BOFAS-Malawi Mini-Fellowship

BOFAS has agreed to support an opportunity for Orthopaedic Trainees to visit and work alongside the Orthopaedic Departments of The Queen Elizabeth Central Hospital and The Beit CURE International Hospital in Blantyre, Malawi. Funding can be awarded up to £2500.

The Fellowship supervisor will be: Dr Noha Nyamulani (nohakhelha@yahoo.com). The duration can be between 4 and 52 weeks with permission from the team in Malawi.

  • Any Fellowship of less than 6 weeks duration will be considered a ‘Visitation fellowship’ and will be expected to be observational with respect to direct surgical procedures.
  • Fellowships of greater than 6 weeks can include direct operative experience.  It will require additional preparatory paperwork incumbent upon the trainee to complete.   

The objectives are:

  • To experience and assist with the trauma management at Queen Elizabeth Central Hospital, with a focus on that relating to the foot and ankle.
  • To experience and assist with the surgical management of paediatric foot and ankle problems managed at Beit Cure International Hospital.
  • To teach Foot and Ankle Anatomy and relevant surgical principles to Orthopaedic Clinical Officers, junior doctors in training and Medical Students.
  • To contribute to the weekly postgraduate educational programme.

BOFAS will provide the funding towards an economy class return airfare from Heathrow to Malawi and contribute to local accommodation costs.

  • Accommodation can be arranged with advice/assistance by the QECH/CURE hosts. Accommodation pegged at 30-50 pounds per night is reasonable.

Travel insurance and local subsistence will be the responsibility of the successful applicant.

Application process:

Applications should be directed to Mr Mark B Davies (mark.davies30@nhs.net) & Mr. Tim Williams (timwilliams1@nhs.net) on behalf of the BOFAS Overseas Education Committee, who will supply further background information.

The application  should include:
1.     A letter of application stating how the Fellowship will contribute to the training and career aims of the trainee.
2.     An indication of preferred duration and timing,
3.     A copy of their CV with email addresses of two professional referees, ideally including support from their Training Programme Director.

Deadline:

The deadline for applications is 1st July each year.  The successful applicant will be expected to travel between 1st July and the end of the following June.

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Background:

Queen Elizabeth Central Hospital (QECH):

QECH is the major teaching centre in Malawi. It is adjacent to the main medical school campus and is the centre of training for Orthopaedic Clinical Officers

It is one of 4 central hospitals in Malawi, with others found in Lilongwe, Mzuzu and Zomba.

These centres in principle offer tertiary referral services for the remaining 3 regions  of the country. In practice, only Blantyre and Lilongwe have regular orthopaedic surgeon access and Blantyre remains the main teaching centre.

There are three Orthopaedic Surgeons that work in QECH: Dr Nohakhelha Nyamulani, Dr Chikumbutso Mpanga and Dr Kaweme Mwafulirwa.

The hospital has to deal with a burgeoning trauma burden with limited resources. There is a large and new accident and emergency department, an image intensifier, a robust nailing system and access to AO type of internal fixation, conventional and anatomical plate locking systems, and monolateral and circular frame external fixation. There is access to a CT and limited access to MRI scanning. On average 2 full orthopaedic theatre lists run everyday with constrained capacity given the burden of demand.

Queen Elizabeth Central Hospital and the Kamuzu University of Health Sciences (KUHES) host a specialist Fellowship training under the College of Surgeons of East, Central and Southern Africa (COSECSA) and an MMed course (Masters degree in Trauma and Orthopaedic Surgery). Visiting senior UK trainees could help as tutors for the orthopaedic registrars engaged on this course.

The department is also committed to training medical students and Orthopaedic Clinical officers. Orthopaedic Clinical Officers (OCOs) are paramedical orthopaedic technicians that provide the back-bone of orthopaedic care throughout the country. They have a paramedical background and do a further 18 months specialty training at the end of which they are able to provide basic orthopaedic and trauma care such as conservative fracture management, ability to diagnose critical conditions and provide initial basic emergency management. The department also trains further OCOs for a further 3 years to attain a BSc in Trauma and Orthopaedics. The fellow will be involved in the teaching of the medical students and OCOs.

 

Beit CURE International Hospital (BCIH):

The hospital was opened in 2002. It was built with generous financial support of the BEIT trust and is run by CURE International[1]. It’s goal is to provide the highest standard of appropriate paediatric orthopaedic care to the children of Malawi and the surrounding region with a strong emphasis on the importance of spiritual as well as physical healing for the children and families it serves. To this end, the hospital has a strong and unapologetic Christian witness. The unit has a close working relationship with the adjacent medical school, teaching hospital and paramedical training departments.  The hospital has a strong commitment to teaching; Medical students, Orthopaedic Clinical Officers and orthopaedic trainees all work and train within the hospital.

The unit provides free services to children with orthopaedic problems and complications of traumatic injuries. Currently three paediatric orthopaedic surgeons work at Beit CURE IH  - Samuel Maina, Nicholas Lubega, Bicheng Yong and a Plastic surgeon Dorothy Bbale.

Suggested Benefits of Fellowship:

  • To assist in training.
     
  • To experience first-hand the burden of trauma facing much of the world in a resource depleted setting of a low- or middle-income country.
     
  • To develop confidence in decision making and management of surgical problems not commonly encountered in the UK.
     
  • To be encouraged and excited by the opportunities for supporting developing world orthopaedics through such exchanges and through appropriate research.

Working conditions:

The conditions and resources in hospitals in Malawi are very different from those in the UK. It is helpful if visitors come with a determination to learn and not judge.

 

HIV is endemic in the population at large and unfortunately prevalence rates in the adult population may be as high as 14% and fairly average compared to neighbouring nations. The true rates of prevalence in the paediatric population we serve are not know but probably are significantly less than the adult population. Safe surgical practice is stressed and emergency retroviral prophylaxis is available though rarely needed. Hospital acquired transmission of HIV worldwide is extremely rare. Even without prophylaxis, seroconversion as a result of solid needlestick injury from a seropositive patient is quoted as being less than 1:1000. Appropriate ARV (anti-retroviral)  prophylaxis is thought to reduce this even further by many-fold. Objectively, road travel in Malawi is a much more serious and important risk to health and injury.

 

The successful candidate will work in exactly the same manner as a senior UK specialist orthopaedic trainee.

For all fellowships - application for registration with the Malawi Medical Council is suggested. As a Non-registered visitor, you would be allowed to teach and help in clinics.

 

Some facts on Malawi:

  • Situated in South-Eastern Africa, Bordered by Zambia, Tanzania and Mozambique, it does not have a sea border or port.
  • Has a population or approximately 20 million, many of whom live be subsistence farming. Is sadly one of the poorest countries in Africa.
  • Main exports are agricultural (tobacco, sugar, tea etc).
  • Is approximately the same length as the UK from North – South.
  • 1/3 the area of the country is filled by a giant lake (lake Malawi) which is, in effect, a fresh water inland sea.
  • Is very beautiful to visit. The people are extremely friendly and the geography varies widely from arid lowlands to high grassy temperate regions and high mountains. The dominating presence of Lake Malawi means that beautiful sunny freshwater beaches are plentiful.
  • Approximately 1/3 million children have a physical disability.
  • Average life expectancy – around 40 years.
  • Is a political democracy and has a history of good stability and a level of security and criminal violence that is envied by many sub-Saharan neighbouring countries.
  • Weather. Temperature from September to April is very pleasant and by day is normally in the upper 20’s or lower 30’s Celsius. In the cold season – from the end of May to the end of August, it remains warm by day (mid to lower 20’s) but is cold at evening time and at night. It is worth bringing some warm clothes if you are coming at this time of year.
  • Is rather conservative in terms of dress code. In the hospital smart dress is required – as in a British hospital. For men; long trousers and collared shirt with / without a tie. For women; skirts reaching to below the knee or smart trousers are acceptable. A modest neck-line is expected. Shorts or jeans in the hospital are not acceptable. On peripheral visits or village locations women may be expected to wear skirts (or a wrap around local Chitenje) rather than trousers to show respect.
  • Electricity: We use UK style 240v square pin plugs –no adaptors for UK equipment is necessary. We do suffer big voltage swings and so sensitive equipment may need to be protected by a voltage regulator (available locally). Laptops and phone chargers are not really sensitive enough to mandate such measures as their own transformers usually afford satisfactory protection.
  • Mobile phones; there is a good mobile network available in Malawi. Local pay-as-you-go SIM cards can easily be purchased for less than $1USD, and these can be “topped up” easily at any street corner.
  • Money – our currency is the Kwacha - current exchange rates (May 24’) are 2,206MKW / 1£. Money can be drawn on a visa card from local ATMs, although most banks charge considerable service fees for such ATM withdrawals. Mastercards and Visacards (both credit and debit cards) are accepted and can be used on all ATM and POS machines. The best exchange rates can be obtained by bringing in Cash (Dollars or Sterling) and exchanging these at a reliable local registered Forex Bureaux (e.g. CLC on Victoria Avenue or the local major banks). Travellers’ cheques are generally more expensive and harder to exchange.

For Longer staying visitors from the UK – look into the excellent current account offered by Norwich and Peterborough Building Society that offer their current account holders FREE withdrawals from ATM overseas with no cash handling charges and very good exchange rates. http://www.nandp.co.uk

  • Security. Malawi is much safer than many African countries and violent theft / muggings are uncommon. Avoiding risk is however essential. One should not walk on the streets after dusk. One can go out at night in company as long as advice is taken and safe destinations are chosen (guarded restaurants etc) and safe approved transport is attained. As it gets dark quickly after 17.30h, the evenings can seem quite long. There is thus ample opportunity for study and bringing a good supply of books etc is recommended. Satellite TV and good internet connectivity is available to allow for further entertainment .

 

[1] CURE International is a charity is the biggest provider of paediatric surgical care in the world. It has programmes and hospitals in 20 of the poorest countries in the world. It has a specific commitment to children with orthopaedic disability and training national surgeons to treat affected children appropriately. It has an established international fellowship programme and proven research track record.