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BOFAS Malawi mini-Fellowship

BOFAS has agreed to support an opportunity for up to two 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.

The Fellowship supervisor will be: Dr Jes Bates, (jbates@medcol.mw). The duration can be between 4 and 52 weeks with permission from the team in Malawi.

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 for an economy class airfare from heathrow to Malawi and local accommodation in the CURE Guest house. Travel insurance and local subsistence will be the responsibility of the  successful applicant.

Application process:

Application should be directed to Mr Rick Brown (Rick.Brown@ouh.nhs.uk) on behalf of the BOFAS 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.

________________________________________________________________________________________________

 

Background:

Queen Elizabeth Central Hospital  (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[1]

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 24 district hospitals around the country. In practice, only Blantyre and Lilongwe have regular orthopaedic surgeon access and Blantyre remains the main centre.

There are two Orthopaedic Surgeons that work in QECH: Professor Nyengo Mkandawire and Dr Jes Bates.

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 basic AO type of internal fixation and monolateral and circular frame external fixation. There is also limited access to a CT (currently awaiting repair) and MRI scanning. Access to theatre is constrained given the burden of demand.

Queen Elizabeth Central Hospital and the Malawi College of Medicine host an MMed course ( Masters degree of Orthopaedic Surgery). Visiting senior UK trainees could help as tutors on for the handful of orthopaedic registrars engaged on this course.

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[2]. 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. To help subsidise this work there is also a small private wing where paying adult patients are catered for. By helping promote private orthopaedic healthcare, not only can the hospital provide free paediatric services, but also help create an economic environment that may allow future Malawian orthopaedic surgeons to consider pursuing a realistic career in orthopaedics without leaving the country.  The hospital performs the only total hip and knee replacement surgery within Malawi as well as offering high quality out-patient and surgical services for the generality of adult orthopaedic conditions. Currently five orthopaedic surgeons work at BCIH (David Burgess[USA], John Cashman[UK], Linda Chokotho[Malawi], Sam Maina[Kenya], Nick Lubega[Uganda]

 

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.

 

Facilities available:

  • Accommodation will be available at approximately 20USD per night self catering, either in CURE guest house or a local flat. Both are secure and comfortable.

  • A bicycle will be available to get around town and a car can be hired when necessary.

 

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 20% 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 world wide 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 short fellowships of one month it is probably not worth the cost and hassle of applying for registration with the Medical Council of Malawi. As an unregistered visitor, you will be allowed to teach, help in clinics, and operate / assist only with a registered surgeon in attendance.

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 14million, 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 1/3million 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 are very pleasant and by day are 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. 20 years ago it was illegal for women to wear trousers in public or for men to have long hair! Jeans were effectively banned!  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. UK phones often need to be “Unlocked” to use our system. This can be done locally if necessary. Local pay-as-you-go SIM cards can easily be purchased for less than $2USD, and these can be “topped up” easily at any street corner. International text messages are then cheap. Subscription to a pre-paid self top-up call provider (such as www.Call2.com) allows reasonably cheap, though slightly unreliable, calls out of Malawi.

  • Money – our currency is the Kwacha- current exchange rates (Dec 2012) are 530Kw / 1£. Money can be drawn on a visa card from local ATMs, although most banks charge considerable service fees for such ATM withdrawals. If you plan to use plastic credit and debit cards from UK / Europe in Malawi – then do first make sure your home bank authorises this, before you leave the UK.  Otherwise they are sometimes declined. Only a few expensive outlets accept credit cards. The best exchange rates can be had by bringing in Cash (Dollars or Sterling) and exchanging these at a reliable local registered Forex Bureaux (e.g. CLC on Victoria Avenue.) 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 / DVDs etc is recommended.

 


[1] Orthopaedic Clinical Officers are paramedical orthopaedic technicians that provide the back-bone of orthopaedic care throughout the country. They have a paramedical background and do a further 18m specialty training at the end of which they are able to provide basic orthopaedic and trauma care such as conservative fracture management, ability to drain septic arthritis and osteomyelitis,  and to debride and externally fix open fractures

[2] 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.


Best CBD Oil UK: The 9 top CBD brands in the UK (2020)

CBD products are making a lot of noise in the market, and it makes complete sense judging by the slew of health benefits that they bring. We’ve gathered the best CBD oils currently available in the UK market to help you narrow down your search.

What is CBD?

CBD or Cannabidiol is a chemical compound extracted from the cannabis plant. We know what you’re thinking. How is this any different from marijuana? The answer is in their THC (tetrahydrocannabinol) content. Weed contains a lot of THC, which is a psychoactive compound that gives the user mind-altering effects. CBD, on the other hand, cannot get you “high.” CBD is widely used for its pain relieving properties. It can be used to minimize the symptoms of conditions like epilepsy, anxiety, diabetes, cancers, among others. 

Whether you have crippling anxiety or you have been dealing with chronic pain for a long time, CBD oil can offer you some relief. With plenty of scientific research emerging to back up anecdotal claims, the UK CBD market shows no signs of slowing down. CBD is 100% legal in the UK as long as its sold as a food supplement and contains less than 0.2% THC content.

If you’re ready to jump on this very promising train, take a look at the best CBD oils in the UK that we’ve tried and recommend. 

The UK's 9 Best CBD Brands (2020 Updated)

1. Blessed CBD

If you don’t want to muck around, the first CBD oil you should try should be the UK’s number one CBD oil brand. Blessed CBD is a family-run operation in the UK. It’s their goal to provide their customers with the very best CBD products, and it’s safe to say that they have been succeeding in the United Kingdom.

Their hemp extracts come in a 10ml bottle and in full-spectrum form, meaning they’re rich in all cannabinoids (CBD, CBDA, CBG, etc) and terpenes. Unlike broad-spectrum oils, full-spectrum CBD oils are extremely effective in relieving pain and inflammation (due to the entourage effect). It’s also worth noting that the hemp plants used in their products are 100% vegan and organically grown. 

cbd oil

What we love about Blessed CBD is their commitment to educating the UK public about CBD. They cater specifically to the UK market, as their products are not available elsewhere else. All their products come with an informational booklet to get you started and customer reviews are majorly positive.

They were also voted the #1 CBD oil UK by leading publications, such as Mirror, Observer, HerbMighty, Manchester Evening News, Liverpool Echo, Birmingham Mail, LA Weekly, Readers Digest, Glasgow Live, Improb and Luxury Lifestyle Mag.

Plus, each batch of oil they produce comes with its own certificate and third party lab reports, so you know exactly what you’re putting into your body and the amount of CBD in each product. 

If you're looking to truly experience the benefits of CBD, give Blessed CBD a try.

For more information, visit BlessedCBD.co.uk.

2. Bud & Tender CBD

Bud & Tender is a British company that’s relatively fresh in the market. However, they’re getting quite the praise because they produce some decent CBD oils. 

A premium CBD oil (with a premium price), it’s a bit more palatable than your average CBD tincture. It has a distinct floral note, which makes it easier to swallow. Using a CO2 extraction process/technique, all their oils are guaranteed to be of the purest quality. 

They only use non-GMO, organic hemp so you’ll know that what you’re getting is an all-natural remedy. If you want to find out more about their products, they’re very transparent about what’s in them. Comprehensive lab results are regularly published on their website. 

3. Jacob Hooy CBD

If you like to frequent Holland & Barrett on the high street, you might have come across this hemp CBD oil from Jacob Hooy. Because it’s so affordable, it’s a viable choice if you’re taking the first steps of your CBD journey. It’s not the most potent oil in the CBD industry, so it's important to have realistic expectations.

It’s also not the most palatable, but you can always wash it down with a generous drink of water. Overall, it’s a reliable starter CBD oil for those who don’t need higher potencies just yet. 

4. Hempura CBD

Hempura is an up-and-coming brand that offers a wide range of quality CBD oil products. Aside from oils, they have edibles, e-juices (for vaping devices/vape pens), and capsules. Even though it’s not full-spectrum, the oil contains a decent amount of cannabinoids. It’s by no means ineffective. 

They also use the CO2 extraction method, which is considered the most efficient and safest technique of getting CBD out of hemp plants. We also love Hempura’s packaging, which is important to some folks. 

Hempura is also part of the Cannabis Trades Association, which shows their commitment to creating high-quality products for their customers.

5. Endoca Raw CBD

Endoca Raw is the CBD oil of choice of those who want make more environmentally sound choices. Endoca Raw’s operations all happen in Northern Europe. It’s worth noting that they use supercritical CO2 extraction, which is the best way to isolate cannabinoids and flavonoids.

The growing process of the hemp crops used in their products all pass strict regulations. They’re non-GMO, vegan, gluten-free, pesticide-free, herbicide-free, and 100% natural. 

Their range of products include CBD tinctures, CBD capsules, gummies, CBD vapes, CBD e-liquid and skincare options.

6. Medterra CBD

Medterra dominates the worldwide CBD oil products market (especially in the USA) and they have only just made their products available for UK residents. Their oils comes in 500mg to 3000mg potencies, so you have a decent range to choose from depending on the symptoms that are ailing you. 

Best CBD Oil UK: The 9 top CBD brands in the UK (2020) Best CBD Oil UK: The 9 top CBD brands in the UK (2020)

Best CBD Oil UK: The 9 top CBD brands in the UK (2020)

One thing that we love about the Medterra's CBD range is its tastelessness. It doesn’t smell like anything either, making it extremely easy to consume. Plus, the dropper cap of this product has marked measurements, so you can measure out your dose every time you take it. 

7. Holistic Herb CBD

If you’re a stickler for quality and always want to go for the premium, look no further than Holistic Herb. They offer strong straightforward potencies of CBD, at 4.2% or 8.2%. If you think you’re going to need higher doses to treat your ailments, then by all means go for this oil. Just so you know, it’s very hard to overdose on CBD oil anyway. You would have to consume gallons of it for it to become detrimental. 

Every batch of their CBD oil sprays are so pure and contain no amount of THC whatsoever. You’re guaranteed to get only the holistic goodness of the crop and not its psychoactive side effects. Since it’s a premium product, it’s the most expensive one on this list, but it’s never really a bad idea to splurge on quality. 

8. NeoHemp

Hemp oil is not exactly the same as CBD oil, but it’s a good place to start if you’re on the fence about using pure CBD. Hemp oil is considered a superfood because of its high amount of fatty acids and bioactive compounds. Unlike CBD oil, Hemp oil is extracted particularly from the crop’s seeds and nowhere else. 

With a 4000mg potency, you can take this oil as is or mix it in with your creams and serums. It’s more affordable than the other picks on this list, but it is also slightly less potent. 

9. Health Hemp Holland

This is another hemp oil. As mentioned above, hemp oils are not to be confused with CBD oils. It’s extracted from the seeds of the hemp plant, while CBD oil is extracted from the leaves, flowers, and steams. 

Hemp oils are mainly used to treat skin problems like acne and visible signs of aging. A lot of folks combine them with their sunscreens and moisturizers to get evenly toned clear skin. Hemp has anti-inflammatory properties which help reduce the appearance of spots. 

This is also a great starter oil for those who only looking to get their feet wet in the wonderful pool of CBD products. 

CBD oil UK: final thoughts and takeaway

There you have it, our top picks for the best CBD oils to buy in the UK.

As a friendly reminder, its best to work your way up if you’re unsure about dosing. Start with a lower potencies and check if it relieves your symptoms. There is some trial and error involved in this. But when you find that sweet spot, you’ll soon realize that CBD oils may work wonders on your physical and mental health.

If you're looking for the best and most reliable CBD oils and CBD creams in the UK, look no further than Blessed CBD.


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