificantdisability- fbr example,hequentchest considerhom a cost-benefitviewpoint,thereare very f'ew chronic inf'ections,inabilityto play or exercisenormally,persistentdiiliculty conditions like congenital heiutdiseisewherethecostis a onceonly with breathing, poor growth - and n'rany children with these paymentandtlrcbenefltis t()talandlif-e-long. raise Suchcomparisons conditionsdie beforeadulthood.Chronicdebilityandearlydeathare
ln theperf'ect world,everyindividualdeserves difticultethicalissues. typical of many chronic diseasesincluding HIV/AIDS, renal the bestpossiblecarewhetherhe or sheis middle-agedanddying of insulliciencyor cerebralpalsy.However,unliketheseotherproblems, AIDS or a youngchildwith a heartproblern.However,decisions to what is almostuniqueaboutthe coffrmontypesof congenitalheart allocateresources aremadeeveryday and everywherebirsedon the diseirseis that they are curableby a single operation.This heart extentof potential Thesechildrenalsohavea rightto a normal benefit. operationis availablein SouthAlrica hasa low operativemortality lif'easwell andmightgrow to repaythenation'sgenerosity. Kanuis in experienced handsandifdonewhenindicated, thechildcanexpect a memberof theNigeriantbotballteamtlrathasrecentlyqualifiedfbr to returnto a normallif-elree of disability.
theWorld Cup.
Malawianchildrenwith congenitalheiutdiseaseregularly Like thechildrenI metatQueenElizabeth CentralHospital attenda clinic at QueensElizabethCentralHospiral(QECH)run by (QECH),Kanu was born with congenitalheartdisease- but he w,irs Dr Ankie Borgstein.They usuallycome trom Blantyredistrictand ffeated. theremustbe many moresuchchildrenstrugglingin the villages.As We believethat the Malawianchildrenwith surgically medicalstudents,we attendedthis clinic to learnaboutheartdisease corectablecongenital heartdiseirse shouldbegiventhatopporrunity. in children. From discussionof n.ranagement issuesfbr childrenwith They shouldbe sentto SouthAf ica on taxpirvers'expense on a congenitalheartdisease,it beciuneclearthat the medicalfteatment regulerbasisi$ a lesponseto the clinicalsitultionradrertlian leii thatthesechildrenreceiveis inadequate.Most suchchildrenin other waitingon a long anduncerlainlist.Alternatively, a cardiacsurgery pars of theworld havealreadyhadan operationandhaveretumedto
teamshouldbe encouraged to conleto QECH annuallyto do such
a normallifb. Many of thechildrenthatwe sawweredoomedto die
operations overthedurationof a coupleof weeks,iu huppns rvith
and would do so within the next f'ew years.Althoughthereis a mechanismin placefbr thesechildrento be considered fbr transt'er to SouthAhica fbr surgery, thisprocess is encountering bng delays.In
in the Paciflcregion.T'hislatteroptionhasthe teamstrom Ausn"alia advantage of irlproving our educationof crdiology and cardia.^
suryery.More inrporlantly, thechild stayscloseto homeandfiunily the meantirne,childrenwith Tetralogyof Fallot ale increir-singlyduringa ver] traurnatic tin1e. cyanosedand polycythaemic(haernatcrcris of greaterthan707oare common) and thosewith septaldef'ectsare developingpulmonary Sincerely, hypertension, renderingtheminoperable. Oftentherealitiesof livingin a resource-purr countryhave Leo Masamba,Yamikani Chinralizeni.Petros Kayangeand to be enduredif not alwaysaccepted. Thereiue other problernsthat Amosi Nyaka deseryeattentionsuchas rnalariaandtuberculosis because theyare very commonandcurablewith low-costtherapy- ttregreatest goul YearIll stuclents,Collegeo.fMadicirrc,Blatttvre fbr the greatestnuntber.The surgerythatthesechildrenneedis
