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You are here: Home / News / 2011 News / UNC surgeon trains future surgeons in Malawi: The Malawi Surgical Initiative

UNC surgeon trains future surgeons in Malawi: The Malawi Surgical Initiative

by maryruth.helms — last modified Oct 12, 2011 12:00 PM
Carol Shores, MD, PhD, FACS, has been interested in the link between viruses and cancer for over 20 years, after working on virus- associated cancers as a pre-doctoral fellow in the UNC Department of Biochemistry and Biophysics. Oropharyngeal cancers, like cervical cancer, are associated with human papilloma viruses and endemic Burkitt lymphoma, a childhood cancer in sub-Saharan Africa, is associated with Epstein-Barr virus.

Dr. Shores with Malawi residents

Shores, associate professor in the Department of Otolaryngology/Head & Neck Surgery, works with the UNC Head and Neck Cancer Program, and is pursuing her virology research interests, maintaining an active clinical practice at UNC and training surgical residents in Malawi with the Malawi Surgical Initiative (MSI). She works in Malawi with the UNC Project (http://www.med.unc.edu/infdis/malawi/).

Malawi is a country where most of the population is poor, and medical facilities are scarce and often distant from the small villages where most people live. The home of the MSI program and the UNC Project is Kamuzu Central Hospital (KCH) in Lilongwe, Malawi. That’s where the residency training and medical work takes place.

Malawi citizens face formidable odds in getting all types of medical and cancer care in particular. There are only 25 surgeons in this country of 14 million people, and only a few are Malawian. There are no radiation therapy facilities, and chemotherapy availability is limited, so surgery is frequently the only curative option for cancer patients.

Dr. Shores and residents in the OR

The KCH Surgical Residency was established in 2009 in collaboration with the Malawi Ministry of Health, KCH surgeons, and surgeons from UNC and Haukland University Hospital (Bergen, Norway). There are currently nine residents in three classes with plans to fill all five years of the program. In August 2011, the program obtained full certification from the College of Surgeons of Southern, Eastern and Central Africa, so that training is recognized throughout Africa and the EU.

Dr. Shores explains, “Our hope is that by establishing a surgical residency program in Malawi, we can increase the number of surgeons in the country and provide lifelong mentoring for them. Our residents have family ties in Malawi and our research projects are designed to provide a vibrant research environment in Malawi for decades.”

There are no CT or MRI machines at KCH, and ultrasound is limited by the lack of trained radiologists. “Diagnosis is done the old fashioned way, by clinical examination,” Shores says. “Enhancing these skills provides excellent training for both the Malawian residents and visiting US surgery residents. And our patients benefit from the increased number of surgeons available to provide care.”

Malawi Operating Room

She reports that because the Malawi Ministry of Health depends on inconsistent foreign aid, basic medical supplies such a lidocaine, a topical anesthetic drug used often in ENT and other procedures, may not be readily available. “Working at KCH requires the ability to be flexible in both diagnostics and clinical care.”

Dr. Shores has visited Malawi four times the past year, for two-week stays each time. During this time she performs operations, sees patients in clinics, gives lectures, trains residents and collaborates with researchers on new and ongoing projects.

UNC Lineberger is a vital partner in improving clinical cancer care and supporting cancer research at KCH.

This summer, in a collaboration among LCCC, KCH, the UNC Project and Malawi Ministry of Health, a pathology lab was established at KCH to support both clinical care and research projects. This lab will particularly impact the care of cancer patients, as previously, most cancers were diagnosed clinically, without pathologic analysis. A part time Malawian pathologist supports the lab, and LCCC is working toward establishing telepathology capabilities for more complex cases.

Post-operative Area

Dr. Shores established the KCH Cancer Database in September 2010 in collaboration with the LCCC Division of Bioinformatics. This web-based system has captured information on >1800 cancer cases. This database /system has provided a wealth of data on the types of cancer seen and provides the basis for current and future research grants. In addition, the Malawi Ministry of Health utilized the data for resource allocation. Data will be presented at the African Organization for Research and Training in Cancer (AORTIC) meeting in Cairo, Egypt in December 2011.

Shores’ first trip to the country was in 2006 to study Burkitt lymphoma (BL), a cancer that has a strong association with the Epstein-Barr virus. BL is relatively rare in most parts of the world, but is endemic in children ages 3-15 in sub-Saharan Africa. The disease is an aggressive, fast-growing type of non-Hodgkin lymphoma that usually affects the jaw, bowel, lymph nodes, or other organs.

Shores and other UNC colleagues have completed a LCCC supported proof of principle study that suggested that anti-viral therapy my improve outcomes in children with BL (Clinical Cancer Research). Dr. Shores and her UNC colleagues reported that a common cancer drug can activate a lytic viral infection, making it susceptible to anti-viral therapy.

Based on this, Dr Dan Olsen, Daniel Olsen, MD, a pediatric resident at the University of Wisconsin, Hospital and Clinic, received a Fogarty International Clinical Research Fellowship to complete a phase 1 trial of valacyclovir (an anti-viral drug) with standard of care cyclophosphamide (chemotherapy agent) in BL patients at KCH, to determine if this drug combination is safe. This study was completed in July 2011 without any significant complications. Dr Shores is now applying for funding for a larger, phase 2 trial, that will test the efficacy of this drug combination in treating BL.

Shores says, “I admire the patients I care for at KCH. They are stoic and put up with a lot to obtain medical care. We want to help them as much as we can. Training Malawian surgeon to provide both clinical care and to become principle investigators in Malawi-based research projects will nurture a sustainable, vibrant health care system.”

If you are interested in supporting Dr. Shore’s efforts in Malawi, please contact Leslie Nelson, major gifts officer with the NC Medical Foundation: leslie_nelson@med.unc.edu or (919) 843-5734.

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