Malawi – Lilongwe

500 miles’ prosthetics and orthotics service in Lilongwe is situated at The Lilongwe Institute of Orthopaedics and Neurosurgery (LION) in Area 3. LION is the main orthopaedic tertiary care hospital for central region. 500 miles runs this service as part of the Malawi government national health service, but at the end of March 2025, we will hand over administrative and fiscal control to the Malawi Ministry of Health (MoH) and LION, with continuing support (see below).

In line with Malawi government policy, the prosthetics and orthotics service at LION is and will continue to be a “paying service”. The charging policy is that everyone should contribute whatever they can afford towards the bare cost of production of their device(s) without causing hardship. It is necessary always to ask for an affordable contribution to try to secure the future sustainability of the service, but 500 miles will continue to meet or subsidise the cost of devices for those who cannot afford to pay.

In January 2024, 500 miles moved our Lilongwe prosthetics and orthotics service from Kamuzu Central Hospital, where we first opened our doors in 2009, into the brand new rehabilitation building which forms part of LION. We occupy the whole of the ground floor, with physiotherapy, occupational therapy and hand therapy upstairs on the first floor. Our new premises are spacious, fit for purpose, laid out to our specification and generally spectacular!

Benadeta Singini has been our manager in Lilongwe since July 2023. Benadeta is a Malawian, fully qualified prosthetist/orthotist. 500 miles sponsored Benadeta’s diploma in orthopaedic technology (2012) and her degree in prosthetics and orthotics (June 2019). Benadeta previously worked at the 500 miles prosthetics and orthotics centre in Mzuzu where, after qualifying with her degree from Mahidol University, she received two years of extensive management training from 500 miles’ expatriate managers there before taking over from them as the manager herself. Read more about Benadeta here.

The department has three additional qualified Prosthetic and Orthotic Technicians (Samuel, George and Peter) and four Prosthetic and Orthotic Assistants (Dominic, Mike, Charles and Yohane) – and our receptionist, Maggie, who will welcome you on arrival.

We have almost completed the installation of the quality management system (QMS) created for 500 miles by internationally recognised prosthetist/orthotist, Sandra Sexton. We commissioned the QMS to secure and sustain the quality of every aspect of our product and service by systematising it so that it becomes automated routine. The thorough implementation of a QMS is crucial for the sustainability of a high-quality service for our patients for the long term.

We are grateful to Strathclyde University for releasing Alana Stevenson and Christine McMonagle, employees of the National Centre for Prosthetics and Orthotics, for three two-week visits to our service at LION during 2024 to complete the installation of Sandra’s QMS and to embed it. Alana and Christine are reviewing and adjusting our practices so that the system operates smoothly at our new premises, making sure our staff are complying with the requirements of the QMS, implementing the quality audit process which is a crucial part of the QMS, teaching P&O skills wherever possible and advising us on where and how the QMS manual should be updated. They are also advising on training needs so that 500 miles can follow up on meeting them.

Since 500 miles first opened its service in Lilongwe in March 2009, we have carried out over 16,000 patient fittings for a register of well over 10,000 people. Our usual production rate is over 120 devices each month. Over half of our patients are returning patients.

Many of our patients “walk-in” because they have heard about us and many are referred by LION or other local medical services but we also work closely and with great cooperation with a number of partners, many of them operating further afield in central region. They include all of the District Hospitals in central region and:

• Malawi Government agencies – MAP and (part funded by Hope and Healing International) MACODA.
• Beit Cure International Hospital, an American private hospital in Blantyre, which runs charitable children’s clinics in central region.
• Children of Blessing Trust
• DIPD (Development and Integration of People with Disabilities project) which was set up by Evelyne Huizinga and operates mainly in the Mchinje area.
• Nkhoma Mission Hospital (https://www.nkhomahospital.org.mw)
• African Vision Malawi (www.africanvision.org.uk), a UK charity which aims to create lasting change for children and vulnerable people in a 400km2 area north west of Lilongwe.
• St John of God Hospitaller Services (www.sjog.mw), a UK charity with an Order in Malawi which provides health and social care to sick, vulnerable and disadvantaged people.
• Sunshine Project Don Bosco

• Christian Service International

At the end of March 2025, 500 miles will hand over full responsibility for running our prosthetics and orthotics service at LION to MoH and LION – but for patients and partners, there should be no noticeable changes.

From when 500 miles first opened our service in Lilongwe, we have been working on integrating it with MoH’s national health service and latterly with LION. When we moved into LION, we took the opportunity to remove all 500 miles branding. Our QMS will have been fully implemented and embedded thereby securing the sustained quality of the prosthetic and orthotic product and service. Benadeta Singini will continue as the manager and she will take on responsibility for the enforcement of the QMS and its audit process. And 500 miles will continue to support the service financially for at least four years.