Malawi is a relatively small landlocked country in South-eastern Africa with 18,6 million inhabitants, and is one of the most densely populated countries in Africa. Africa has 24% of the global burden of disease, but only 3% of the health workers and less than 1% of the world expenditure on health. In Malawi this is very apparent on the ground. The World Health Organization (WHO) estimates that approximately 5.700 people die due to road traffic accidents in Malawi annually, and about 100.000 are injured in traffic every year. Over 400 000 children are estimated to be living with musculoskeletal impairments that could be treated by surgery.

Outside orthopaedic unit for children
Outside orthopaedic ward for children

Lilongwe is the capital in Malawi and is the fastest growing city in the country with a population of approximately 2,5 million (including the rural areas). The capital also has the highest rate of road traffic deaths in the country, far higher than any other district according to Ministry of Health statistics.

Kamuzu Central Hospital (KCH) is the tertiary referral hospital for 7 million people in the Central Region of Malawi, and is situated in Lilongwe. KCH has a capacity of about 900 beds with about 90 beds earmarked for orthopaedic patients. However, at any time, KCH has between 120-160 patients admitted to the wards with orthopaedic conditions, including an average of 50 children. These children share 24 available beds. The Orthopaedic section at KCH currently performs about 1.000 surgeries a year, using the one theatre available for Orthopaedic surgeons. LION will allow a scale up in annual operations to over 3.000 within the first three years.

Before 2008 there were no qualified orthopaedic surgeons at Kamuzu Central Hospital. However, after the startup of the training programme for surgeons at KCH in 2009, 2 orthopaedic surgeons have been trained in Lilongwe and 3 more are in training now. There are 12 orthopaedic surgeons in the whole country, with 7 working in public hospitals. In the absence of a sufficient number of qualified orthopaedic and trauma surgeons, the majority of orthopaedic trauma care is provided by Orthopaedic Clinical officers (OCOs). OCOs have 18 months training in basic orthopaedic management of fractures, orthopaedic infections and club foot casting, on top of a foundation of health assistant (2 years) or general clinical officer (3 years). Over the last 20 years, the Malawi orthopaedic clinical officer programme has trained over 100 OCOs to staff all the district hospitals run by the Government of Malawi (GoM) and the Christian Hospital Association of Malawi (CHAM).

LION will increase the number of timely surgical operations performed at the hospital and thus reduce complications resulting from late or no surgical procedures. This will reduce the number of disabilities in the population, and allow shorter stays in the hospital for the patients. Kamuzu Central Hospital will be able to take on more patients from surrounding district hospitals and thus increase the capacity of the health systems in the region. The patients referred from the district hospitals will be able to return to their home district must faster than today, for rehabilitation close to home. The concentration of surgical expertise and facilities at LION will support the training of new surgeons in Malawi, facilitate a faster scale up of services and contribute to the retention of surgeons in the country.

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