labour of love
Rob Freeman spent a life-changing year as a senior orthopaedic fellow in Malawi
"Patients and their guardians are hugely grateful and the people of Malawi are so warm, friendly and stoical that it is a privilege to work among them"
From July 2007 to July 2008, I was part of a team of five surgeons who operated on over 1,500 children at the Beit Cure Hospital in Malawi. I was there thanks to a generous travel grant from the Ethicon Foundation.
Malawi is surrounded by Mozambique to the east, south and west, while Tanzania and Zambia form its boundaries to the north-east and north-west. There is a population of 13 million, of which an estimated 20% are HIV-positive. One in seven children die before the age of five, and the average life expectancy is 38. There are 200 doctors registered in the country of which eight are orthopaedic surgeons (that’s one per 1.7 million patients). Only one of the orthopaedic surgeons is Malawian, so a key role for visiting Fellows is to support and educate indigenous medical students and clinical officers.
Beit Cure is a mission hospital providing orthopaedic care for the children of Malawi and parts of Mozambique. The hospital is partly funded by donations and from treating adult patients privately and pumping this money back into providing free care for the kids.
The range and severity of the conditions shocked me. Levels of disability and deformity are frighteningly high and the majority of affected kids are kept at home, totally excluded by society. Partly, there is no infrastructure to deal with them; wheelchairs are rarely seen outside of hospitals – there are no ramps, no pavements and few properly surfaced roads.
The most common conditions I saw were severe club foot and osteomyelitis.
However, bone tumours, severe limb deformity, burn contracture, and congenital anomalies are common. Road traffic accidents are the country’s biggest killer and referrals from under-resourced district hospitals kept us extremely busy, as well as more exotic injuries including crocodile bites and elephant trampling injuries.
Beit Cure boasts world-class surgeons, good nursing care and modern operating theatres. Across the road at the government-run Queen Elizabeth Central Hospital, where I operated on a weekly trauma list, conditions are very different. Malaria, HIV and malnourishment all played a part in stretching resources to breaking point.
Operating in these conditions was extremely difficult. Equipment is limited and often broken. There are no power drills, often no X-rays, and surgeons must improvise with the available resources. But such challenges helped me build surgical confidence and resourcefulness.
Throughout the difficulties, trials and exhilarating successes, I was guided and supported by the senior surgeons, Jim Harrison and John Cashman. The surgery is extremely rewarding, results are often highly visible and immediately life-changing. Patients and their guardians are hugely grateful and the people of Malawi are so warm, friendly and stoical that it is a privilege to work among them.
During my time at Beit Cure I was able to tackle procedures that I’d be unlikely to encounter in the whole of a Western career. Severe cases of neglected club foot, Blount’s disease, and complex congenital malformations were all common.
Beyond my clinical duties, I started work on a Doctor of Medicine degree into the causes of lower limb deformity in Malawian children and the outcomes of surgery.
Professionally and personally this year was probably the best of my life. I made many great friends, gained a wealth of experience, learned a great deal about compassion and discovered where my priorities in life lie. It was a great privilege to work in Malawi, a beautiful country, full of warm and welcoming people.
Thank you for helping to make it happen.