07 October 2026 (Last updated: 7 Oct 2026 15:31)
September has been a full change for the BSSH volunteer team witht Malawi’s dry season well underway. Thomas Sjöberg, a plastic surgery consultant from Norway, has been joined by UK orthopaedic trainee John Hardie. The therapy team Fleur Nicholas and Chloë Baxter returned to Malawi, enriching the team with their previous experiences at LION.
Tanzanian fellow, Ali Mohammed, comes to the end of his six-month fellowship at the unit. After a well-deserved break, he will be supported to visit the UK for a surgical observership at the end of 2026. Ali hands over to Zambian trainee, Cephas Bwalya, who will be undertaking his first plastic surgery training rotation with the BSSH hand team.
Volunteers are working on a background of a challenging economic situation in Malawi. The country relies on imports, but shortages of ‘forex’ hard currencies such as dollars and euros have become more acute. This has resulted in major problems for Malawian citizens, with limited ability to pay for fuel and equipment. As a result, businesses are struggling and the fuel pumps are frequently dry. At the time of writing, Malawian fuel prices are the second highest in the world (second only to Hong Kong).
Clinical work
The hand team now has a well-established routine, nearly four years into BSSH’s partnership with the LION hospital. In September there were 66 new referrals to the BSSH hand team via the Kamuzu Central Hospital on call orthopaedic team.
In September 226 patients were seen in the twice-weekly dressings clinics. The LION nursing team work alongside the BSSH team, ensuring the busy twice-weekly dressings clinics run efficiently.
The dry season has brought with it the additional challenge of encounters with local wildlife – the team have extracted crocodile teeth from the arms of the fishermen from lake Malawi, and discovered the damage a hippo can do to the human forearm! Complex panga knife injuries and road traffic accidents remain the main source of surgical cases, often requiring multi-tendon and nerve repairs. 42 theatre cases were carried out during the Tuesday and Thursday ‘A&E theatre’ local anaesthetic/regional block lists and the main LION theatre general anaesthetic Wednesday lists.
Volunteer BSSH surgeons come from both orthopaedic and plastics surgery traditions, and therefore cases from the waiting list selected based on skills available as well as clinical urgency. With a plastics-oriented team in September patients could benefit from procedures such as groin and kite flaps to cover extensive soft-tissue injuries. Whilst the unit only has limited access to a microscope and lacks the clinical support to facilitate free-flaps, pedicled flaps are life-changing procedures for patients who might otherwise suffer permanent functional loss.
The LION hand therapy team continue to develop their international partnerships. Chloë has returned for her fourth trip to see the progress made year on year in the hand therapy team. Priscilla has recently returned from a six-month exchange in Norway where she experienced working in Haukeland University Hospital. She enjoyed seeing how a Western style hospital works and spent time hiking and enjoying the outdoors. Along with Lucius, the hand therapy team continues to work well alongside the BSSH hand team and the wider LION orthopaedic team, treating patients on the ward and in the therapy department as outpatients.
The therapy team now holds two years data showing the range of conditions treated, attendance rates and usage of splint materials. This is particularly useful for the final months of the project for transition planning.
Equipment
Training has commenced with the donated Zimmer dermatome, conferring significant benefits over the less reliable manual skin-graft harvesting techniques.
Equipment, gratefully received, is often donated to the BSSH team from the UK and beyond. After years of donations, some consolidation has been required in the stock cupboard. The team has used the opportunity between cases to take stock, particularly of the eccentric library of suture material!
Long-term procurement for the LION unit from ‘handover’ in January 2028 is a more challenging prospect from both a surgical and therapy perspective. The therapy team are exploring options for procurement of off the shelf splints and thermoplastic splinting materials for LION to continue independently.
Education
The weekly teaching programme for the visiting BSSH team, Malawian residents and medical students once again followed the BSSH global surgery curriculum. Topics delivered included the mangled hand, reconstructive options, and pedicle flaps.
Preparations are underway for teaching on the upcoming AO Wrist Course being held at LION in October. Lucius and Priscilla will help Sarah Mee and Chloë Baxter lead the non-operative and post-operative rehab management discussion, giving them a chance to enhance their teaching skills and promoting the specialist role of hand therapy to the surgeons attending the course.
Other
Looking forward to the end of the month and into October, Dean Boyce and Kath Hamlin from the UK arrive at LION, and Amina Usman Gobe joins the team from Ethiopia.
Congratulations to our hand therapist Fleur Nicholas who after months of training, has successfully climbed Kilimanjaro to raise funds for the LION project. She reports:
“Climbing Kilimanjaro was one of the toughest yet most rewarding things I’ve ever done. Despite the unexpected challenge of wildfires on the mountain and suffering from altitude sickness, I managed to reach the summit in just 6 days . The incredible support of everyone who donated gave me much needed motivation to keep going, particularly during the -20’C summit night. I’m so grateful to everyone who supported me and helped me to achieve something I’ll never forget.
Please keep supporting Fleur’s fundraising through her Just Giving page :
Fleur Nicholas is fundraising for British Society for Surgery of the Hand
The ambitious fundraising programme in the UK will be complemented with a local event on 10th October, coinciding with the AO/BSSH wrist course.
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