When Dr. Anthony Charles first arrived at the Kamuzu Central Hospital in Lilongwe, the capital of Malawi, in 2008, there was only one surgeon at the hospital — and he was 82 years old.
Now, 13 years later, thanks to Charles and his team, the number of certified surgeons has increased to 16 and is expected to keep growing in the years to come.
Charles, director of global surgery at the Institute of Global Health and Infectious Diseases at the UNC School of Medicine, is focused on improving surgical quality in low and medium-income countries.
"In the United States, you have roughly between eight and nine surgeons per hundred thousand population," Charles said. "In most parts of Africa, you have one surgeon for 1 million people."
Charles said this creates two main problems: there are not enough surgeons for all patients, so non-surgeons and non-physicians will have to perform surgeries.
"We have to increase the opportunities for doctors to become surgeons, and we have to train non-surgeons to do surgery and do it well," Charles said. "We also train physician assistants and clinical officers that can do simple surgeries."
The Malawian Surgical Initiative that Charles has built is designed to be self-sustainable, in which the surgeons trained by Charles will continue to train future surgeons.
Charles said a big part of the initiative's success comes from building trust and meeting the communities where they are.
"If I go visit somebody in Malawi and they're having a meal, and they're all sitting on the floor, I'll sit on the floor with them,” he said. “I will do what they do. It means I understand their culture too. It means I meet them where they are, and there is all about cultural awareness and generating trust."
Dr. Jared Gallaher, adjunct professor with the UNC Gillings School of Global Public Health, did a two-year research fellowship with Charles during his residency. During that time, he spent a whole year in Malawi, where he focused on the administrative and research side of the initiative.
"We hope we will have a long-lasting impact, not just for what we're doing in Malawi but also throughout the region," Gallaher said. "Increasing the number of surgeons in the country is incredible. We have learned a tremendous amount from them, taking care of patients in a new way and their perspective."
Gallaher said Charles is a gifted mentor and a great boss, from which he said he had learned a tremendous amount, describing working with him as an incredible opportunity.
Dr. Laura Purcell, a general surgery resident, has worked as an intern with Charles, with him serving as her research mentor.
When Purcell was a young resident, she said she worked with Charles to learn how to do quality medical research. After her third year of general surgery residency, she went into research with Charles as her primary mentor as she worked toward her master's of public health at UNC.
While Purcell was in Malawi, she said she worked with the department of surgery and pediatrics on a quality of life project to study the health and quality of life of patients before an abdominal operation compared to after, during their recovery.
"I helped one of the pediatric surgeons in Malawi to do pediatric surgery operations when he needed an extra set of hands to make sure the operation run more smoothly," Purcell said. "It was an outstanding experience for me, and I would not have been able to do any of that if it wasn't for Dr. Charles."
Charles said the initiative could be replicated in other parts of the world — even in some areas of the United States where there are not many surgeons and people don't have access to care.
But because of funding limitations, Charles said the initiative is focused on staying in the same area for a long period of time.
"When I go down to Malawi now, I don't operate as much because I've trained folks, and they can handle it,” Charles said. “So now what we do most of is we have a research program where we are collecting a lot of data, and we also write papers with the local Malawians. We're teaching them how to research as an academic institution."
Charles also gives lectures and ensures that research projects are going well, helping them sort any administrative problems they may encounter. He expects to be able to go back to Malawi later this year.
“The fact that I used to go to Malawi and operate a lot, but I do not have to do that anymore, shows that we've come a long way,” he said. “I have empowered my local colleagues in Malawi to do for themselves, and I think that's what I'm proudest of."
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