18 April 2024 (Last updated: 24 Jun 2024 12:04) by BSSH
Lion Hand Unit - April 2024 Update / Volounteer experience & Snake bite case story
In Brita
in, we are experiencing April showers and sunshine, while the BSSH LION Hand team has survived the rainy months. Meanwhile, in Lilongwe, there is a significant drop in rainfall, humidity, and cloud cover. It’s all relative, of course! For any potential visitors, it’s a good time to come as the sun shines longer, the days are warmer, and the pressure starts to rise, heralding the onset of the drier months. Lilongwe's average high temperature at the onset of April reaches a still warm 25.3°C (77.5°F), down from March's 25.8°C (78.4°F), but never below 15.0 °C. The average relative humidity in Lilongwe remains at 81%, which can be a factor during a busy day at the LION Hospital. In April, it rains for 17 days, with typically 32mm (1.26") of accumulated precipitation. Throughout the entire year, Lilongwe experiences rainfall for 160.7 days, accumulating up to 807mm (31.77") of precipitation. But “rain or shine,” the team is still pressing on with the project. Here is a report from Carol Chan, Orthopedic Consultant from Leeds, who has just returned following her time as a volunteer:
"I spent 4 weeks in the LION unit this February. It was a lot of hard work but thoroughly rewarding. 
This was my first time volunteering in an LMIC setting. I arrived on Sunday and started on Monday. Thankfully, there was only a 2-hour time difference, so the jet lag wasn’t so bad. My amazing team had already been there for some time; therefore, I had guidance on how things worked. The week consisted of clinics on Mondays and Fridays. The theatre days included Tuesday, Wednesday, and Thursday. There were two A&E lists offering block/local capacity and one main theatre list with GA capacity. I had a BSSH hand fellow (Gladys), a UK registrar (Abdul), a UK hand therapist (Rodrigo), and a local hand therapist (Daston), as well as rotating local residents and interns with me, so it was always bustling and lively.
Theatre team taken in A&E theatres: Abdul, Mike Chiwapula (our amazing anaesthetist), Bosco Kalala (resident), Carol, Sakala (Our lovely theatre nurse)
In clinic, we saw both trauma and elective cases, both adults and children. Many cases presented quite late, which provided challenges regarding the management plans. I got to see the whole spectrum of hand surgery. There were a lot of serious traumas, with Panga knife injuries being common. The patients were kind and remained happy despite their injuries. Some traveled long distances to see us. Follow-up can be an issue. The local orthopedic surgeons were wonderful and made me feel welcomed. We worked together to tackle the large amount of trauma that presents daily with the limited resources we had. We used WALANT and regional blocks whenever we could to maximize capacity. Sometimes, we had to get creative, and thinking outside of the box is a very useful skill to have. It was a very rewarding time to be able to help with some of the hand problems in Malawi."
Lunchtime at on-site Kina restaurant with Pyoka Mfune, Abdul Hassan, Carol Chan, Boston Munthali and Sven Young & February Lion team taken in outpatients: Martin, Shan Shan, Gladys, Carol, Bosco, Abdul, Dustin, Rodrigo
The LION project is now in its 16th month, with Sean Walsh currently on an 11-week volunteer stint, having visited for 7 weeks last year. The current trainee is actually a Consultant and was one of the IFSSH Fellows from London 2022. The contacts that BSSH has via IFSSH, FESSH, and the Global Partnership Committee continue to lead to new opportunities in global surgery and support for projects in LMICs.
This is a case report from BSSH LION. A 35-year-old farmer was bitten by a stiletto viper on the back of his left hand while chopping down maize on his land, resulting in tissue necrosis down to the extensor tendons. The team, led by Tony Barabas at the time, performed a reverse radial forearm flap. This intervention yielded a very good result, enabling the patient to return to work on his farm. The combination of timely soft tissue cover and expert hand therapy led to a positive functional outcome. The patient and his family were immensely grateful for the treatment received, as it restored his livelihood.
Dorsal hand wound with exposed extensor tendons after initial debridement of necrotic tissue.
Post operative photo following a reverse forearm flap
This is one of the many challenging cases, including machete injuries, late-presenting fractures, and deep infections, that the team deals with. However, they are well supported by the local orthopaedic team and have satisfactory equipment available. Life in the volunteer residence is comfortable, and the team morale is always high, despite the continual turnover of staff. There is an admirable focus on pressing forward with the aims of the project, which is to establish a reputable specialist hand service in Malawi.
There will be a formal update about the LION Project at both the Global Partnership Day and the Spring Meeting in Leeds. The Project has enjoyed much success but faces many challenges including rising costs and a falloff in Consultant recruitment, despite the Trainee and Therapy calendars being full up to 2026. We would encourage any consultants who are interested in volunteering to contact the BSSH secretariat at secretariat@bssh.ac.uk. We are actively seeking a Consultant Volunteer for November / December 2024 and January / February 2025. Please do come to the Global Partnership stand in Leeds or contact any of the Leadership Team listed below if you wish to chat about joining this exciting project.
On the fundraising side, we are inviting more members to become Platinum, Gold, Silver, or Bronze partners by contributing £1000, £750, £500, or £250 to or actively engage in fundraising, running marathons or cycling to help make this project succeed. We have managed to raise 25% of the funds needed (i.e £125,000 of £500,000) and we encourage you as BSSH members or your friends and family to become stakeholders in the BSSH LION Hand Project, which is a unique opportunity to Help Heal The Hands of Malawi.
Jonathan Jones
BSSH LION Leadership Team
Kate Owers
Jonathan Jones
Rowa Taha
Sean Walsh
Martin Wood
Sarah Mee
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