28 August 2026 (Last updated: 25 Sep 2026 11:34)
In August, the BSSH LION team said goodbye to Soham Gangopadhyay (T &O consultant) and his daughter, Sriya (Medical Student) and welcomed Lisa Leonard (T &O consultant), Helen Stark (plastics senior registrar) and Fleur Nicholas (hand therapist). Fleur is returning, having spent time in Malawi in 2024.
The BSSH team outside the LION Helen, Lisa, Fleur, Sriya and Soham
Clinical activity
Until the 30th August, at the time of writing, the team had run eight clinics during which 190 patients were seen of which 84 were new referrals to the hand service. The clinics included a wide mixture of patients ranging from simple elective problems, such as trigger finger, to complex trauma resulting from a hippopotamus bite! We have been able to follow a number of patients who have had previous reconstructions using BTM (Biological Temporising Matrix). These have shown good results allowing subsequent skin grafting to finalise healing rather than having to resort to a more complex reconstruction.
A total of 48 patients were booked for surgery from clinic. Booked cases were treated in order of clinical priority but this was sometimes challenging due to the volume and complexity of work load.
Operative activity
The recorded operative log included 42 procedures. There were many interesting cases. We learnt rapidly to be suspicious of any injury involving a ‘Panga’ knife – VERY sharp local machetes. In one particular incident the patient was trying to chop wood for use at home, missed to log and cut into the radial side of his carpus. In theatre we found he had cut through the first 3 extensor compartments and the radial half of his carpal tunnel tendons just grazing the median nerve. The knife had also cleanly gone through the distal third of the scaphoid and shaved off a thin piece of the trapezium.
In another case a 5cm defect of the median nerve was treated with sural nerve cable grafting after previous debridement and FPL reconstruction.
Helen and Ali working on the sural nerve cable grafting in main theatre.
Hand therapy activity
Fleur has been working closely with local hand therapist Lucius Wesley. The most common injuries referred for specialist hand rehabilitation are phalangeal fractures, distal radius fractures, flexor tendon repairs, tenosynovitis and amputation. The red and green general orthopaedic teams at LION regularly refer patients in for hand therapy and on several occasions the main Kamuzu Central Hospital have also referred patients.
Fleur and Lucius are continuing to complete ward rounds to identify patients that have no treatment/rehabilitation plan for their hand injury. They then discuss such cases with the BSSH team, the red/green ward staff and the nurses to progress each patient’s recovery.
Fleur has also been participating in the monthly hand therapy training run by the Norwegian volunteers.
Education
Regular Tuesday morning teaching continues after the trauma meeting. Helen completed a talk on fingertip reconstruction. Lisa finished the requested registrar revision topics of CTS and Rheumatoid hand and wrist and then recommenced the planned BSSH teaching programme. Whilst the registrars were away doing their exams Lisa and Fleur delivered a talk on hand injuries to the Clinical Officers in training which was well received.
As well as the formal teaching session on Tuesday mornings we have all been involved in regular clinical teaching in the clinic and theatre setting. For one week we hosted Benson, a GP trainee, who was getting additional experience of hands in theatre and clinic. All the clinics were well attended by the Clinical Officers in training who enjoyed taking histories and learning about hands. They were really helpful with translating for patients who often did not speak much English.
Dermatome presentation Lisa teaching on Tuesday morning
During August Dr Kachitsa returned from Canada to resume working at LION. Due to fund raising efforts by BSSH we were able to present him with an air powered dermatome which Helen then trained the team on how to use.
Social
Outside the hospital, the team enjoyed spending time with local colleagues and exploring Malawi.
Fleur socialising with Lucius’s new puppy Sophie
Walking in Ntchisi rainforest
Other trips to Lake Malawi and Zambia South Luangwa safari
Overall
We all had a great trip, felt welcomed into the hospital team and were pleased to have played a small part in this exciting and positive project. We are keen to keep supporting this work.
Fleur is hiking Kilimanjaro to raise money for the project in mid-September - CLICK HERE TO FIND OUT MORE
Lisa has set up a just giving page - CLICK HERE TO FIND OUT MORE
This project could not continue without our generous supporters, donating financially and through practical donations. We are particularly grateful for the fantastic recent addition of an air powered dermatome for skin grafting. Thank you to Zimmer for offering us a discounted rate, and to all donors who helped purchase this equipment following a specific fundraising appeal. Watch this space for updates on how it is being used by the LION surgeons!
Please spread the word of how to donate to our project through the BSSH Just Giving page, and help heal the hands of Malawi.
JUST GIVING
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