Training

Consultant Orthopaedic surgeon Steve Mannion over with local Orthopaedic Clinical Officers Given the shortage of orthopaedic surgeons the majority of orthopaedic care in Malawi is provided by Orthopaedic Clinical Officers (OCOs), a non doctor grade who have three years of general medical training then 18 months specific to orthopaedics.
The majority of the district hospitals will have only one OCO appointed to them and this individual is responsible for the care of all orthopaedic and musculoskeletal patients attending that hospital.
OCOs are trained in the basics of operative wound care and in fracture management along conservative lines, using plaster of Paris or traction.
They have also had limited training in the use of external fixation methods for treating severe compound fractures


Lilongwe Central Hospital

Lilongwe Central Hospital is the major hospital in the capital city. All cases of orthopaedic trauma occurring within the Lilongwe area attend this facility. It also acts as a referral centre for orthopaedic cases from the district hospitals of the entire Central and Northern Regions of the country, a catchment population of some 6-7 million people.
The orthopaedic department at Lilongwe Central Hospital consists of four OCOs, with only occasional support in the form of monthly one or two day visits from orthopaedic consultants based in Blantyre. At any one time the orthopaedic department will be responsible for the care of 50 - 70 in-patients and see 70 - 100 outpatients per day.


Malawi Against Physical Disability

Malawi Against Physical Disability The Lilongwe MAP Unit is primarily responsible for the treatment of children with physical disability,
but adults with non-traumatic orthopaedic conditions ( tumours, infections, degenerative disease) are also seen there.

During the course of Steve's last visit to malawi, he undertook a number of clinics at the Lilongwe MAP Unit, in association with the Senior Orthopaedic Clinical officer there, Mr Sandy Chimangeni.

Selected cases underwent surgical correction of deformity, the operations being carried out at LCH.



Hospital Support Visits

Hand's On In addition to work at LCH and the Lilongwe MAP Unit, Steve conducted clinical support visits to two District Hospitals in the Northern Region of Malawi in order to assist the OCOs working in these units.
These hospitals are not otherwise routinely supported by visits from orthopaedic surgeons.

The hospitals chosen were : At each district hospital the following was carried out:
  1. An outpatient clinic for patients for whom the clinical officer is uncertain of the diagnosis or ideal management.
  2. A ward round, advising the clinical officer of optimal management strategies for in-patient cases and also conducting "on-the job" OCO training.
  3. Operating on selected cases with the clinical officer, with an emphasis on improving the operative skills and surgical repertoire of the OCO.
  4. Referring cases requiring more sophisticated forms of orthopaedic management ( eg internal fixation of fractures, complex reconstruction) to LCH.