Malawi 2016

In February 2016, I had the amazing opportunity to travel to Lilongwe, Malawi in southeast Africa. The women of Malawi, and many other poor areas of the world, have minimal access to maternal healthcare. When these women encounter a situation where they have obstructed labor, most have no access to an emergency cesarean delivery. These women may be in labor for 2 or more days without progress, be in severe pain, and many times the baby dies. Due to the prolonged pressure from the baby’s head in the birth canal, some of the tissue can die and an abnormal connection can develop between the vagina and the bladder. This abnormal connection is called an obstetric fistula, and it leads to continuous incontinence. Because they are always leaking urine, smell badly, and may not have normal sexual function, many of these women become outcasts from their societies and families.

A small group of gynecologists dedicate their time and lives to helping this underserved group of women. Over the years they have developed good techniques for repairing the fistulas and helping the women return to a more normal life. Some of the more severe cases can be very difficult to repair and have a high rate of failure. Dr. Jeffrey Wilkinson is one of these dedicated physicians, and he recognized the need to improve the care for women with the most severe fistulas. He felt that plastic surgery may have some techniques that could help in these difficult situations. I was asked to work with Dr. Wilkinson and his team. My goal was to teach them plastic surgery techniques that help these difficult repairs be more successful and return the patients to more normal function.

In February 2016, I visited and worked with an amazing group of people at the Fistula Care Center in Lilongwe during a week and a half in Malawi. This center is dedicated to improving maternal healthcare in the region and was opened by The Freedom from Fistula Foundation. During my time there, we did numerous operations and I was able to teach several gynecologists about how to do a few reconstructive flaps to move healthy, non-injured tissue into the area and allow the fistula to heal and the patient to regain more normal function. It was an experience that I will always remember. Although I had to return home, this important work is still being carried forward by the surgeons I was able to teach. The women we helped are strong, motivated, and appreciative despite having gone through a horrific personal event and being made an outcast in their society. They deserve only the best care possible. To learn more about these strong, resilient women and the effort to improve maternal healthcare in these areas, visit and consider making a donation.

Another very common problem, and underserved population, in the developing world is people with burn contractures. Due to the lack of fire safety regulations and the lack of access to acute burn treatment, there are millions of people who suffer from burn contractures. If a severe burn is not treated appropriately soon after it occurs, and is allowed to heal on its own, the area can heal with a contracted scar that severely limits mobility. If this involves important areas of movement such as the fingers, knee, shoulder, or neck it can be crippling and disabling. By performing surgery to release the contractures and improve their mobility, patients can return to more normal levels of activity in their work and play. During my trip to Malawi, I encountered a few patients suffering from burn contractures of their fingers and arm. I was able to perform burn contracture release and reconstructive surgeries for them and significantly improve their mobility. I am very privileged to be a plastic surgeon for a living. The least I can do is to give back to those less fortunate. I plan on returning in to Malawi in the near future to continue my efforts.