Malawi-Liverpool Endoscopy Link Established: 2009

This Health Link supports gastrointestinal endoscopy in Malawi. It is between the Clinical Investigation Unit of the Queen Elizabeth

Central Hospital, Blantyre (QECH), Malawi and the Mersey School of Endoscopy at the Royal Liverpool University Hospital (RLUH), UK. It was registered in March 2009 on a background of 5-6 years of informal support, training and equipment donation, during which time Dr Melita Gordon (now Senior Clinical Lecturer in Gastroenterology at RLUH) was working in Blantyre.

The Gastroenterology Unit at Royal Liverpool University Hospital is home to the Mersey School of Endoscopy, a national training centre for endoscopy. It is directed by Dr Paul O’Toole (and previously Prof Tony Morris).www.liverpoolgastroenterology.nhs.uk/educationtraining/merseyschoolendos/index.asp.

QECH is home to Malawi’s only Medical School (the College of Medicine), and has an endoscopy unit which is jointly run in the clinical Investigation Unit by the Departments of Medicine and Surgery and the Malawi-Liverpool-Wellcome Trust unit (MLW).

We received a THET Seedcorn grant in 2008 for an initial visit in 2009 to establish the Link, which is now registered and active.

Activities

March 2009 – Seedcorn visit by Dr Melita Gordon, Professor Tony Morris and Sr Christine Ireland to establish the Link and conduct hands-on multi-layered endoscopy training for medical and nursing staff. A number of training and procedural needs were identified for future visits and ongoing support, recommendations were agreed, and the Health Link was registered. Read the report here.

 

October 2009 – Training visit by Dr Paul O’Toole from RLUH to QECH, for hands-on parallel Basic Skills and  teaching of Malawian trainers. Read the report here.

In April 2010 Sister Rose Malamba, the chief endoscopy nurse from the Malawi unit, visited the Mersey School of Endoscopy at the Royal Liverpool University Hospital for training and to develop locally relevant training and protocol documents. You can read the report here.

During May 2010, we shipped training equipment including an upper endoscopy phantom model, to Blantyre. We have also installed an on-line computer and printer in the unit, to run reporting, training and audit software.

In June 2010 Mr Kai Hellberg visited Liverpool for a TTT course.

In September 2010 Dr Paul O’Toole visited Malawi to run 2 weeks of basic skills and skills enhancement training for Malawian endoscopists. He was accompanied by a Liverpool trainee, Dr Joe Geraghty, who started an endoscopy audit project. Read the report here.

In October 2010, another Malawian endoscopist , Mr Anstead Kankwatira came to Liverpool for TTT and endoscopic therapy training, and another nurse, Sr Marie Kunkeyani visited for nursing and endoscope decontamination training.

In May 2011, Dr Paul O’Toole visited Malawi to develop a locally-deliverable full gastroscopy basic skills course format, and to make preliminary assessment visits to endoscopy units in the Central hospitals in all the regions of Malawi, with a view to extending teaching and training to less well-supported units. You can read the report here

In September 2011 we made a visit focused on extending training to less well-resourced central hospitals in other regions of Malawi. Dr O’Toole was joined by Dr Hendrickse and Sr Fitzpatrick (Blackpool), Dr Feeney and Sr Yates (Torbay) and Dr Geraghty and Dr Gordon (Liverpool link co-ordinator) to run a comprehensive programme of 5 training courses in Malawi for nurses and endoscopists, including basic skills, skills enhancement, training the gastroscopy trainers (TGT), and nursing skills. Courses were run both in Blantyre and Lilongwe, and delegates came from all the regional central hospitals around Malawi (KCH Lilongwe, ZCH Zomba and MCH Mzuzu), and even from Zambia.

first training-the-gastroscopy-trainers course in Malawi Training the Trainers, Feeney and Chiwewe TGT, O'Toole and Feeney

For the first time, in addition to running  a TGT course, mentored local faculty were part of all the courses, so that they can develop their ability to run endoscopy courses themselves. Our new TGT-trained trainers (Kankwatira and Kalongolera) led and delivered a basic-skills course for the first time. You can read the report for September 20111 here

local faculty delivering basic skills course local trainers delivering basic skills course local trainers delivering basic skills course

Participation from all the regional central hospitals was very enthusiastic, and in the final week the international faculty made supporting visits to several of the participating hospitals. 2 new endoscopy Health Links have been forged between Lilongwe-Blackpool and Zomba-Torbay. We also supplied / donated new training equipment including a dummy training model,decomissioned endoscopes, re-usable variceal banding kits, and minnesota tubes. We are grateful for a Round 3 IHLFS grant, and for an International Training grant from the British Society of Gastroenterology which allowed us to make this important new move to support less well-resourced centres.

Following up these, in May and June 2012 we  made 2 further follow-up visits over 3 weeks to Blantyre, Zomba and Mzuzu (O’Toole, Fitzpatrick, Feeney, Yates and Gordon) and Lilongwe (Hendrickse), to reinforce basic skills teaching, continue to mentor trainers and trainees, teach new therapeutic skills, and we had the excitement of helping Mzuzu Central Hospital to commission and set up their new endoscopy facility, and perform their first procedure. We hope to establish a new link between a UK base-hospital and Mzuzu. We also used this visit to evaluate the whole programme to date with our local partners, in readiness for a new HPS grant application. You can read the reports for May 2012 and June 2012 here

**SAGE Shire Award for Gastrointestinal Excellence ! ** We’re thrilled and honoured to announce that in June 2012 we were awarded a first-place SAGE award for our endoscopy training programme, presented  during the 2012 Digestive Diseases Federation meeting in Liverpool by Tom Smith, the chief executive of the British Society of Gastroenterology.

We chaired and presented at a  symposium at the national Digestive Diseases Federation meeting at Liverpool Arena on Weds 20 June 2012, on endoscopy and gastroenterology training in low-resource settings, which hosted very helpful discussions between several groups working in Africa about common experiences, sustainability, logistics and equipment, and measuring impact and outcomes following training. We are very grateful to the British Society of Gastroenterology for prioritising this in the meeting programme, for their programme of International training grants for low-resource settings, and for their support in several other areas.

Our funding support: Following a THET Seedcorn grant (2009), we have been supported by the British Council and THET (round 2 and round 3 Medium IHLFS grants), the British Society of Gastroenterology (International Training Grant), a Shire SAGE award, individual donations, self-funded trips, donations in kind or donations of decommissioned equipment, and a commercial educational grant (Cook Medical). We are very grateful to our UK NHS base-hospitals (Royal Liverpool University Hospital Trust, Blackpool Teaching Hospitals NHS Foundation Trust, South Devon Healthcare NHS Foundation Trust) for their continued support.

Link Requests

Locally relevant endoscopy equipment donations
Sponsorship of training visits
Appropriate endoscopy training materials and models
Endoscopy training needs identified in the region

Contact Details

Dr Melita Gordon
Senior Lecturer in Gastroenterology

Nuffield Building
Crown Street
Liverpool
L69 3GE

magordon@liv.ac.uk

 

 

 

 

 

 

 

Dr Neema Mtunthama
Senior Nurse Manager

MLW laboratories
PO Box 30096
Blantyre 3
Malawi

nmtunthama@mlw.medcol.mw

Additional Information

Dr Paul O'Toole
Email: Paul.O'Toole@rlbuht.nhs.uk

Dr Henry Mwandumba
Email:mwa1965@liverpool.ac.uk

Website: www.liv.ac.uk/gastroenterology/index.htm