Arbutus Medical and the AO Alliance have come together to provide hospitals in Malawi with the Arbutus DrillCover technology to treat long bone fractures. According to Precious Kamange – the AO Alliance on-site project consultant – the main mandate is to support and aid district hospitals, doctors, and surgeons to improve fracture care in the country.
The AO Alliance is a nonprofit development organization whose mission is to reduce human suffering, disability, and poverty through programs that enhance local fracture care capacity for a sustainable impact. With projects currently underway in over 30 countries in sub-Saharan Africa and Asia, the organization is in the midst of a three-phase project in Malawi in collaboration with the Johnson & Johnson Foundation.
“Over the course of the last 18 months, we’ve implemented the first phase, which was improving the technical capabilities of the two central hospitals by providing them with sets of implants and equipment to be able to deal with lower extremity long bone fractures,” said Dr Claude Martin Jr., the managing director of AO Alliance.
The second phase of the project was partnering with KidsOR, a UK based NGO, which refurbishes operating rooms. They started off with children’s operating rooms but are now involved in adult operating rooms as well. “We identified four district hospitals that would be amenable to having their operating rooms upgraded,” said Dr Martin. This, he explained, is where the program’s relationship with Arbutus DrillCover Technology comes in.
“Along with equipping the operating rooms, we wanted to equip the orthopedic clinical officers – essentially paramedics – who work there with appropriate equipment to be able to provide nonoperative fracture care,” he said. “So, four hospitals were selected to upgrade the operating rooms, but all the district hospitals – 28 of them – were also equipped with an Arbutus drill, cast saw, cast cutters, and cast spreaders.” This equipment was delivered in early 2023.
Ensuring that district hospitals are also well equipped is an important part of this project, as pointed out by Kamange. He explained that since central hospitals were the best equipped, cases of trauma and long bone fractures were referred there. Patients from all over the country had to travel to these hospitals, increasing the cost and effort for the patient and the government alike, and adding immense pressure on the surgeons. “With the long bone fracture program, we’re trying to treat the people that can be treated where they are to make it efficient for the patient, the government and the people that are working on it.”
Dr Martin’s relationship with Arbutus Medical goes back to its initial days, when he was introduced to the company by a friend – also an orthopedic trauma surgeon – at the Vancouver General Hospital. “Trauma and orthopedic surgery is a bells-and-whistles-and-toys dependent specialty. So, you need plates, you need screws, you need nails, but you also need power tools to insert the hardware.”
High income countries can afford the latest tools to be used in surgery, which many low-income countries still lack. This isn’t the only problem. Supply, sterilization, cleaning, and on-going maintenance of equipment are also costs to be considered and reasons for lack of access to safe surgery for many. Arbutus Medical’s DrillCover technology makes use of a sterile enclosure around a nonsterile power drill so that it can be safely used in surgery. This means that hospitals do not need to sterilize the drills between surgeries, saving both time and money.
As a result of this program, Dr Martin hopes patients will have shorter stays in the hospitals and will be appropriately referred to central hospitals. However, he points out that sustainability is key to programs like these, and it is important for the local surgeons to be trained and ready. “Having all these increased technical capabilities at the central hospitals also helps the quality of the residency programs because the trainees are being exposed to techniques that they may not see during the course of their programs, and they get exposed to techniques that are available to them after the program as well,” he said.
Phase three of the program will be looking to upgrade the Zomba and Mzuzu central hospitals. “One is in the southern region, and one is in the northern region, and we hope that by then there will be permanent local trauma and orthopedic surgeons,” said Dr Martin.
This is important to feel the program’s long-term impact. “Our metric for the number of trauma and orthopedic surgeons was that by the end of 2024, we would have more than 20 in the country with the majority of them being Malawian nationals,” he said. This is why it is important to get the Ministry of Health and other government agencies more involved and make sure that this becomes a priority.
The work done by the AO Alliance is an important reminder of the necessity for access to safe surgery for every patient. Low- and middle-income countries (LMICs) experience a disproportionate number of injury related deaths, due to lack of surgical infrastructure and personnel. Sub-Saharan Africa, for instance, is home to 11 percent of the world’s population, 24 percent of the total global burden of disease but only 3 percent of the global health workforce. There is also currently a shortage of 1 million surgical, anesthesia, and obstetric specialists in LMICs.
Lack of investment in surgical systems results in losses in economic productivity in LMICs which could total 12.3 trillion USD by 2030, and improvements in the system could save up to 2 million lives annually. For countries looking to advance their overall development, investment in surgical care is of the utmost importance.