From one neurologist to one unit: turning the tide against stroke in Malawi

Laura Benjamin recalls talking to the Ministry of Health in Malawi in 2017. “They had put together a health sector strategic plan for the next four years, and this document highlighted the diseases of focus for the country, prioritised by those with the greatest burden. They talked about hypertension, diabetes, and heart disease, but they didn’t talk about stroke, which goes hand in hand with these diseases. They said they didn’t have the data to show its importance.”

Benjamin, a British neurologist, arrived in the southern African country expecting to study the links between stroke and HIV for her PhD. But she found herself immediately on the frontlines at Queen Elizabeth Hospital in Blantyre.

“When I arrived in 2010, I had completed five years of clinical training and was in my first year of specialist training in neurology. I was the only [neurologist] in the country at the time. There had been some visiting neurologists who came from Australia or Europe for brief periods, but I was mostly alone for the two and a half years of my fellowship. People would come from across the whole country, sometimes travelling 300 miles, to see me. And I was thinking, ‘I’m not even a proper neurologist yet’, but the demand was huge.”

She found herself facing a paucity of data on the burden of stroke and very little public awareness—as well as a critical lack of infrastructure to treat a condition that requires immediate action to avoid long term disability.

“People with mild or moderate strokes—who should have been able to function and …