UPMC Children’s Pediatric Cardiologist Reflects on Visiting Professorship in Malawi

Craig P. Dobson, MD, FACC, FAHA, associate professor of pediatrics and clinical director of the Division of Pediatric Cardiology at the Heart Institute at UPMC Children’s Hospital of Pittsburgh, recently returned from a two-week visiting professorship at Kamuzu Central Hospital (KCH) in Lilongwe, the capital of Malawi. His role was part of a broader effort led by Baylor University and Texas Children’s Hospital to combat rheumatic heart disease (RHD) and improve cardiac care infrastructure in the country.

Dr. Dobson was joined in the training by Amy E. Sanyahumbi, MD, a pediatric cardiologist from Baylor University and Texas Children’s Hospital who lives in Malawi and works at Kamuzu Central Hospital.

The Need: Cardiac Care in Malawi

Malawi, with a population of 21 million, ranks seventh lowest globally in terms of GDP and has a highly limited health infrastructure, especially in cardiology. The entire nation lacks cardiac surgical and catheter-based services. For any specialized interventions, patients must be referred abroad, usually to India, and the government subsidizes only the simplest cardiac procedures. The scarcity of adult cardiologists compounds these challenges.

“Malawi’s cardiovascular landscape is extremely under-resourced,” says Dr. Dobson. “It’s staggering when you consider the population and the scale of the need. There are only two pediatric cardiologists serving the entire country, and there’s not even an adult cardiologist in the capital. We’re trying to make sustainable, impactful changes with the resources at hand.”

The Rising Threat of Rheumatic Heart Disease

While HIV was once the dominant health concern in sub-Saharan Africa, public health efforts have made managing HIV more feasible. This shift has exposed other chronic conditions, like RHD, which have become increasingly prevalent. Globally, RHD is now more common than HIV, and the disease is particularly aggressive in low-income countries. In Malawi, 85% of children with RHD are only diagnosed when their condition has progressed to a severe state, making treatment options limited and outcomes poor.

“Rheumatic heart disease is a devastating consequence of untreated strep infections,” explains Dr. Dobson. “It’s preventable. In countries like the U.S., it’s almost unheard of to see a case, but in areas like Malawi, they see so many children coming in with end-stage heart failure as a result. Early diagnosis could help to save and improve many lives, but we need to equip communities with the clinical education and tools to recognize RHD and intervene sooner.”

RHD is a significant global health concern, particularly in low- and middle-income countries. According to the World Health Organization (WHO), RHD is the most commonly acquired heart disease in individuals under 25 years of age, resulting in over 288,000 deaths annually.¹

Additionally, The World Heart Federation reports that more than 40 million people worldwide are currently living with RHD,² with the disease disproportionately affecting children and adolescents in regions where poverty is widespread and access to health care is limited. 

Echocardiography as a Diagnostic Tool

The gold standard for diagnosing RHD and congenital heart disease is echocardiography. While Malawi has some echocardiography machines, the clinical knowledge to use them effectively in recognizing and diagnosing RHD and congenital cardiac lesions was lacking, particularly in rural districts. Dr. Dobson’s work was centered on bridging this gap.

“Our goal with the training was to empower clinical officers and radiographers — nonphysician health care providers — to perform and interpret basic echocardiograms,” says Dr. Dobson. “This training enables early detection of both congenital and acquired heart diseases. We provided hands-on, practical education that these health care workers could immediately apply in their regions.”

Training Program Overview

Week One: Clinical Education

The first week of Dr. Dobson’s professorship was dedicated to teaching and hands-on clinical work at KCH. The hospital operates under challenging conditions.

“Imagine a pediatric cardiology clinic where up to three families share a single exam room, and patient visits often occur outdoors due to space constraints,” says Dr. Dobson. Medical records are kept in “Health Passport” books carried by patients themselves, a system that reflects broader logistical hurdles in the area.

The training involved interns, registrars, and medical students, following the British-style medical education system that exists in Malawi.

“We focused on basic cardiac care, and I delivered lectures tailored to their unique challenges and patient demographics,” says Dr. Dobson.

Week Two: Echocardiography Training for Non-Physicians

The second week of Dr. Dobson’s work involved an intensive echocardiography course for non-physicians. The course, backed by Partners in Health, drew clinical officers and radiographers from health districts across Malawi. “These individuals are the backbone of health care in rural areas,” says Dr. Dobson. “They perform ultrasounds and see patients daily, yet many lacked formal training in interpreting echocardiographic images.”

Participants were trained to capture standard echocardiographic views, which can then be transmitted to pediatric cardiologists in the capital for expert review. This setup extends the reach of specialist diagnosis without necessitating patient travel.

“We demonstrated techniques for acquiring and interpreting images, emphasizing reproducible, high-yield views,” explains Dr. Dobson. “For instance, we walked through methods to identify significant mitral regurgitation, a hallmark of advanced RHD. This hands-on approach built their confidence in recognizing abnormalities.”

Impact and Early Successes

Shortly after the training concluded, its impact was evident. One clinical officer, armed with new knowledge, identified a newborn with an atrioventricular canal defect — a serious congenital anomaly.

“He was able to send echocardiographic images to the capital for confirmation, and the patient has since been referred for surgery in India,” shares Dr. Dobson. “This case perfectly illustrates the potential of empowering local health care workers.”

Addressing Equipment and Sustainability and the Long-Terms Goals of the Program

While equipment availability remains a challenge, advances in lower-cost, portable technology offer hope.

“They have echocardiography machines, but they’re often older or less sophisticated than what we use at UPMC Children’s,” says Dr. Dobson. “However, there are promising low-cost options available and in development, like portable echocardiography devices that connect to tablets. These types of echo devices could have a good deal of impact on access to affordable diagnostic tools that have as much clinical utility as the larger machines you typically see in hospitals or clinics.”

The long-term vision includes a sustainable, self-propagating training model.

“They are working to create a network of trainers,” says Dr. Dobson. “By educating a small cadre of providers now, the hope is that they can and will pass that knowledge and training to other health care workers in the country, ensuring that the knowledge doesn’t just vanish after our short visit. It’s about creating a legacy of continuous improvement in cardiac care.”

Reflections and Gratitude

For Dr. Dobson, this experience builds on a career rich with humanitarian work, including his prior service in war zones and low-resource settings like Laos as a physician for more than two decades in the United States Army Medical Corps.

“I’m deeply grateful to Heart Institute co-director and division chief of Pediatric Cardiology, Jacqueline Kreutzer, MD, and the leadership at UPMC for supporting this initiative,” says Dr. Dobson. “Their backing made it possible for me to contribute meaningfully to this life-changing work.”

References

1. World Health Organization. Rheumatic Heart Disease.
2. World Heart Federation. What We Do: Rheumatic Heart Disease.

Further Reading

Learn more about Dr. Dobson and the Heart Institute at UPMC Children’s Hospital of Pittsburgh.