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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 supervisors will be: Dr Jes Bates, (jbates@medcol.mw) and Mr Kyle James respectively (kyle.james@cure.org). The duration will be between 4 and 8 weeks.

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.


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