Left untreated, long bone fractures—a break or crack in a long bone (such as in the arm or leg) that can be caused from a motor vehicle accident, fall or sports injury—can result in long-term disability, and more than 70% of people globally do not have access to essential surgical services.
In Malawi, the country’s few orthopaedic surgeons are stationed in central hospitals located in urban centers, while 85% of Malawi’s population lives in rural communities. Lacking capacity to provide surgical care, the district hospitals serving much of Malawi’s predominantly rural population have been referring patients to central hospitals for treatment, resulting in a delay in trauma care, which often worsens the severity of the injury. Additionally, the financial burden of the cost of travel to a central hospital, compounded by time off from work, prevents many from seeking the care they need.
Now, thanks to a partnership between Johnson & Johnson Foundation, Johnson & Johnson MedTech, AO Alliance, KidsOR and Malawi’s Ministry of Health, four district hospitals (Dowa, Machinga, Ntcheu & Salima) and one central hospital (Mzuzu) feature new operating rooms with state-of-the-art equipment and supplies and trained staff—addressing a huge unmet need for long bone fracture treatment at the local level.
The project is part of Johnson & Johnson’s global surgery commitment to support broader access to surgical treatments for people living in low- and middle-income countries and close the gaps between communities and care.
Building surgical capacity and upskilling staff
By creating high-quality, well-equipped operating rooms in the district hospitals serving the highest volume of patients, the project aims to significantly improve the range of procedures and the standard of care patients can access without being referred to a central hospital. The range of support includes developing and deploying external fixation treatment devices tailored by Johnson & Johnson MedTech to meet the needs of remote hospitals, as well as providing an inventory support tracking tool to enable providers to easily order new devices to avoid stockouts and disruptions in care. All of the operating rooms are fitted with solar power and battery storage to ensure energy and light during crucial operations—a first for Malawi.
The project also facilitated the upskilling of nonphysician orthopaedic clinical officers in district hospitals on the use of new, highly specialized equipment, enabling them to reduce inefficiencies and perform more complex operations.
“The experience has given us the confidence to manage open long bone fractures with much ease and skill,” said Laxcy Kapapa, Salima District Hospital. “The support in terms of resources and training has boosted our morale, which was on the verge of collapse, having been neglected by the system for so long. We now have the ability, resources and enough skills to manage at least some of the open fractures in our district hospitals. This will reduce unnecessary referrals, which were putting much toll on patients’ families and government financial resources.”
Additionally, because a large percentage of patients needing treatment for long bone fractures are children, each of these new operating rooms has also been equipped with more than 3,000 pieces of child-friendly surgical equipment, ensuring that patients of all ages can get the comprehensive surgical care they need.
As operating rooms can be unfamiliar, scary and unpleasant places for many people, especially children, the project also involved transforming the entire surgical environment to improve the healing process and patients’ experiences in the operating room. Drawing inspiration from native Malawi landscapes and wildlife, the KidsOR design team created colorful and interesting backdrops to the clinical spaces that children and adults alike can take comfort in.
“Long bone fractures are easily treated in many parts of the world, yet, in Malawi, many people can’t access essential treatment,” says Ian Walker, Global Strategic Partnership Lead, Global Health Equity for Johnson & Johnson. “Working together with our partners, we are delivering the tools and training needed to cultivate surgical capabilities and significantly elevate the standard of care so that no matter where people live, they can receive the treatment they need.”