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.

Dr. Rajiv Singal

Dr. Rajiv Singal is leading the Malawi 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. The following is his 2020 Nov 30 update

I hope this note finds you happy, safe and healthy.  It has been an unprecedented year for all of us.  The disruption to normal life has been staggering and the toll on families and businesses incalculable.    On the upside Covid has  allowed for some needed reflection for everyone.  There will be better days.

As many  know I have a big commitment to global health as I work to support and develop surgical capacity in the developing world.  I was in Kenya as late as February but Covid upended plans to go to rural Jamaica and to Malawi as the year went on.  Nevertheless there has been much progress.  Through this fund that we started at U of T with support from so many of you we have made strides in capacity building in urology even in this confusion year.  Dr Wanangwa Chisenga ( who we fully supported) qualified as a urology at the end of 2019 and has been working in Zomba since the start of the year.  Dr Charles Mabedi, who was separately funded  is working in Lilongwe.  In late October the two of them ( at the back in the attached picture), ran a  regional camp to help work through a backlog of some men with chronic indwelling urinary catheters who needed prostate surgery.  It was run entirely by local talent as you can see.    It is a remarkable place to be given that when I first came to Malawi in 2016 there were no urologists anywhere in the country.

I have just committed to fund the training of two more Malawian physicians to start in 2021.  They will double the pool when they finish in late 2025.    The University of North Carolina is potentially funding another and my German colleagues have funding from the German government to supplement our efforts further.  All said some nice progress in a year where so many things have come to a standstill.

As many of you also know my Movember efforts over the years have transitioned to supporting this project which I really see as a Men’s Health advocacy project on a larger scale.  As we approach the holiday season ( and with giving Tuesday a day away) you will make decisions around which of so many worthy projects to support.    I would ask that you consider the Global Urology fund at the university as you make your choices.  A direct link to the fund is provided here:

I have not had a chance to write much this year but here is a link to the blog site that describes the various things I have done over the years.

I aim to be back in Africa in 2021 once safety is ensured