18 June 2026 (Last updated: 18 Jun 2026 12:17)
In May, the BSSH LION team said goodbye to Vinay Itte (plastics consultant), Ross McAllister (T&O trainee) and Miranda Watkins (hand therapist), and welcomed Sean Walsh (T&O consultant), Anoopama Ramjeeawon (plastics trainee) and Isobel Fairway (hand therapist). This visit is Sean Walsh’s 4th visit, and by the end of this visit he will have spent 31 weeks volunteering at the LION with BSSH!
Lucius, Anoo, Mway, Sean, Ali and Isobel outside the LION hospital.
Ali Mohamed, T&O consultant from Tanzania, continues his BSSH hand fellowship at the LION, and the team also welcomed local resident Mway Nkhumbwah.
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Isobel Fairway (Therapist), Ali Mohamed (Fellow), and Anoopama Ramjeeawon (Trainee) on the first floor of the LION hospital.
Clinical Activity
May 2026 was a busy month, with 205 patients seen in clinic and 39 operations performed.
This included a mixture of trauma and elective work. Trauma cases ranged from lacerations to mangled hands, and elective work included release of carpal tunnels, de Quervain’s and trigger fingers, in addition to management of problems related to chronic/untreated injuries.
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Anoo, Mway and Ali operating together in A&E theatres.
Notable cases included:
- Division of 2 groin flaps and 1 cross finger flap that had the first stages performed under Vinay Itte
- 1 case where BTM (synthetic skin) was used for soft tissue reconstruction following a failed skin graft to burn injuries to multiple fingers
- 5 spaghetti wrist (multiple tendon +/- nerve) injuries
- 1 hand blast injury
- 4 patients with mangled hand injuries – salvage procedures were performed for all patients however one ultimately required an amputation at wrist level
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Sean and Ali operating together in A&E theatres.
Hand Therapy activity
Isobel worked closely with local hand therapist Lucius Williams. The patients treated included a variety chronic and complex orthopaedic and plastics hand and wrist injuries. The Hand Therapists saw 169 patients in May 2026.
The majority of trauma was secondary to motor vehicle accidents, interpersonal conflict and machine crush injuries. The chronic injuries were often tendonitis, trigger thumbs and stiff hands secondary to previous trauma.
“We mainly use thermoplastic splints and other splints donated from hospitals in UK and UK medical equipment suppliers. Lucius is very creative and adapts to using the material donated.
The MDT is still struggling to get referrals from the wards to the Hand Team. It is improving with MDT close communication on the wards and doing regular ward rounds. Lucius manages to get most patients discharged home within a week following their operation and have them return for appropriate rehab protocols.”
Education and research
Education underpins our presence at the LION. In addition to training Ali, the BSSH fellow, we took great pride in encouraging and teaching the wider team. This included local resident Mway, who learnt how to perform a carpal tunnel release and de Quervain’s tenosynovitis release start to finish. Another commendable learner was nursing assistant Getrude, who had her first day during our first week, and made fantastic progress with setting up the A&E operating theatres, helping our lists to run efficiently.
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L-R: Gertrude, Comfort, Sean, Mway, Anoo and Ali in A&E theatres
During Tuesday morning surgical department teaching Isobel ran a flexor tendon rehabilitation session, and Anoo ran a session on tendon reconstruction. These sessions were well attended and engaged by the local team!
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Anoo and Isobel delivering teaching sessions during Tuesday surgical department teaching.
Some interesting cases were seen in clinic, including a clinically diagnosed case of Crest Syndrome and Ulnar Dimelia, which the team are currently writing up as case reports, with a specific focus on the management of these conditions in low and middle income countries.
Social
In addition to volunteering at the LION, the team enjoyed socialising with our local team members and the Norwegian team also volunteering at the LION, exploring Lilongwe and further afield. A highlight of Lilongwe was visiting the old town market, with Sean as the knowledgeable tour guide, where Isobel and Anoo bought chitenjes to wear to a Malawi Night hosted at Kumbali Farm, a celebration of ‘the warm heart of Africa’, with traditional music, dancing and food.
Isobel braves the traditional wooden bridge over the river to the old town market.
Anoo and Isobel model chitenjes in the beautiful garden at Benetolo house (L) and traditional Malawian dancers at Malawi Night social event.
Charles and Mercy Mahonga with Isobel and Anoo at Benetolo house.
Overall
This visit highlighted both the challenges and rewarding impact of delivering specialist hand care in a resource-limited setting. There were many patients presenting with severe traumatic hand injuries, including delayed presentation, in addition to those with chronic untreated hand problems. The limitations of equipment, high patient volume, and challenges related to ability of patients to attend follow ups required the team to be flexible and adaptable in managing these patients. Despite these challenges the hand multidisciplinary team worked hard to help treat these patients and empower the local team to provide good outcomes for patients.
This was a busy month, with a fantastic team!
L-R: Lucius, Anoo, Mway, Sean, Ali, Isobel
Anoopama Ramjeeawon & The BSSH LION Hand Team
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