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After almost 10 years in Malawi, doctor urges others to aid in global orthopaedic care
Christopher B.D. Lavy estimates 150,000 people in Malawi need basic orthopaedic surgery.
Orthopaedic surgeons can help bring desperately needed treatments to developing countries like Malawi and Rwanda in a variety of ways beyond just going there to work as a volunteer, according to Christopher B.D. Lavy, MCh, FCS, FRCS, of the Nuffield Department of Orthopaedic Surgery, Oxford, England.
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Volunteers willing to travel to Malawi and other sub-Saharan countries are needed. But orthopaedic surgeons can play an equally critical role in addressing the global need for orthopaedic care through political action, research, training and monetary donations.
Lavy discussed his work in Malawi during the Watson Jones Lecture delivered at the British Orthopaedic Association (BOA) Annual Congress in Glasgow.
After a vacation there about 20 years ago, Lavy spent 1996 to 2005 in Malawi performing surgeries, training local physicians and health care workers, and helping establish an orthopaedic hospital in Blantyre. The 66-bed Beit Trust CURE International Hospital, built by CURE International, and financed by the Breit Trust UK, opened in 2002. Today, orthopaedists perform about 2,000 surgeries annually at the hospital — the majority of the orthopaedic operations performed in the country.
Still, that facility is not impacting the region enough, he said. Although exact figures are unavailable, the number of people in Malawi who need orthopaedic treatment must be considerable, based on the results of a musculoskeletal impairment survey Lavy and others conducted last year in Rwanda, a smaller African country.
The researchers found about 100,000 orthopaedic cases in Rwanda needing to be handled by the country’s health services, Lavy said.
Extrapolating those figures, he estimated about 150,000 people in Malawi today need basic orthopaedic surgery.
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Images: Lavy CBD |
The most common types of impairment the researchers found in Rwanda in order of highest frequency were: sequelae of trauma, nontraumatic joint problems, angular limb deformity, congenital limb deformity, amputation, and bone and joint infections.
“I’m not suggesting everyone here drops our power tools and we all go out to Africa,” he said. “Some, of course, may want to go, and that’s fine. But I am going to suggest that all of us look at this major global problem and see if we can play some part, however small.”
He encouraged the physicians in attendance to consider what they can do to help.
Lavy, who was elected chairman of the U.K. branch of World Orthopaedic Concern (WOC) during the BOA meeting, urged orthopaedic surgeons to bring greater attention to musculoskeletal problems worldwide. He said this is essential because, in light of its focus on areas like tuberculosis, HIV and polio, the WOC has often overlooked orthopaedic maladies like scoliosis, congenital limb deformities and other conditions that severely affect the quality of life of numerous adults and children, particularly in impoverished areas.
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“As surgeons, I feel that we’ve been too silent for too long,” he said.
Orthopaedists also need to show the World Health Organization (WHO) and other health organizations the real economic advantages of orthopaedic surgery, he said. For example, compared to the recurring annual cost of 100 pounds [US $187] to treat someone with a retroviral medication, a single surgery to correct a child’s bowlegs forever has a one-time cost of 200 pounds [US $375]. “Which treatment is the most cost-effective?” Lavy asked.
“We need to stand up and shout out the economics. … We need to engage WHO and bring surgery onto their agenda,” he said.
Those interested in clinical and epidemiological research can help considerably, Lavy said. An orthopaedic research department in any developed part of the world has much to offer.
“You can make links with a country that needs help in the area of research,” he said. “The epidemiological research needs to be done, as does outcomes research.” He noted that researchers are needed now to study the long-term outcomes of the corrective surgeries he and others performed.
Orthopaedic training programs can serve a dual purpose in advancing care in places like Malawi, he said. They can add a component to the curriculum emphasizing the global need in orthopaedics, or having a surgeon in training from sub-Sahara Africa lecture on the status of orthopaedic care in his or her country.
Taking the training programs available in the developed nations on the road might be another effective approach to improving global orthopaedic care. Lavy said a hip replacement course that Peter K. Kay, FRCS, at Wrightington Hospital, and Hugh Phillips, FRCS, set up on a 1-week trip to Malawi “changed the face of our landscape.”
For those interested in helping out in person, Lavy recommended talking to someone who has gone on a similar trip first and only going under the auspices of a legitimate organization.
“If you can’t or don’t want to go, consider supporting,” he said. One orthopaedist can support another by doing his or her call while they are away, or simply donating a week’s pay would help a lot. “Running our hospital in Malawi costs over 1000 pounds a day [US $1877],” so there are considerable financial needs
“It wouldn’t be possible to do all that we’ve done in Malawi without the help of a lot of organizations,” he said.
For more information:
- Lavy CBD. Watson Jones Lecture: The global need in orthopaedics — Can we do anything about it? Session 29. Presented at the British Orthopaedic Association Annual Congress. Sept. 27-29, 2006. Glasgow.
- Find out more about volunteering through the World Orthopaedic Concern at wocuk.org.
- Information about CURE International can be found at: cureinternational.org.