Making the Dream of Safe Surgery a Reality - Darwin's Journey as a PFP Scholar

Written by Dr. Darwin Nyirenda, Physicians for Peace Surgery Scholar, Set to Graduate December 2026 (Malawi)

This year marks my fourth year as a PFP scholar. Each passing day makes the dream of safe surgery in Malawi a reality. The belief of becoming one of the locally trained and regionally relevant surgeons possible. Being trained locally means understanding unique challenges to our population thereby employing locally relevant solutions within the global surgery community.

This year is my second year of fellowship training in general surgery at Queen Elizabeth Central Hospital Malawi (QECH). It is an exciting year as I plan to do rotations in four subspecialty areas so as to be able to provide all-round life-saving surgical care for our people.

I have started pediatric surgery rotation at Mercy James Centre (MJC) for 3 months then will go on to rotate in urology, ear, nose, throat (ENT), and finally the intensive care and anesthesia department.

Mercy James is a center of excellence for the provision of specialized surgical care to children in Malawi, managing most of the challenging cases with excellent results. It is also a center for training pediatric surgeons in the College of Surgeons of East, Central and Southern Africa (COSECSA) region. Having been part of the team for 3 months, I gained valuable insights managing pediatric emergency cases, pediatric urology patients, and gastrointestinal patients.

While with the team, I developed a keen interest in the management of patients with bowel perforation due to typhoid disease. Traditionally, these patients will have their perforated bowels repaired rather than having a stoma. However, a quick follow-up of the cases of typhoid managed during my rotation showed that most of these patients go back to theatre multiple times and eventually end up with a stoma. With the limited theatre resources, it raises the question of whether we should be repairing the perforation or treat such patients with a stoma. To answer this question, I am leading an audit of such patients treated at MJC for the past 5 years under the mentorship of Medical Director Professor Eric Borgstein, hoping to come up with locally evidence-based answers for the future management of typhoid perforation patients at the Centre.

Further to the clinical skills gained at MJC, I have also gained non-surgical skills relevant to the delivery of quality care to our surgical patients at QECH. These include good communication within the teams, theatre time optimization, and mentorship of district referring officers for safe patient transfers. These are skills that can easily be taught and replicated at QECH with minimal resources but great results on patient care and outcomes.

I believe that being a PFP scholar has made a tremendous impact on my career as well as patients’ outcomes already. I believe by the end of the training I will harness enough knowledge, skills, and qualification to be a surgeon and leader in the provision of safe surgery in Malawi.

Mwayi Darwin Nyirenda