Mass General Brigham's Center of Expertise in Global and Community Health

Queen Elizabeth Central Hospital in Blantyre, Malawi

C. Chang

Queen Elizabeth Central Hospital (QECH) in Blantyre is the largest hospital in Malawi with 1,300 beds, and is the home to the University of Malawi College of Medicine, the country's only medical school. Following my 2 weeks at Muhimbili National Hospital in Dar Es Salaam, Tanzania, I spent 2 weeks in QECH's Accident and Emergency Trauma Centre, continuing my work on assessing the acceptability and feasibility of the medical emergency documentation tool as part of an effort led by the African Federation for Emergency Medicine.

While much of the effort in global health has focused on preventive health and the management of chronic illnesses, low- and middle-income countries are facing a growing burden of emergency conditions. Where EDs exist, they frequently see large volume of patients with high acuity and mortality rates. Many EDs in national referral centers, such as the one at QECH, serve as the main entrance to the hospital, serving sickest patients transferred from all over the country, often in private vehicles due to the lack of robust ambulance systems.

Spending time in clinical settings in LMICs often highlight the need for improved data collection so that already-limited resources can be allocated optimally. EKGs, which are indispensible to Western EDs, are rarely obtained in Malawi. They are arguably of limited utility in a place where one would be more likely to find electrolyte abnormalities on EKG than myocardial infarctions. Not surprisingly, the QECH ED's expensive EKG machine spends most of its time locked up in the department chair's office, and it's the rare clinician who knows how to interpret an EKG.  Even critically ill patients are rarely intubated due to the shortage of ventilators, oxygen tanks, medications, trained staff, electricity, or all of the above, and while considerable effort is spent on securing these resources, EDs frequently find themselves lacking one or more key pieces of the puzzle, rendering the whole endeavor futile.

Experiences such as these at Muhimbili National Hospital in Tanzania and QECH in Malawi brought home the potential for a robust, systematic data collection effort to improve our understanding of the role of EDs in LMICs and optimize their operations. I am excited about the potential for this project to improve patient care and resource allocation in low-resource EDs, and look forward to sharing the results in the near future!