Malawi: The Warm Heart of Africa

By Joe Serra

I have been going to Malawi for the past 28 years, and several years ago wrote an article for our magazine, The Rotarian, about our project to operate on polio victims called “crawlers.” These were children, teens and adults afflicted with paralysis in their legs due to polio, thus preventing them to stand and walk. Thus the term “crawlers.”

Malawi Against Polio (MAP) Rotary Project After Care Unit and Workshop.

In 1981, Rotary International provided a humanitarian grant of $250,000 for a project to operate on selected crawlers to straighten their legs, fit them with braces and crutches, and teach them to walk upright. Eight orthopedic surgeons were selected from around the world, four from the US, to go to Malawi; one every three months, and staying from 1-2 months to do the surgery. The project had two full-time volunteer physicians, Drs. Paul and Margie Binks who moved to Malawi for three years to be medical directors of the project. We had four physical therapists full-time, and two medical assistants who we trained to apply and remove casts, assist in surgery; do dressing changes and other tasks. So the program had continuity of follow-up and patient selection which made it function extremely well. For example, when I would arrive in Malawi at Queen Elizabeth Central Hospital, there would be 30-40 patients already selected as potential surgical candidates ranging in age from 5 years to early 20’s. For the next 4-6 week stay, my work was to do as many surgeries as possible 2-3 days a week, and conduct pre and post-op clinics the rest of the time. The team worked well, and excellent records were kept on each patient so the next orthopedist to arrive could continue with the follow-up care, and do surgery on new arriving patients.

The project worked so well that the project continued for three years. During that time, the eight of us and our team saw more than 5,000 crawlers, and operated on over 2,300. Some crawlers did not require surgery, but merely needed braces and crutches. Others were not good candidates for surgery, and were fitted with wheelchairs, both standard hospital-style wheelchairs; and some three-wheeled tricycle chairs which polio victims with good arm strength could propel by hand sprocket like a bicycle.

This is why I went to this beautiful country of mountains, lakes, tea plantations, and incredible vistas; and above all the kindest, gentlest, and most appreciative people one could meet. I returned to Malawi four times by 1989. The polio surgery expanded to include knee fusions, foot fusions to provide stability, and re-alignment of femurs and lower legs. Also, there were no orthopedic surgeons in Malawi in 1981 so we did fracture care, and club foot corrective surgery. Many of the general surgeons in the country wanted to learn about orthopedics since they were the only ones treating trauma.

Wilbourn Chavula following surgery

In 1985 an 18 month course was developed to prepare skilled technicians to do basic orthopedics at the three central hospitals and 28 district hospitals throughout the country. These students had two years of college, and a minimum of three years working in hospitals prior to applying to this graduate program. There are full-time Malawian faculty members teaching in the program and visiting orthopedists from around the world to assist in teaching; visiting and instructing the graduates in practice in various hospitals. This is why I have returned to Malawi for eight visits averaging one month each- to teach orthopedics. They learn fracture care, reduce dislocations, apply skeletal traction, drain septic joints, and recognize tumors, tuberculosis, and other conditions. These graduates are called Orthopedic Clinical Officers, and are assigned to hospitals and clinics throughout the country to do the basic orthopedic care. It is amazing to see how well most of them do in practice. When they see cases they can’t handle, they refer them to the orthopedic surgeons at the three medical center hospitals. There are four orthopedists at Queen Elizabeth Medical Center and three at the Cure International Children’s hospital.

Cure International is a non-profit organization based in Lancaster, PA. Which has built four hospitals in Africa with Malawi being the third? It was built seven years ago, and is a modern state-of –the- art facility with 60 children’s beds, and 10 adult beds. The adults pay for their care, and this plus donations from charitable organizations like Rotary, provides free care for the children. The children are similar to Shriner’s patients with trauma, congenital anomalies, and burns. Their treatment is superb. The adult’s treatment includes joint replacements, spine surgery, and trauma. The three orthopedists at Cure hospital are from the UK, and are excellent. The youngest orthopedist is a woman specializing in hand surgery who just arrived last year. One would not expect to see a modern hospital such as this in Africa. In fact the University of Pacific Doctorate Physical Therapy program has placed three interns at Cure for eight weeks doing adult and children’s physical therapy, and they hope to continue.

Left: Dr. Paul Binks, Medical Director. Right: Dr. Peter Moody, DVM, member of Lilongwe Rotary Club. Seated: Dr. Joe Serra member of Rotary Club of Stockton.

The Rotary Club of Stockton was the lead club of a matching Grant sending a forty-foot container of medical supplies and equipment to Malawi in August, 2010. It means a lot to me that club/district members travelled with me to Malawi to present this container to Queen Elizabeth Central Hospital and Beit-Cure Children’s hospital. Our group consisted of Dave and Sally Mantooth from Escalon Sunrise; and from our club Frank Moore, Gary Gillis and daughter Erin, Cathy Peterson and her dad, Ron Peterson, and I.

There is a newly approved Matching Grant from our Club/ District to provide funds for surgery on children at Beit-Cure hospital.

My one month tours are under the auspices of Health Volunteers Overseas in Washington, D.C. Four to five orthopedic surgeons and now also residents in orthopedics from around the world go to Malawi each year as visiting professors. Housing and an auto are available for use. We see some fascinating cases that are rarely seen in practice. Trauma is a major problem due to road traffic accidents. Therefore treatment of trauma is the main concern today in Malawi. This is true in many African countries where pedestrians, bicycles, and old roads are no match for SUV’s, large sedans, and trucks.

Malawi is a beautiful country little known to tourists, but slowly being recognized as a tourist attraction. There are game parks; beautiful Lake Malawi, rolling hills and mountains; stunning tea and coffee plantations and a wonderful temperate climate; and markets with vegetables and fruits to rival any farmer’s market anywhere.

I have met many wonderful people as patients, colleagues, and friends.

Wilbourn two years after surgery.

An example is my friend, Wilbourn Chavula; a polio crawler. Our treatment was successful, and Wilbourn was able to complete his education walking with braces and a cane. As a high school student, Wilbourn was brought to California to ride on the Rose Parade Float New Year’s Day 1986. We were both on the float; what an incredible day for this boy from a village in Africa. He stood up and waved for two and one-half hours along the route. Wilbourn spent two weeks with our family. He attended our club meeting at the Holiday Inn; spoke to students at Tokay High School, and Davis Elementary. Wilbourn completed college and received a teaching credential and taught mathematics and English in his city of Karonga. Dorothy and I supported Wilbourn through school and beyond. He married, and had three children. The first two were named Dorothy and Joseph. Wilbourn would write us beautiful letters; and when their daughter was born he wrote “and her name is Dorothy, so there will always be a Dorothy in my village.”

Wilbourn passed away seven years ago, but he had 22 years on his feet, and was successful as a husband, father, and teacher.

Wilbourn’s eldest, Dorothy, just completed the first year of college, and “Little Joe” is completing primary school.

To me, Wilbourn is an example of what our programs in Rotary are able to do to improve people’s lives around the world. We make the world a better place every day.

Thank You,
Joe Serra