Government Central Hospital located at the foot of the dramatic Zomba plateau in the old colonial town and ex-capital city, Zomba, which is in the Southern part of Malawi about an hour drive North of Blantyre. The hospital functions as a tertiary referral centre, receiving patients from district hospitals in the Eastern Region of Malawi, health centres within Zomba and self-referrals. Queen Elizabeth Central Hospital in Blantyre takes the most complex cases and is also the location of the country’s only medical school. The Zomba Central Hospital itself is made up of some old original buildings and some new government funded buildings, only some of which are in use.
The hospital has 4 main departments – surgery (including a male ward, female ward, clinic and 3 operating theatres), adult medicine (including male and female wards, male and female TB/isolation wards, a prison ward, medical clinic, HIV HAART clinic, staff clinic), paediatrics (including a medical paeds ward, a surgical paeds ward, a nutrition ward, a neonatal unit, a kangaroo baby care unit and the under 5s clinic), an eye clinic and Obs & Gynae (including a labour ward, prenatal ward, postnatal ward and gynae clinic). The hospital also has a 4 bed ICU, a rudimentary laboratory, radiology department and a physiotherapy unit.
At the Outpatient department, patients are able to visit the various clinics with and without referral. Zomba is also home to the school of nursing.
Specialists available include 2 general surgeons( a Malawian and Dutch), 1 anaesthetist, 1 dermatologist 2 obstetrician/gynaecologists and 1 Internist. The hospital does not have a paediatrician at the moment.
A little way down the road is Zomba Mental Hospital, Malawi’s only state run mental hospital.
The hospital has around 400 beds, but the hospital runs at 2 times capacity with patients sharing beds/lying on the floor and under other beds, especially in paediatric wards.
The hospital encourages community surgery, i.e. they try to give capacity and training to the district hospital staff to try to enable them to manage cases, rather to refer on. Visiting surgeons would be encouraged to visit local district hospitals and provide training. They also conduct medical health camps in the surrounding health centres.
Paediatricians, Internists( Plus all other subspecialties), surgeons(General, and orthopaedic), Obstetricians and Gynaecologists.
Elective students are very welcome from all health professions.
The hospital is located approximately 1-1.5 hrs drive from the main airport near Blantyre and about 5-6hrs from Lilongwe. Zomba is well served for buses/minibuses as it is the 3rd biggest town in Malawi and is located on the main road between Blantyre. The beautiful Liwonde National Park is easily accessible, being around one and a half hours drive.
Zomba has a range of lodges from budget to luxury. Alternatively there is very cheap accommodation available at the school of nursing right next to the hospital. Visiting doctors and elective students are advised to contact AMECA or colleagues in Malawi as there are host families in the area who may offer hospitality.
2-3 months is sufficient to get a feel for how the hospital works and the type of medicine they deal with. Length of stay will depend on the visitor but the hospital is very understaffed and appreciates as much time as people can afford.
A tourist visa is required for Malawi for UK visitors, but a temporary employment permit must be obtained for stays of more than three months. To find out more information, click on this link.
Nursing school accommodation contact:
Contact the hospital administrator on firstname.lastname@example.org
I spent a short time working in Zomba Central Hospital. It does not have access too all the equipment that would be required and it experiences several power cuts each day, but these difficulties are more than made up for by the commitment and expertise of the amazing staff who work there. As a podiatry student, I worked with physio’s during several different clinics and learned a great deal about the difficulties faced by health care professionals in Africa compared to England. Zomba is a beautiful area and easy to get to by bus from Blantyre. I would love to return to work in Zomba Central Hospital and I would defiantly recommend it to other students.
I completed a 6 week medical elective at Zomba Central Hospital Feb-April 2012. It was the most amazing experience and everyone at the hospital was incredibly friendly. Malawi is a fabulous, welcoming country and ideal for anyone who wants to visit Africa for the first time. If you want loads of hands on experience and opportunities you just don’t get in the UK then Zomba is a great place to go – I got to deliver babies alone, perform minor surgery alone, and conduct paeds ward rounds alone. The hospital is happy for you to construct your elective anyway you fancy – I did 2 weeks of surgery, 2 weeks of O&G and 2 weeks of paeds.
We stayed in the nursing school and would deifintely recommend it – it is very basic with cold showers and regular power cuts but it is a great way of meeting local students and is very cheap and convenient for the hospital.
- Philippa Cory reviewed 2 years ago
- last edited 2 years ago
Zomba is a government run central hospital and I really enjoyed my 6 week elective there. There are a lot of issues that arise from working in a resource-poor setting where staff are seemingly not motivated to provide good care, but I had a great time as the Malawian people are so friendly and I was given a lot of responsibility.
The hospital let us organise our elective as we wished so although we spent the 6 weeks in the medical department we did also have time out to visit paediatrics, ITU and theatres. I’d advise bringing small hand gels, a pulse oximeter, thermometer and glucose test strips. We wore scrubs which was fine and very practical but all the staff wear smart clothes. Don’t expect a lot of communication from the hospital before you arrive, they are mostly concerned with receiving the hospital supervision and administration fee ($500 for 6 weeks) and registration with the Malawian Medical Council ($150). We organised the placement via the hospital director Mr Thom-Chisale (email@example.com). The medical department were not expecting us although this wasn’t really a problem.
It was shocking seeing the devastating effect that HIV has and how it complicates diagnosis and management. I was often the only staff member involved in cannulating and providing fluid resuscitation as well as palliative care to many patients who were emaciated and severely wasted.
We stayed in the nursing school accommodation which is a 2 minute walk from the hospital, however this is very basic. The cost was 1000 kwacha per night (£1.10) but we had to provide our own bedding, which we bought at the market the day after arriving. There were regular power cuts, very thin mattresses and limited water supply meaning showering was generally with a bucket of cold water. There are a few local shops and a market just behind the hospital where we ate regularly and brought food to make our own breakfast and lunch although we had no cooking facilities. The local nursing students made us very welcome but they are not quiet in the mornings and rise as all Malawians do with the sun at 5.30am! Zomba town is approximately 1.5km walk.
- Jack Broadhusrt reviewed 6 months ago
- last edited 6 months ago
Jack and Laura Broadhurst, with their two young children, are living in Zomba, Malawi, for a few months.
Jack is currently volunteering at Zomba Central Hospital having completed his surgical training in Wessex this year. He will be taking up a consultant post in Winchester in early 2018. Laura has supported the work on the Wessex Network and organised visits to Wessex by Zimbabwean doctors on Commonwealth Fellowships. She is volunteering with Maternity Worldwide. Their daughters are at the International School.
What is it like in Zomba? Zomba is one of only four tertiary referral hospitals in Malawi with a catchment area of around 4 million people. Malawi has a population of 19 million people and is one of the top ten poorest countries in the world. So, even though a tertiary hospital, it is severely under-resourced.
What is it like to be a patient in Zomba?
There are 64 adult surgical beds in 2 wards which at times have had 106 patients admitted. The extras lie on rubber mattresses on the floor and down the corridor. Their personal care and feeding is attended to by their family member or guardian. If you don’t have a guardian you are in trouble.
Throughout the country the power is on for an average of about 5 hours/day which makes life difficult. The hospital is deliberately spared on the grid but there is usually a power cut about once/week. There is a glossy generator in the car park donated by US/UK aid but it doesn’t kick in because there’s no fuel in it.
What facilities are there to help make a diagnosis? These are very limited
- The blood tests available include haemoglobin (occasionally a full blood count), HIV and hepatitis screen
- Urea, electrolytes, liver function tests, clotting etc are no longer available because the lab does not have the reagents.
- Microbiology and histology are not available. Patients can have their histology sent to Blantyre but it costs them the equivalent of £15, which the majority cannot afford, so they choose to take their chances.
- The only imaging available is x-ray and ultrasound and this depends on the day.
What about other staff?
Anaesthesia : Anaesthesia is very poorly resourced with minimal monitoring and low numbers of trained staff. Lists usually start late and finish early because of the anaesthetist rather than the surgeon which makes a change! There is a six bed ICU that can ventilate a single patient but the only vasopressor is adrenaline. Anaesthesia is performed generally with Halothane, thiopentone and ketamine. I have performed CPR on the table 3 times so far.
Nursing : Standards of nursing care are very basic. The nurses only do observations, venepuncture and drug administration.
What are the implications of this for your work?
Essentially this means that nearly all diagnoses are made clinically and we perform a lot of ‘exploratory’ laparotomies. General surgery here is performed in its most original definition and encompasses neonatal, paediatric, neuro, plastic and ENT surgery so surgical life is very interesting. There are two Malawian general surgeons, one still in training, and a retired Dutch surgeon. Between us we manage every presentation as best we can.
The chronicity of the conditions can often be determined by the number of small scars over a lesion or region that have been performed by the local traditional healer to release spirits etc.
What are the most common conditions you come across?
Peritonitis : Our most frequent emergency presentations are peritonitis secondary to typhoid perforation and sigmoid volvulus, which seems to present at much younger age than in the UK and is thought to be related to eating maize, particularly when it is too green
Trauma : There is also a vast amount of trauma secondary to RTAs. These are caused by a fatal combination of absent pavements and overloaded minibuses, motorbikes and bicycles.
Burns : Burns are a major problem with the population cooking over open fires, and with many untreated epileptics in the community this can result in some horrific injuries that are hard to manage. As we move into the rainy season this will get worse as the fires move indoors. Skin grafting is frequently necessary although our dermatome is broken and the Humby knife is very rusty. A German team brought out a new battery for the dermatome but unfortunately after one use it was sterilised along with the battery which unsurprisingly melted.
Snake bites : These are a frequent occurrence with approximately two admissions per week. These often require grafting or amputation and are usually from the Puff Adder which causes severe tissue necrosis. Bites from the mambas tend not to make it to hospital. We have a general antiserum but it is rarely available.
What other conditions have you come across?
Exploratory laparotomies for abdominal mass are always exciting. With minimal preceding imaging the diagnosis is usually a surprise. So far my largest finding has been a 7.5kg pancreatic tail cyst that required a distal pancreatectomy, splenectomy and transverse colectomy (see photos). Others include a massive splenic cyst, and a massive diverticulum of the renal pelvis. Of course there is also the usual fare of strangulated hernias of all types. Here inguinal hernia repairs are performed using the Bassini technique in the absence of mesh. The use of mosquito net instead of mesh is also considered too expensive.
We also have performed a number of neonatal operations including pull-throughs for Hirschprungs, anoplasty for imperforate anus, laparotomies for atresia and malrotation, gastroschisis and exomphalos and also the odd cystic hygroma, branchial cyst, posterior urethral valve and keloid. We perform at least 2 ventriculo-peritoneal shunts per week.
What haven’t you seen? I have yet to see a single appendicitis or diverticulitis!
What about staffing generally?
Staffing is a huge issue with the vast majority of services provided by clinical officers. These officers have had a relatively basic training and learn mostly through experience. There are currently only two Malawian general surgeons in Zomba with a medical degree and one will soon be moving to Blantyre for two years to finish his training. Their 1:2 on call is about to become 1:1.
What does this mean for people like yourself?
There is a great need for further surgeons and all visitors will be welcomed. There is a good set up with comfortable and safe accommodation just outside Zomba in the wing of an old colonial farmhouse. It comes with a vehicle and preferential rates for volunteers at the hospital. There is a good school and Zomba is in a beautiful part of Malawi with easy access to the country’s best attractions.
If anyone was interested in helping, what should they do?
If you are interested please contact : Jack and Laura Broadhurst.
Jack_broadhurst@yahoo.co.uk / firstname.lastname@example.org
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