An American Pathologist in Malawi: Settling into a Rhythm

            It is always just a matter of time for someone to get used to his or her surroundings.  Even far away from home, I’ve come to establish a routine for my days.  The Malawian sun rises around 5:30 AM, seemingly perfectly timed to the cacophony of cawing crows and barking neighborhood dogs.  After enjoying some local breakfast of “Jungle Oats” and coffee, I take the short walk to the College of Medicine and arrive around 8:00 AM.  On most days, the slides and paperwork await.  On other days, there are no cases in our inbox for one reason or another.  There have been a few days where the college has lost water or power (or both), leaving the histology technician helpless to prepare the daily cases.  Even if the cases are ready, we need electricity to power the light in the microscopes and the computers to generate our reports. 

I’ve come to consider these issues to be minor hiccups in the lives of pathologists here.  This is compared to pathology back in Boston, where losing water and power aren’t usually an issue.  However, the routine problems encountered in Malawi are replaced by a slough of other issues that exist in the majority of larger institutions with more equipment, staff and cases (misplaced slides, misplaced paperwork, crashing computer servers, etc.).  It is sobering to see that no institution is perfect, regardless of the size of the facilities.

Cutting surgical specimens with a
Malawian pathology registrar

            I have become used to other aspects of the Malawian department as well.  For example, I have settled into the method of teaching here.  There appears to be much more hands on training in the laboratory in the first years of medical training.  The medical students and rotating residents (called “registrars”) here are eager to learn, both at the grossing bench and the microscope.  I must admit it is quite enjoyable to watch them approach pathology with such enthusiasm. 

            By now, we have completely caught up with the backlogged workload, and are examining specimens that were taken just a few days ago.  Furthermore, my initial shock and awe at the severity of lesions biopsied here have subsided, allowing me to settle into a rhythm of diagnosing cases relatively comfortably.  We, as BWH pathologists, are very fortunate in that we have expertise available back home for unusual cases.  (We already have sent a few cases back to Boston to be looked at by the BWH subspecialty pathology services.)  For this reason, I have been afforded the opportunity to start an interesting teaching collection of rare cases to show my colleagues back home. 

            This has been once-in-a-lifetime experience so far.  I feel that my contribution here in Malawi has been worthwhile up to this point, and I have seen how much I can produce given the limited resources.  Accepting the challenges here and taking this worthwhile experience home will certainly help me overcome any challenges at home. 

Kevin Golden, MD/PhD

PGY-5, Surgical Pathology Fellow