Hematology Around the World: Lessons Learned in Malawi

Global hematology is often framed as a future aspiration taking shape as infrastructure and workforce capacity mature. In Malawi, global hematology unfolds in crowded clinics, wards, and blood banks where sickle cell disease (SCD), cancer, and transfusion medicine intersect. We approach this work on parallel paths. Dr. Banda-Zgambo is a Malawian clinician completing her PhD and expanding local research on SCD. Dr. Mack is an American medical student focused on platelet transfusion in cancer. Malawi has taught us two lessons.

Lesson 1: Global hematology is built through shared training and community.
We first met not in Malawi, but during orientation at the National Institutes of Health (NIH) in Bethesda, MD. Through the Fogarty LAUNCH¹ and Fulbright–Fogarty² programs, U.S. and international trainees prepare to integrate into local research and clinical systems. Between lectures and shared meals in our mentors’ homes, we formed relationships feeling less like “networking” and more like a cohort preparing to work side by side. That week clarified that global hematology is not something to observe, but something practiced together.

Our training in Malawi reflects this shift. In Lilongwe, our work is anchored at Kamuzu Central Hospital, UNC Project Malawi,³ and Texas Children’s Global HOPE.⁴ Kambe’s work focuses on SCD, building on a local registry (GRNDMA) to define complications such as kidney disease. Pediatric SCD care in Lilongwe has improved substantially through access to hydroxyurea and a well-established clinic; however, this success created a growing adolescent and young adult (AYA) population with new clinical and psychosocial needs. As Kambe shifted to adult care, she saw clinic attendance drop sharply. Patients described barriers ranging from clinic location to loss of continuity with trusted providers.

This transition carries high mortality⁵ and exposed a gap that medicine alone could not fill. Community-based care became essential. We worked with a community health worker living with SCD in the community department at UNC Project Malawi. Through education sessions and informal conversations, we supported AYAs navigating the transition to adult care. Patients followed due to trust, not protocol. This reshaped our understanding of partnerships between trainees and mentors, hospitals and communities, and data and lived experiences. Successful care depends on keeping the clinic and community connected.

Lesson 2: Data and blood systems determine who receives care.
Ryan’s work examines how blood systems shape cancer care, particularly access to platelet transfusions. Many countries in sub-Saharan Africa lack the capacity to isolate platelets; however, Malawi has built infrastructure through the Malawi Blood Transfusion Services (MBTS), and NIH partnerships like BLOODSAFE⁶ are reducing bloodborne infections.⁷ Even so, availability remains constrained by reality.

Integrated into daily pediatric oncology rounds, Ryan works with clinicians as they document required blood products (often for children with platelets in the single digits), sending requests to MBTS without knowing if they will be fulfilled. Because demand is constant and supply is unpredictable, children may wait hours for platelets to be walked over to the ward. At MBTS, staff carefully prepare platelets via the platelet-rich plasma method with limited equipment. Some months there are no reagents to run full blood counts; other times, funds are unavailable to replace a broken pH meter for quality control. Samples must travel five hours to Blantyre for testing while bags in the “unscreened” platelet agitator inch closer to expiration, moving in circles less than a mile from the children who need them most.

These moments define Ryan’s “vein-to-vein” study. By tracking platelets from donor collection through processing to the patient, we aim to identify losses and inefficiencies. In Malawi, blood systems and data gaps directly shape who receives lifesaving care.

Together, we see global hematology as a core dimension of our field. Sustained investment in training, research infrastructure, and international partnerships is essential. Malawi demonstrates what is possible when support exists. It’s now up to our generation— and our funders⁸ — to continue building it.

1. Fogarty International Center. Global Health Program for Fellows and Scholars (LAUNCH). National Institutes of Health. Updated December 29, 2025. Accessed January 20, 2026.
2. Fulbright U.S. Student Program. Fulbright-Fogarty Fellowships in Public Health. Institute of International Education. Accessed January 20, 2026.
3. UNC Institute for Global Health and Infectious Diseases. UNC Project Malawi. Accessed January 20, 2026.
4. Texas Children’s Global Health Network. Global HOPE. Accessed January 20, 2026.
5. Kayle M, Docherty SL, Sloane R, et al. Transition to adult care in sickle cell disease: a longitudinal study of clinical characteristics and disease severity. Pediatr Blood Cancer. 2019;66(1):e27463.
6. National Heart, Lung, and Blood Institute. Meet the BLOODSAFE program. National Institutes of Health. Accessed January 20, 2026.
7. Singogo E, Chagomerana M, Van Ryn C, et al. Prevalence and incidence of transfusion-transmissible infections among blood donors in Malawi: a population-level study. Transfus Med. 2023;33(6):483-496.
8. American Society of Hematology. Global Research Award. Accessed January 20, 2026.

Disclosure Statement: The authors indicated no relevant conflicts of interest.

Acknowledgment: This article was edited by Ruby Arora, MD, and Andrew Volk, PhD.