Kamuzu Central Hospital (KCH) is situated in Lilongwe, the capital of Malawi, and is the tertiary referral hospital for the 7 million people living in the Central Region. The hospital is government owned through the Malawi Ministry of Health and has approximately 900 beds. At any time there are about 1200 patients admitted, 120 to 160 in-patients with orthopaedic problems, including an average of 50 children. Annually, approximately 1,000 major orthopaedic operations are performed in the one operating theatre, and about 13,000 patients are seen in the orthopaedic outpatient department. The postgraduate surgery training programme at KCH is currently one of the most successful in the region, with six young Malawian doctors currently training to become surgeons in Lilongwe, and six more newly qualified, under the College of Surgeons of East, Central and Southern Africa (COSECSA).
Established in 1991, the College of Medicine (COM) is one of four colleges constituting the University of Malawi (UNIMA). COM offers undergraduate programmes in medicine, surgery, pharmacy, physiotherapy, medical laboratory technology, and health management. COM has a student and staff population of 1,156 and 137 respectively. It is funded through the Ministry of Education, and runs as an autonomous unit within the federal structure of the University of Malawi. This autonomy means that the college runs its own administration, and financial and management systems. To a large extent the college is able to establish its own direction and goals within national objectives.
Haukeland University Hospital (HUH) in Bergen, Norway, employs approximately 11,800 people and serves as the local hospital for the city of Bergen, and also as the central hospital of Hordaland county and the regional/tertiary hospital for Western Norway (population about 1 million). Haukeland is the national specialist hospital and resource centre for burn injuries, air-pressure injuries (diving), corneal prostheses and the treatment of intracranial tumours. At Haukeland University Hospital each year almost 600,000 patients are treated and more than a thousand health care workers are educated.
Haukeland has been supporting Kamuzu Central Hospital in Lilongwe since 2007 to develop the postgraduate training programme in general and orthopaedic surgery. Since that time HUH has facilitated donations of equipment worth over US$2 million to KCH and Bwaila hospitals, and has seconded one experienced orthopaedic or general surgeon full time to KCH to ensure the hospital meets the requirements of a teaching hospital and its accreditation as a surgery training site under COSECSA. HUH has also helped start a diploma programme for medical engineers under the college of Health Sciences on Zanzibar, and has sponsored three of the medical engineers at Physical Assets Management (PAM) department at KCH to complete this course. In addition, HUH also supplies radiographers to the radiology department and technicians to the pathology laboratory, and regularly sends medical engineers to help service and repair medical equipment at KCH.
Haukeland University Hospital has a long track record of fundraising and providing technical advice for hospital infrastructure projects in Africa. The CEO of Haukeland has generously agreed to use HUH’s own hospital funds to support KCH with technical advice and to lead the fundraising drive to realize the LION project. HUH has raised NOK 32 million (US$4 million) from a private donor in Norway for the LION project.
CBM is an international Christian development organization, committed to improving the quality of life of people with disabilities in the poorest communities of the world. CBM has Member Associations raising funds and awareness of disability issues in high-income countries worldwide. CBM began its work in Malawi in the early 1970s, starting with support to Montfort College of the Blind in construction of Schools for the Blind throughout the country in 1971, and in 1976 CBM began supporting Nkhoma Hospital Eye Department. CBM has been heavily involved in the development of the Medical Eye Care Plan of the Government of Malawi 2012-2016, and is presently working together with the Ministry of Gender, Children, Disability and Social Welfare to develop capacities for mainstreaming disability in central government. In 2011, CBM opened a country office in Lilongwe.
The emphasis throughout CBM's work is on local capacity development. This increases and improves service delivery in the fields of healthcare, education, rehabilitation and livelihood development, while also promoting organizational development in the partner organizations. Since 2011 CBM has seconded a fully qualified orthopaedic surgeon to KCH to support the surgical training programme, thereby contributing to the treatment and prevention of disability in the Central Region.
CBM has signed an MoU with MoH, KCH and HUH to join as a partner to help fundraise for the project and has pledged EUR1 million (US$1.25 million) towards the realization of LION.
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The AO Alliance Foundation is a medically guided, non-profit organization led by an international group of surgeons specialized in the treatment of trauma and disorders of the musculoskeletal system. Founded in 1958 by 13 visionary surgeons as Arbeitsgemeinschaft für Osteosynthesefragen (AO), AO today fosters one of the most extensive networks of more than 12,000 surgeons, operating room personnel and scientists, in over 100 countries. AO’s vision is excellence in the surgical management of trauma and disorders of the musculoskeletal system and their mission is to foster and expand their network of healthcare professionals. AO has established speciality areas for trauma, spine, craniomaxillofacial and veterinary surgery, and these specialities are continually redefined by maintaining activities in research, development, clinical investigation and education, with the aim of achieving more effective patient care worldwide.
In 2014 the AO Alliance Foundation (AOAF) was established with funds from the sale of the AO’s commercial branch, in order to partner with selected low-income countries. Malawi has been lucky to be selected and AOAF has pledged to support the training of orthopaedic surgeons in Malawi for the next 5 years. AOAF has also pledged 1 million Swiss Francs (US$1.1 million) towards the realization of the LION project.
SIGN Fracture Care International (SIGN) supply intramedullary (IM) nails to hospitals in low- and middle-income countries for the repair of femoral (i.e. thigh bone) and other long bone fractures. SIGN has realised the problem of re-supply of orthopaedic consumables in low-income countries and replaces all used IM nails for free so long as the operations are reported to SIGN with a photo of the post-operative x-ray. Doctors at SIGN give personal feedback to surgeons on any surgery that is out of the ordinary or not optimal, and therefore also serve as an important source of continuous professional development for trauma surgeons in LMICs. SIGN has supplied KCH with IM nails since 2008, and nearly 1,000 people are walking in Malawi today because of SIGN’s support.
SIGN is trying to find the best way to scale up trauma services in LMICs, and is working with selected institutions to develop the idea of trauma short-stay centres. SIGN has pledged increased support to LION to meet the increased demand for nails if the trauma short-stay principle is introduced. In this way the Institute is guaranteed a sustainable supply of IM nails as long as the surgeries are reported regularly via the internet.
500 miles is a Scottish charity founded in 2008 to help people with mobility difficulties and to give them a chance to live independent lives. 500 miles supports the development and delivery of prosthetic and orthotic services in Malawi, Zambia and Zanzibar. The organization helps people with impaired mobility of all kinds to get moving, as well and as independently as possible, by helping them to access prostheses and orthoses.
The 500 miles Prosthetic and Orthotic (P&O) Centre in Lilongwe is in the grounds of Kamuzu Central Hospital. 500 miles has built and run this facility for the Malawi Ministry of Health since 2008 as part of the government health service; 500 miles has responsibility for management and funding, and the qualified Malawian staffs are employed by MoH. The 500 miles Centre was also supported by an exchange programme funded by FK Norway.
500 miles has expressed interest to join as a partner in this project with the intention to move KCH’s P&O services to better facilities in the new centre, and to continue support for these specific services until LION is able to make them self-sustaining.