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
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
