Malawi Endoscopy training visit report 16th - 23rd November 2024 

UK faculty: Dr Neil McDougall (Belfast) & Prof Adrian Stanley (Glasgow) Local Faculty: Lilongwe - Mr Chipilimo at Kamuzu Central Hospital (KCH) Local Faculty: Blantyre - Mr Anstead Kankwatira and Sister Rose Malamba at Queen Elizabeth Central Hospital (QECH) & Dr Alex Stockdale at Malawi- Liverpool- Welcome Trust 

Aims 

Lilongwe 

After arriving in Lilongwe, we visited KCH and met the local Endoscopy team including Mr Chipilimo and the two senior local trainees who had both undertaken <5 endoscopies previously but had been identified by senior clinicians for Foundation endoscopy training at the unit. We spoke with them regarding their current work, resources and requirements and donated endoscopic equipment from Glasgow. They currently had 7 functioning endoscopes in the department. 

Over the 2 days there, we ran a Foundation Endoscopy course using a mixture of short presentations, educational discussions and videos covering issues including indications, consent, complications, common findings and management. We then provided endoscopic training for the trainees on the existing KCH endoscopy model and showed and discussed relevant training videos. This was followed by closely supervised live cases for each delegate with local senior clinical input from Mr Chipilimo. Feedback was provided by us after each case. 

At the end of the course, we had a prearranged meeting with the Hospital Director, Dr Jonathan Ngoma (a Hepatologist) and we discussed further potential Endoscopic and Hepatology training at KCH. He indicated that the training to date was very helpful and he was very keen for further endoscopy training and help with running another Malawi Liver Conference in the future. 

For the Foundation course, similar to Lilongwe, we ran 2-days of theory, videos and discussions, model work and live cases with regular one-to one feedback to trainees. A simple endoscopy quiz was given to each trainee before, and after the course, and a formal WGO feedback form was also completed by each trainee at the end (see feedback results in appendix) 

For the Upskilling course, we ran two days of hands-on training with two all-day lists that included patients with varices, ulcers, oesophageal cancer and gastric cancer. Fortunately, the Blantyre unit had just received a new “Euroligator”, a re- usable endoscopic banding device to treat varices (see photo below). Malawi adapted DOPS forms were also completed for each delegate (see appendix). At the end of the Upskilling course, a formal WGO feedback form was completed by each delegate (see appendix). We also had discussions with Dr Alex Stockdale and Tamara Phiri, Deputy Head of Medicine at QECH, regarding further endoscopy and Hepatology training support from BSG/UK, which she supported. 

In both KCH and QECH, the nurses performed to a very high standard led by Senior nurses Khatsza and Bertha at KCH, and Sister Rose Malamba at QECH. All patients had the procedure fully explained and informed written consent obtained. Pre-procedure patient observations were completed, equipment  checked and peri-procedural care was to a high standard. The endoscopes were cleaned, brushed, disinfected and stored appropriately as per previously provided and agreed protocols. In Blantyre, Sister Rose Malamba ran a parallel Nurse training course for 9 nurses during our Foundation and Upskilling courses. At a short ceremony at the end of the training visit, all attendees at each course were given a certificate of attendance.

Case difficulty