title: Establishing a children's orthopaedic hospital for Malawi: A review after 10 years.
abstract: BACKGROUND
  BEIT CURE International Hospital (BCIH) opened in 2002 providing orthopaedic surgical services to children in Malawi. This study reviews the hospital's progress 10 years after establishment of operational services. In addition we assess the impact of the hospital's Malawi national clubfoot programme (MNCP) and influence on orthopaedic training.
  
  
  METHODS
  All operative paediatric procedures performed by BCIH services in the 10th operative year were included. Data on clubfoot clinic locations and number of patients treated were obtained from the MNCP. BCIH records were reviewed to identify the number of healthcare professionals who have received training at the BCIH.
  
  
  RESULTS
  609 new patients were operated on in the 10th year of hospital service. Patients were treated from all regions; however 60% came from Southern regions compared with the 48% in the 5th year. Clubfoot, burn contracture and angular lower limb deformities were the three most common pathologies treated surgically. In total BCIH managed 9,842 patients surgically over a 10-year period. BCIH helped to establish and co-ordinate the MNCP since 2007. At present the program has a total of 29 clinics, which have treated 5748 patients. Furthermore, BCIH has overseen the full or partial training of 5 orthopaedic surgeons and 82 orthopaedic clinical officers in Malawi.
  
  
  CONCLUSIONS
  The BCIH has improved the care of paediatric patients in a country that prior to its establishment had no dedicated paediatric orthopaedic service, treating almost 10,000 patients surgically and 6,000 patients in the MNCP. This service has remained consistent over a 10-year period despite times of global austerity. Whilst the type of training placement offered at BCIH has changed in the last 10 years, the priority placed on training has remained paramount. The strategic impact of long-term training commitments are now being realised, in particular by the addition of Orthopaedic surgeons serving the nation.
authors.affiliation: Royal Liverpool University Hospital.
authors.forename: S L
authors.initials: SL
authors.lastname: Dorman
authors.affiliation: Royal Liverpool University Hospital.
authors.forename: S M
authors.initials: SM
authors.lastname: Graham
authors.affiliation: Royal Liverpool University Hospital.
authors.forename: J
authors.initials: J
authors.lastname: Paniker
authors.affiliation: Beit cure international hospital.
authors.forename: S
authors.initials: S
authors.lastname: Phalira
authors.affiliation: Chester Hospital.
authors.forename: W J
authors.initials: WJ
authors.lastname: Harrison
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003025:Clubfoot / Q000601:surgery*; D003695:Delivery of Health Care / Q000458:organization & administration*; D006282:Health Personnel; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D008295:Malawi; D008297:Male; D009985:Orthopedics / Q000458:organization & administration*; D010043:Outcome and Process Assessment, Health Care; D015397:Program Evaluation; D011787:Quality of Health Care