Gynecological Oncology at Msf in Malawi W/m

**Description interne**

Médecins Sans Frontières (MSF) is an international, independent, medical humanitarian organization created in 1971 that delivers emergency aid to people affected by armed conflict, epidemics, healthcare exclusion and natural disasters. MSF is one of the largest independent medical humanitarian organizations in the world, with projects located in 65 countries worldwide. Its work is based on the humanitarian principles of medical ethics; the goal of MSF is to provide emergency care and to offer assistance to people based only on need and irrespective of race, religion, gender or political affiliation. The French section is present in around thirty countries.

**Why join MSF?**:
Over the past years Cervical Cancer has swept across Malawi as it accounts for 40% of all cancers among women and kills an estimated 2,300 a year. MSF has opened an operating theatre, an 18-bed inpatient ward and a day clinic as well as palliative care services. MSF also supports the Ministry of Health in provision of chemotherapy for the cervical cancer patients, and is currently looking into the possibilities of implementation radiotherapy. This has all been done with the aim of helping make a lasting difference in the lives of the affected women.

**Brief description of Malawi**:
The republic of Malawi is a landlocked country in South-eastern Africa spans over 118,484 km2 (45,747 sq. mi) and has an estimated population of 17,563,749 [i]. Malawi’s population is young, with 44% aged under 15years, 51% aged between 15-59 years and 5% aged 60 years or older. Malawi is a generally peaceful country and has had stable governments since independence in 1964. One-party rule ended in 1993; since then multi-party presidential and parliamentary elections have been held every five years. Malawi remains one of the poorest countries in the world despite making significant economic and structural reforms to sustain economic growth. The economy is heavily dependent on agriculture, employing nearly 80% of the population, and it is vulnerable to external shocks, particularly climatic shocks.

**Description of MSF Assignment in Malawi**

In 2017 MSF-France took on the challenge of developing a comprehensive Cervical Cancer program with the ambition of addressing complex issues as inequalities in accessing screening programs, early diagnosis, and treatment encountered in low
- and middle-income countries. The program aims to develop new approaches and targets all stages of the Cervical Cancer disease course from HPV-infection, development of pre-cancerous lesions and high-grade lesions, progression into invasive cancer, metastatic cancer and end of life phase. In collaboration with the national Ministry of Health, an integrated approach to the diagnosis and management of women's cancers involving vaccination, screening, diagnosis, treatment, surgery, chemotherapy and palliative care is provided by a team of specialists, both expatriate and national.

**Testimonial from the national gyne-oncological surgeon**
- “The unavailability or otherwise inadequate treatment options for those diagnosed with cervical cancer in Malawi resulted in the creation of “cervical cancer death reservoirs”. These are pools of women who are at risk of dying from undiagnosed, diagnosed but untreated or inappropriately treated cervical cancers. I joined MSF in 2019, as it presented an opportunity for me to take part in addressing this problem. Along with it, has been an amazing learning and collaborative working experience that has truly changed the lives of over many women within. To date, over 9 ESGO Onco-surgeons have rotated through the project, bringing with them the much-needed experience and skills that have been imparted on me and my colleagues. The holistic approach that we follow at MSF has made it possible to have those that are disadvantaged the most be reached and helped. It is a journey with its highs and lows as the tasks can be challenging, but we keep moving as I continue making new friends” Dr George Chilinda (_**_MALAWI_**_)_

**Testimonial from one of the expatriate gyne-oncological surgeons**
- “When MSF sent me on my first mission to Malawi, I had heard about the endemic threat of cervical cancer in the country, but I had, of course, no idea of how big the problem really was. Treating so many patients, many of them in late stages of the disease, can be challenging, physically and mentally. But I was and still am amazed about the high standards and quality of treatment we at MSF are able to provide, even under circumstances in a low-income country. This is due to our interdisciplinary team of extremely skilled surgeons, gynecologists and medical doctors, dedicated and caring nurses, psychologists and social workers and not to forget the big bunch of logistics and paramedical services. The professional management of the project made my start very easy. The warmth of the friends I made here will make my parting rather hard”, says _Dr S