title: Initiating and developing clinical services, training and research in a low resource setting: the Malawi ENT experience.
abstract: BACKGROUND
  Sub-Saharan Africa countries like Malawi have a paucity of ear, nose and throat (ENT) data, services and training opportunities.
  
  
  OBJECTIVE
  To reflect on new Malawian ENT experience and to propose guidelines to poorly resourced countries.
  
  
  METHODS
  Analysis of data predating and following establishment of ENT services in Malawi.
  
  
  RESULTS
  In 2008 the first and only Malawian ENT specialist established ENT services with external funding. Fifteen clinical officers have been trained and a nurse placed at each outreach hospital. In 2012, 15,284 consultations were recorded: 543 (3.6%) from outreach clinics. Forty-nine percent needed medical treatment, while 45% needed medical advice. Surgery was performed on 2.7% of patients; 21% for foreign bodies in the nose and throat and 18% for foreign bodies and biopsies of ears.
  
  
  CONCLUSIONS
  To establish accessible and sustainable specialist ENT services in a poor country requires building on an established local health delivery system, careful planning and investment in personnel, infrastructure, training and data collection.
authors.affiliation: ENT Surgeon and Head of Unit, College of Medicine, University of Malawi, Malawi.
authors.forename: Wakisa
authors.initials: W
authors.lastname: Mulwafu
authors.affiliation: South-South Networking and Capacity Development Manager, European and Developing Countries Clinical Trials Partnership, Medical Research Council, Cape Town, South Africa nyirenda@edctp.org.
authors.forename: Thomas Elliot
authors.initials: TE
authors.lastname: Nyirenda
authors.affiliation: Professor and Chairman, Division of Otolaryngology, University of Cape Town, Cape Town, South Africa.
authors.forename: Johannes J
authors.initials: JJ
authors.lastname: Fagan
authors.affiliation: Consultant ENT and Neck Surgeon, Bradford Hospital, United Kingdom.
authors.forename: Chris
authors.initials: C
authors.lastname: Bem
authors.affiliation: CBM/BMZ Project Coordinator, College of Medicine, University of Malawi, Malawi.
authors.forename: Kumvana
authors.initials: K
authors.lastname: Mlumbe
authors.affiliation: Company Manager, Clinical Research Education and Management Services Limited, Malawi.
authors.forename: Jean
authors.initials: J
authors.lastname: Chitule
mesh_terms: D000554:Ambulatory Care Facilities / Q000458:organization & administration; D003695:Delivery of Health Care / Q000458:organization & administration*; D003906:Developing Countries; D004501:Education, Medical / Q000458:organization & administration; D005260:Female; D005378:Financial Support; D006801:Humans; D008295:Malawi; D008297:Male; D010036:Otolaryngology / Q000191:economics / Q000458:organization & administration*; D010038:Otorhinolaryngologic Diseases / Q000191:economics / Q000628:therapy*; D040841:Resource Allocation
keywords: ENT; Malawi; clinical officer; developing country; otorhinolaryngology; training