‘An historic moment’: The first breast health training programme in Malawi

Mr Antonio Jaén Osuna describes the roll-out of a training programme for healthcare providers in rural communities in Malawi on the early detection of breast cancer

More than 40 frontline health workers located in Blantyre, the southern region of Malawi, have recently completed an intensive three-day breast health programme. It is the first-ever such course in the country. This course has given healthcare providers who work in rural communities a comprehensive knowledge of the early detection of breast cancer and how to assess women with breast health-related issues.

“This course is an historic occasion for our people,” said Dr Kondwani Chalulu, one of the five breast cancer surgeons in Malawi. “We were dealing with primary caregivers who have never before examined breasts in a clinical setting and after the three days of teaching, they were able to make a diagnosis of breast diseases,” Dr Chalulu explained.

In Malawi, breast cancer is the third most common cancer in women, with very low survival rates from the time of diagnosis – only 9.5 per cent of patients survive beyond 18 months. However, Malawi does not have a specific policy on breast cancer. Bringing the right knowledge to frontline health workers can help to save lives. Breast cancer, if detected during the first stages, has a high rate of survival. For women diagnosed at an early or localised stage, the chances of staying alive or free from a relapse over five years after diagnosis is on average 96 per cent in the European Union. That is the reason the Akazi project team (‘Akazi’ means ‘woman’ in the Chichewa language) designed this training as part of its goal of promoting a systematic approach to breast cancer control in Malawi.

“This training is very important as it will help us to identify breast cancer,” said Ms Modesta Mwagomba, District Nursing Officer at Blantyre District Health and Social Office. “Before, it was not possible, because we didn’t have the knowledge nor the skills. This training is going to help us to identify the cancer and then treat it accordingly and in good time. Breast cancer is curable. But we need to identify it at early stages,” she added.  

Heading in the right direction

A pre- and post-course assessment was conducted to evaluate the course. Results demonstrated great improvements in knowledge about breast health among the trainees. This has already translated into improved clinical practice of the trainees.  “A woman came to see me with a problem in her breast,” said Ms Ruth Bauleni, Senior Medical Assistant at Chileka Health Centre, and one of the course participants. “I took the advantage of the training to examine the patient and to refer her to the breast clinic at the central hospital. It has been a very good experience because I had the courage and the confidence. I was very comfortable doing the examination and telling the patient what I found out,” she added. 

The workload in rural areas can be overwhelming. Malawi is very densely populated and many of the health centres in Blantyre see hundreds of patients daily. Maintaining health workers’ high motivation is essential as their attitude plays a crucial role in the chances of survival for their patients. Adding breast cancer examination to their already full schedule was a concern for the project team. However, the training was warmly welcomed by the participants. “Looking at the way the students were engaging and interacting, you can definitely see that there is some shift in them,” said Dr Palesa Chisala, a surgeon and breast cancer specialist at Queen Elizabeth Central Hospital, and one of the faculty at the Akazi breast health course. “I hope this change persists because they will encounter thousands of patients and I hope they don’t forget the knowledge they have gained so they can continue practising it.”

The primary objective of scaling up the curriculum is to establish standardised clinical breast examination practices across Malawi. This expansion would empower primary caregivers to conduct breast examinations and accurately identify symptoms, particularly those associated with breast cancer. As a result, women in need of specialist attention could be referred to the nearest central hospital for treatment.

Dr Jonathan Chiwanda from the Ministry of Health in Malawi was enthusiastic about the training and acknowledged its potential for further implementation. He emphasised that the results obtained from the pilot programme provided valuable insights into the necessary modifications, both in terms of material and teaching approach, to ensure its relevance when scaled up nationwide.

What to expect?

The impact of this training on women’s health is yet to be seen. Nevertheless, the Akazi project has brought breast health to the forefront in a country where there was no systematic response to such a widespread health issue among the population.

Once the seed is planted, a little nurturing might be enough to see the desired results. “If we can educate more people who can then educate others, creating a cascade effect, we might see an increase in knowledge within our communities and achieve better outcomes,” according to Dr Chisala.

It is now in the hands of Malawian authorities to take the next steps and implement this project across the country.

This article was produced by the RCSI. The project is funded by the Irish Research Council and the Department of Foreign Affairs under the COALESCE programme.