The story of Traditional Authority (T/A) Chikumbu of Mulanje is a heart-wrenching example of the human cost to a silent crisis that is the lack of orthopaedic surgeons in Malawi’s public health facilities.
One Sunday morning in July 2024 after attending a church service in the district, the traditional leader sought a restroom from one of the houses as she walked home.
But little did she know what would befall her.
“The restroom collapsed on me,” said Chikumbu in a telephone interview last week.
She was rushed to Mulanje District Hospital, but got discharged the same day.
But despite being discharged, she was still enduring pain in one of her legs, which had swollen.
The situation worsened and she returned to the hospital where she was subsequently referred to Queen Elizabeth Central Hospital (Qech) as she required a surgical procedure.
While at the referral facility, Chikumbu was admitted for three days and got discharged. But she still had to visit the hospital to meet the surgeon.
“Now considering that Mulanje is a bit far from Qech, I opted to rent a house in Chigumula Township to cut expenses,” she said.
Chikumbu was paying K300 000 per month. She rented it from August 2024 to December 2024.
Prior to renting the house, her leg was amputated on July 31 2024.
She said: “But with time, I ran out of money and returned to Mulanje.”
She was advised to buy a prosthetic leg, which she did. However, she said she still faces challenges; hence, she uses a wheelchair.
For services requiring an orthopaedic surgeon or orthopaedic clinical officer, Chikumbu visits Mulanje Mission Hospital since the district hospital does not have one.
And the problem is national.
Nation on Sunday has established that Malawi has 16 trained orthopaedic surgeons and 108 orthopaedic clinical officers against the projected 20 million population. In the midst of the escalating injuries, particularly pertaining to road accidents, that level of expertise is insufficient.
Orthopaedic surgeons specialise in surgical procedures to treat musculoskeletal problems, including joint replacements, fracture repairs and spinal injuries.
On the other hand, orthopaedic clinical officers, who are the first point of contact for musculoskeletal problems, only focus on diagnosing and treating the particular musculoskeletal conditions, and may refer patients to orthopedic surgeons for surgical intervention.
In essence, the orthopaedics, as they are often referred to collectively, attend to victims of accidents of all sorts.
Despite a rise in the number of accidents, mainly those occurring on the country’s roads, orthopaedic surgeons are, however, not found in the country’s 26 district hospitals—they only have orthopaedic clinical officers. Only central hospitals have orthopaedic surgeons.
This means hundreds of patients requiring surgical procedures are either delayed for critical surgeries, or develop complications or worse still, have their arms or legs amputated since orthopaedic clinical officers in district hospitals have to refer the patients to the orthopaedic surgeons at central hospitals.
According to a paper titled Technical Priorities for Orthopaedic Trauma Care Development in Malawi published in 2024, Malawi has a high and rising incidence of musculoskeletal injuries.
The situation is compounded by lack of infrastructure, trauma equipment and general surgery equipment.
It states that most Malawians have limited access to trauma care, in particular, those from the rural areas who have to travel long distances and incur indirect healthcare costs in the form of transportation, lost income and other related expenses.
Part of the paper reads: “Approximately one-third of Malawians are living with an untreated surgical condition due to lack of access to surgical care. The majority of musculoskeletal injuries are treated non-operatively due to limited surgical capacity.
“There is a need to reduce the burden of musculoskeletal trauma in Malawi by preventing injuries and improving access to essential orthopaedic care”.
The paper stated that orthopaedic trauma care in Malawi remains a complex, multifaceted system requiring injury prevention, pre-hospital care and transportation, rural health centres, district hospitals and central hospitals.
Further, the paper states that at 33 road traffic-related deaths per 100 000 people, Malawi has the world’s 13th highest annual road injury mortality rate, underscoring a high burden of trauma.
Most recent statistics from the Directorate of Road Traffic and Safety Services show that in 2023, Malawi recorded 4 977 road accidents with 1 001 people succumbing to them.
This was an increase from 2022 when 919 road accidents were recorded where 1 226 people died.
These statistics were presented at the 2024 Africa Road Safety Day in November.
Malawi Orthopaedic Association board chairperson Maziko Matemba in an interview on Friday said the low numbers of orthopaedics is disheartening.
He said the situation means the orthopaedics are not being able to fulfil their much needed support towards accident victims.
He said: “What needs to be done is that we need to increase the number of specialisations of orthopaedics.
“We also need to make sure that government should promote those who are already in service because this is a layered cadre, which we don’t have much numbers”.
Matemba, who is also executive director of Health and Rights Education Programme, said government also needs to leverage the current recruitments of healthcare workers to recruit more orthopaedics considering that road accidents have recently been on the rise.
Minister of Health Khumbize Kandodo Chiponda on Friday said government plans to recruit 6 700 healthcare workers in the 2025/26 fiscal year. She said this in Lilongwe during a weekly briefing called Boma Likutinji.
But our questionnaire to Ministry of Health was yet to be responded to. Nation on Sunday wanted to know what efforts are being put in place to train and hire orthopaedics.
However, in October 2024, during a two-day National Trauma Summit in Lilongwe organised by the Malawi Orthopaedic Association, Chiponda acknowledged the burden orthopaedics face.
She, therefore, expressed commitment in development of an Emergency and Injury Policy to help address emergency and injury care challenges, in a bid to reduce the burden that orthopedics face, among others.
