Latest Blogs

Jun 2nd 2019

Zomba Urology Week 2019

Zomba Urology Week 2019

Three years ago I first came to Zomba Malawi to begin to try and understand the impact that the lack of access to surgical care has on the lives of so many people around the world.    The Lancet Commission on Global Surgery estimated that up to 5 billion people do not have the access to surgery that we take for granted in developed countries.  More people die from this lack of access on an annual basis than HIV, malaria and tuberculosis combined.  Think about that for a minute.   Addressing the challenges of global surgery is essential if we hope to make gains in the broader discipline of global health



There is so much we can specifically do as urologists.    Urinary retention from prostate enlargement, urethral stricture and the presence of prostate and bladder cancer is an immense challenge in Africa and a source of tremendous disability.     Surgical expertise in our field is both necessary and sorely lacking.   Furthermore, establishing an infrastructure to work safely, invest in nursing and anaesthesia is at least as important.      In 2016 I first came to  Zomba and began the process of trying to understand this better.   I quickly realized that coming for a week or two to perform some cases  will never lead to a path of sustainability.  Most of the surgical work done throughout much of Africa is done by specialty clinical officers.  I have described this in detail before.   Teaching common surgical techniques to clinical officers, investing in talent and working with other international partners is the only way to hope to improve surgical care for so many people and leave something more permanent behind.   


To date a number of things have been achieved and I will highlight three.


1.   A clinical officer, Duncan Goche conducts some common urological procedures in Zomba and contacts myself and others regularly for advice on encountered challenges.  


2.   In 2017 we identified and have funded the training of a Malawian surgeon to gain specialty certification through the College of  Surgeons of Eastern Central and Southern Africa (COSECSA) in urology.  He will complete his training at the end of this year, write his exams and then arrive full time as a urologist in Zomba to build on our efforts in January 2020.  


Meet Dr Wanangwa Chisenga: 



3.  We funded a pilot project through the University of Toronto in partnership with an NGO on the ground to run a prostate outreach camp. Led by local surgeons to work through a backlog of patients with long tern indwelling catheters (many for years) and perform prostatectomy.  Data on this project has been reviewed and a publication is planned for submission shortly




Finally, a delegation from Germany  has been coming in parallel to Zomba the last several years to work to improve surgical care following similar principles.   Dr Henning Mothes in particular has been an extraordinary force and leads their efforts.   A German surgeon, he served as the Head of Surgery at Zomba from 2003-2006 and has come regularly since then for short visits. He understands the local infrastructure well and has built valuable relationships within the broader Malawi healthcare system.   While not a urologist, he has quickly come to see urologic surgery  as a grossly neglected service in Malawi.   With the overwhelming need to manage more acute, life-threathening problems such as C Section, trauma as well as acute abdominal emergencies such as appendicitis and bowel obstruction, men with indwelling catheters are forgotten.     Dr Mothes has also engaged urological colleagues from Germany to support the Zomba effort.  Dr Christian  Weidemann, a urologist and two anaesthetists have also joined us.  Furthermore, my German colleagues  have secured funding for the trainee of a second Malawian surgeon under COSESCA that we will together identify this week.    



Dr Heimrath, far left. Dr Mothes, third from right, Dr Weidemann second from right 

As I arrive in Malawi today I are very excited to coordinate a “Zomba Urology Week” with my German colleagues and new friends.  It is a great pleasure to see how far Zomba urology has evolved from my first trip in June 2016.  There is so much more to do.    I have also brought our recent MGH fellow, friend  and now colleague Olivier Heimrath  with me to build on our efforts to date and work with our new colleagues.  He has been to Zomba with our support once before and has also worked in Rwanda.  In addition to performing surgical cases this week, an entire itinerary that includes colleagues from the University of Malawi, healthcare officials and Zomba Central Hospital administrators awaits us.  There is an opportunity for Zomba Central Hospital to seize a lead role in providing good urological care throughout this country and in doing so improve the health of men more broadly.  




Welcome to Zomba Urology week 2019!    Further updates to follow!






Posted: June 03, 2019

By: Ronald Roach

I dont know how you get the energy to do all this amazing work You and your colleagues are just super folks.

Posted: June 03, 2019

By: Ronald Roach

Amazing work done by Dr Singal and his colleagues. How they find the time and energy to do all this is beyond me .

Posted: June 03, 2019

By: Robert Eisenberg

Whoever saves a single life is considered by Scripture to have saved the whole world. What you are doing could not be more important or praiseworthy. I can only imagine the relief your efforts provide to those in pain, catheterized for inhumane periods of time, or worse. .

Posted: June 03, 2019

By: Paul Fahey MBA, CFA

Your work is inspirational. Thank you for taking on this tremendous challenge!

Posted: June 03, 2019

By: Sheila Sontz

Raj it's so nice to see how this fellow appreciates what you are doing for him on multiple levels. For him personally, for his career, for his community in Zomba and for his nation Malawi. You chose well. Let's hope he continues and develops a program to train others there. As we say in my tribe, kol ha k'vod!!!!!

Posted: June 04, 2019

By: Geoff Bowes

...and I fret about having a catheter for a couple of days after TURBT. You have taken your life's work to another level by reaching out across the world to relieve suffering. Bless you and your colleagues!

Posted: June 04, 2019

By: Martin McFarland

Congratulations! Terrific work.

Posted: June 04, 2019

By: Samuel Kolber

Dr. Singal;

Yes, we are blessed with the access we have to the best care imaginable and they are blessed to have access to the best of minds and dedication in improving their quality of health and personal comfort.
Safe travels.

Posted: June 04, 2019

By: Mike Holmes

Dr Singal and team I commend you on your constant hard work and dedication for sharing your great talents.

Posted: June 06, 2019

By: Dan Sibley

Very impressive and inspirational. Congratulations!

One of my sons went to Kenya working in a remote village working with children, doing AIDs education in the schools and hosting a soccer tournament with all the local schools. He did this for four summers while working on his MD degree from UBC. He's now a very successful Pediatrician in Vancouver. It reminds me of how inspirational it was at the time and how it helped shape Matt into the wonderful person he is today.

Thanks for sharing this ... Dan

Posted: June 06, 2019

By: Tristan Juvet

Hi Dr. Singal,

Great to hear about your trip, I can't believe it's been over a year since I have been!

Would love to continue to be involved in the project as time goes on and will stay in touch over the next year while I'm down in the States. Just came back from a trip in April with IVUmed and it continued to cement my interest in Global Health!

All the best, enjoy the rest of the week there and my best regards to Duncan and Olivier,


Posted: June 06, 2019

By: Michael Bentley Taylor

Very proud of you Rajiv
Lots of similarities to our work in Angola and China and starting last yr in Cambodia.


Posted: June 08, 2019

By: Fareedah Lila

Good morning Dr. Singal.

Have missed reading your blogs.

This is awesome. Help is always appreciated, continuity is what makes it a blessing.

As you reflect from the start of your journey and realize how far you have come, this is all thanks to you, your efforts, your team and sponsors have made this possible. All I can say is “GOD BLESS YOU”
Please don’t stop.


With gratitude from an African.

May God protect and guide you all.

Be blessed

Fareedah Lila.

Post a Comment