Advancing Malawi’s Care

Since 2011, Joseph J. Fulton, MD, Chief of Vascular Surgery at MidHudson Regional Hospital (MHRH), part of the Westchester Medical Center Health Network, has been traveling to the sub-Saharan African country of Malawi.  The population there is 16.7 million people, but the number of surgeons in residence nationwide is just 25.

Yes, Malawi is nearly devoid of surgeons. So Dr. Fulton goes there to train new and existing ones, lecture, and perform clinical rounds and surgeries as part of the Malawi Surgical Initiative (MSI). Launched by the University of North Carolina School of Medicine in 2006 in partnership with the Malawi government and the University of Bergen in Norway, MSI aims to create a self-sustaining, native surgical workforce in the country. “When the Malawi Surgical Initiative began in 2006, I think there were only four or five surgeons in the entire country,” Dr. Fulton explains. “I’m pretty sure I’m the only vascular surgeon that’s been over there. Ever.”

Back in Poughkeepsie, Dr. Fulton wears a very different hat. He is MHRH’s newly appointed Chief of Vascular Surgery. As a nationally recognized surgeon, educator and researcher, Fulton is among the best in his field. Indeed, his expertise allows MHRH to diagnose and manage the entire spectrum of vascular disease.  “His experience and expertise will no doubt serve mid-Hudson Valley patients well when they seek the most advanced and professional vascular care available in the area,” says Sateesh Babu, MD, Chief of Vascular Surgery for Westchester Medical Center.

Similarly, Dr. Fulton’s involvement in MSI is a boon to the effort to advance surgical care in Malawi.  “We are proud of Dr. Fulton’s role in the Malawi Surgical Initiative,” says Paul Hochenberg, Executive Director for MHRH. “We are a global community, and global health is an issue we should all be thinking about.”

Dr. Fulton first became involved in Malawi during his previous position as a vascular surgeon at the University of North Carolina School of Medicine’s Center for Heart and Vascular Care. Explaining his role, Dr. Fulton says, “About five years ago, my colleague, Dr. Anthony Charles, approached me with the idea to introduce vascular surgical care and training in Malawi. I jumped at the chance. My initial role was dedicated to creating arteriovenous fistulae for dialysis dependent patients. I quickly found myself assisting with whatever showed up at the hospital, such as an alligator bite, an arrow through the chest, or a ruptured spleen. There was even a patient who traveled several days to see me about varicose veins”

Whereas Dr. Fulton’s role as Chief of Vascular Surgery at MHRH provides him access to the newest advances in technology, state-of-the-art facilities and a world-class staff, Malawi is in the early stages of technological development. Dr. Fulton says, “Malawi is several decades behind the United States with respect to the equipment, imaging modalities, and surgical tools that are readily available for patient care. It can be scary when you first arrive and are put in an acute situation without many of the tools you are used to having.   Over the years, I have learned some pretty creative clinical and surgical skills from the Malawian surgeons who are adept at caring for patients using limited resources. I must add that I have particularly enjoyed the people of Malawi, who are collectively among the warmest and friendliest I have ever met.”

Of his hopes for the future of MSI, Dr. Fulton explains, “The goals of the partners of the Malawi Surgical Initiative include stopping the ‘brain-drain’ of trained surgeons out of Malawi, providing necessary resources and funding for education, clinical care, and research, and being surgical educators and mentors. We want to create a self-renewing, self-sustaining program made of local surgeons who can train future Malawi surgeons.  MSI believes that this program may be a model for developing surgical residency programs in other developing countries.” Dr. Fulton sees it incumbent upon him—and the medical community at large— to assist and partner with programs in less advanced communities. “Everything is getting more global now,” he says. “And most medical centers are thinking about—or should be thinking about—their role in global health.”

---

About Dr. Fulton
Joseph J. Fulton, MD, F.A.C.S., a nationally recognized surgeon, educator, and researcher, has been appointed to Westchester Medical Center’s Heart and Vascular Institute as Chief of Vascular Surgery at MidHudson Regional Hospital.
The addition of Dr. Fulton allows MidHudson Regional Hospital to offer diagnosis and management of the entire spectrum of vascular disease. Dr. Fulton’s office can be reached at 845-483-5934 or [email protected].