A team of healthcare workers from the UK EMT register returned early last week from a successful overseas training deployment (OTD) to the Queen Elizabeth Central Hospital in Blantyre, Malawi.

This is the latest in a series of observational OTDs in Malawi which has run yearly since 2014 and presents UK EMT register members who will be working with paediatric patients with a valuable opportunity to observe healthcare practice in a low resource setting. Participants witness the challenges and solutions of working within a different healthcare system and cultural context, in anticipation for a future emergency response deployment.

The trip is organised in conjunction with the Queen Elizabeth Central Hospital and the Malawi Ministry of Health.

“The trip was great, being provided a safe place with welcoming clinicians taking you through their day and experiencing first-hand the challenges they manage, including how cultural context influences the treatment of patients and their families.

You experience how clinical diagnosis is made and treatment delivered with little or no diagnostic resources. Imagine how you would make decisions when you can only use three CT scans a month in a different hospital, relying on dated x-ray slides and some availability to ultrasound. Basic blood tests take 48 hours if you’re lucky, leading to empirically treating feverish children with broad spectrum antibiotics and observing for further symptoms that may lead decision making in the fear of missing malaria and meningitis.  Many patients receive lumber puncture testing to help rule out meningitis thus helping to rule in other differential diagnosis.  When diagnosis is made the drugs cupboard has only the bare basics, leading to broadly treating many different conditions.

The logistics of care is also a challenge; patients share cots and beds, and when busy they are cared for on the floor which is accepted without complaint. Hand sanitation is managed with large pots of methylated spirits as alcohol gel isn’t available and functioning sinks are not everywhere. Patient records are the responsibility of the patients themselves and exist in the form of a small paper notebook, which aren’t always looked after.

These are real challenges, but these are challenges that we will have to manage on a deployment. Learning how to travel around, what is safe and what isn’t and how to avoid social faux pas are invaluable in places that we are not used to. I’m thankful that I have been able to experience some of this in a controlled and safe environment.”

Adrian Fell, HEMS Critical Care Paramedic