Providing a long-term sustainable urological solution for Malawi

 What is the global problem?

  • 5 billion people lack access to safe and affordable surgical care.
  • Only 6% of global surgical procedures are performed in the poorest countries.

What is the problem in Malawi?

  • There are no urologist doctors.
  • Many women haver vescio-vaginal fistulas (abnormal opening between vagina and bladder). They are social and economic outcasts
  • An estimated 2,000 men are walking around with long-term catheters in the Southeast Zomba region alone. Many of these catheters could be removed with treatment.
  • Lack of prostate cancer screening means that those diagnosed with prostate cancer present late, with advanced disease and typically die.

Why Malawi?

  • There are thousands of women and men with urological problems. Many lives can be saved, and with major improvements to the quality of life.
  • These people, with access to improved surgical care, can become productive members of the economy, rather than a drain.
  • Increasing employment improves health and reduces social unrest, which benefits both the local community and, ultimately, all of us.
  • The lessons learned in Malawi could then be applied to other resource-limited communities in the developing world as well as in Canada (such as the far north)

What is the long-term, sustainable solution?

Rather than just having doctors fly in to treat patients and then fly back out again, the sustainable solution uses well-trained visiting urologists to educate local doctors in urology.  The local doctors will then have the needed skills to support their communities.


  • Provide basic urological care at ZCH (Zomba Central Hospital, in Malawi). ZCH is one of four public hospitals in Malawi, serving a region of 4 million people.  When specialized urology care is available, patients from an additional 6-million-person region may potentially come to ZCH.
  • Train clinical officers in Malawi, who perform the bulk of medical procedures, to perform urology procedures.
  • Educate at least two Malawi medical school graduates to become urologists in Malawi.
  • Integrate U of T’s Urology residency into ZCH services. This will also result in better trained doctors in Canada.
  • Acquire additional urology medical equipment.
  • Integrate our efforts with a German surgical group who have been working in the same region, in parallel with our efforts. The first combined onsite effort is scheduled for June 2019.

What is the value?

  • Saving lives and improving the quality of life is important.
  • Improving health will result in increased economic growth and decreased social unrest. People with improved health are able to work and support their families, contributing to better health outcomes for the larger community.
  • U of T medical residents will be enriched by the experience of working in this environment and hopefully become better doctors in Canada, to the benefit of us all.

Who is the team leading the effort?

  • Rajiv Singal is leading the effort. He is a Urologic Surgeon at Michael Garron Hospital (Formerly Toronto East General Hospital) and Assistant Professor in the Department of Surgery at U of T (the University of Toronto). Global Surgery is a strategic priority for the Department of surgery at U of T.
  • He is working with: Dr. Eric Borgstein (pediatric surgeon, who serves as a Professor of Surgery at the University of Malawi College of Medicine); Dignatas International, a charity with deep connections in Malawi; and with the Global Surgery Program in the Department of Surgery at U of T. Dr Singal is the urology lead for that initiative.
  • To date, Dr. Singal has raised almost $1,000,000 of his $2,000,000 goal thanks to very generous supporters.

Accomplishments to date include:

  • A Malawian surgeon, funded through this initiative, will complete his urology residency in 2019 and return to Malawi as the country’s first full-time urologist. He will be based in Zomba where the U of T urology presence resides.

 Your next steps

  • Please contact me to learn more about what Dr. Singal is doing.
  • You can read more on Dr. Singal’s blog at: