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Evaluation of a Managed Surgical Consultation Network in Malawi

  • Surgery in Low- and Middle-Income Countries
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Access to surgery is a challenge for low-income countries like Malawi due to shortages of specialists, especially in rural areas. District hospitals (DH) cater for the immediate surgical needs of rural patients, sending difficult cases to central hospitals (CH), usually with no prior communication.

Methods

In 2018, a secure surgical managed consultation network (MCN) was established to improve communication between specialist surgeons and anaesthetists at Queen Elizabeth and Zomba Central Hospitals, and surgical providers from nine DHs referring to these facilities.

Results

From May to December 2018, DHs requested specialist advice on 249 surgical cases through the MCN, including anonymised images (52% of cases). Ninety six percent of cases received advice, with a median of two specialists answering. For 74% of cases, a first response was received within an hour, and in 68% of the cases, a decision was taken within an hour from posting the case on MCN. In 60% of the cases, the advice was to refer immediately, in 26% not to refer and 11% to possibly refer at a later stage.

Conclusion

The MCN facilitated quick access to consultations with specialists on how to manage surgical patients in remote rural areas. It also helped to prevent unnecessary referrals, saving costs for patients, their guardians, referring hospitals and the health system as a whole. With time, the network has had spillover benefits, allowing the Ministry of Health closer monitoring of surgical activities in the districts and to respond faster to shortages of essential surgical resources.

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Funding

Work was supported by the European Union’s Horizon 2020 Programme (Grant Agreement No. 733391).

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Authors and Affiliations

  1. College of Medicine, University of Malawi, Mahatma Ghandi Road, Blantyre, Malawi

    Gerald Mwapasa & Nyengo Mkandawire

  2. Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland

    Chiara Pittalis, Morgane Clarke & Ruairi Brugha

  3. Radboud University Medical Centre, Nijmegen, Netherlands

    Leon Bijlmakers

  4. Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, UK

    Grace Le

  5. Queen Elizabeth Central Hospital, Blantyre, Malawi

    Eric Borgstein

  6. Institute of Global Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland

    Jakub Gajewski

Authors
  1. Gerald Mwapasa
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  2. Chiara Pittalis
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  3. Morgane Clarke
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  4. Leon Bijlmakers
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  5. Grace Le
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  6. Nyengo Mkandawire
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  7. Ruairi Brugha
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  8. Eric Borgstein
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  9. Jakub Gajewski
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Corresponding author

Correspondence to Gerald Mwapasa.

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Mwapasa, G., Pittalis, C., Clarke, M. et al. Evaluation of a Managed Surgical Consultation Network in Malawi. World J Surg 45, 356–361 (2021). https://doi.org/10.1007/s00268-020-05809-3

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  • DOI: https://doi.org/10.1007/s00268-020-05809-3

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