The 500 miles Prosthetics and Orthotics Centre is in the grounds of Mzuzu Central Hospital (MCH), the main tertiary care hospital for northern region. As in Lilongwe, 500 miles currently runs this facility for the Malawi Ministry of Health (MoH) as part of the government health service, but on 1st July 2021 fiscal and administrative responsibility for the centre will pass to MCH. MCH intends to run the facility independently but 500 miles will be ready to assist if requested.
In line with Malawi government policy, 500 miles is a “paying service” and we always ask for an affordable contribution to try to secure its future sustainability, but until handover, we will always meet the cost of devices for those who cannot afford to pay.
All of the buildings at MCH are uniform and so our premises, which consist of a 250 sqm modern clinic and workshop and a 100sqm hostel to accommodate travelling patients, had to be constructed using a traditional Malawian building method and local labour. The layout of the buildings was designed by Andreas Huck of Sophies Minde Ortopedi. Funded by The Maitri Trust, the Centre was constructed during 2012 using a Malawian professional team and construction company.
Our joint managers are Australian husband and wife, Charlie Freeman and Samantha Burgio (pictured above with Benadeta). Charlie is an exercise physiologist and Samantha previously worked as the manager of the Illawarra regional re-settlement programme for refuges in New South Wales. Samantha and Charlie have been with us since February 2017. You can read their reflections on life in Malawi, written in the spring of 2019, here→
On 1st July 2021, Samantha and Charlie will hand over the management reins to Benadeta Singini who attained a degree in prosthetics and orthotics in June 2019 and who is currently the clinical leader at the centre.
We currently have three qualified Prosthetic and Orthotic Technicians (Benadeta, Tiwonge and Maxwell) and three Prosthetic and Orthotic Assistants (Eviness, Clinstone and Yohane). All but Yohane are already employed by MoH in readiness for handover.
We are in the process of creating and installing the same quality management system (QMS) at our centre at MCH as for our centre at KCH, largely funded by Johnson & Johnson. Our internationally recognised Quality Improvement Consultant, Sandra Sexton has completed only phase one of this two-phase initiative due to the interruption caused by Covid-19, but as the creation and implementation of a QMS is crucial for the sustainability of a high-quality service for the long term, we hope MCH will permit 500 miles to complete the job post-handover.
Since 500 miles at MCH opened to patients in November 2012, we have carried out over 4,500 patient fittings for a register of over 2,500 people. Our usual production rate is around 60 devices each month. This level of demand is unlikely to be sustained after handover because approximately half of our patients are generated by 500 miles’ outreach programme which MCH will not continue after handover.
Due to the different and more challenging demographics of northern region (compared with central region), from late 2013 onwards, 500 miles developed and ran an outreach programme to ensure that people in the north of the country who needed our service were aware of it and were able to access it. We embarked on a comprehensive, systematic, community by community sensitisation and screening programme, concentrating on the largest and most populated district, Mzimba. In addition, we carried out regular outreaches in Rumphi and Nkhata Bay.
We also developed the centre’s client base through collaborating with a number of partners locally and in our outreach work, including MCH itself, the District Hospitals of northern region and also:
- Malawi Government agencies – MAP and MACOHA (funded by CBM).
- Beit Cure International Hospital, an American private hospital in Blantyre, which runs charitable children’s clinics in northern region with MACOHA.
- Luke International (lukeinternational.no), a Norwegian registered NGO with health, capacity building and community programmes in Malawi.
- 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.
- RIPPLE Africa (www.rippleafrica.org), a UK-based charity which is involved with education, healthcare, and environmental projects in Nkhata Bay District.
- Teneil Jayne, an American missionary, working in the Nkhata Bay area.
- Ekwendeni Mission Hospital, with which we have just made a plan.
- The Education Department of the Mzuzu Diocese supporting St Mary Magdalene School in Rumphi.
Although the outreach practice will not be funded after handover, the centre should be able to sustain and build on these partnerships.