Saturday January 24th 2026
Juliet treating a patient in Mzuzu Central Hospital, Malawi.
This article has been written by physiotherapist Juliet Gold
The irony was not lost on us, as we – a multidisciplinary team of orthopaedic specialists drove in the dark (most advice is to avoid driving after nightfall) for 7 hours in a minibus with questionable seat belts and no head rests, heading for Northern Malawi. Most of the orthopaedic trauma in Malawi is related to car, truck, motorbike and push bike accidents.
I was travelling with a team from Project Kuyenda (meaning ‘walk’), a charity set up in 2022 by an experienced orthopaedic trauma consultant from the Royal Infirmary of Edinburgh who had been born in Malawi, and two senior orthopaedic trainees, with the aim of supporting orthopaedic trauma in Northern Malawi. Grossly underfunded and with only one permanent trauma surgeon for a population of between 4 and 5 million, the aim is to support the local team by teaching whilst operating and giving technical advice to the surgeon and operating team in Mzuzu General Hospital.
Our group, the largest which had travelled to Mzuzu, comprised 2 orthopaedic trauma consultants, 2 senior orthopaedic trainees (surgeons who are specialising in orthopaedics), 3 anaesthetists, a scrub nurse, a medical student, an infectious diseases consultant – who, although slightly less directly connected to orthopaedics was incredibly valuable for many reasons, and myself – the first and only physio to have travelled with Project Kuyenda.
I have been a physiotherapist for over 30 years and worked in orthopaedics – both with in-patient orthopaedic trauma, musculoskeletal outpatients and latterly as a knee specialist Extended Scope Practitioner in elective orthopaedics, for most of my career.
A corridor conversation on the back of a second highly successful fundraising ball at the beginning of 2025, when I asked whether a physio would be valuable for the next trip, was the platform for me to consider ‘signing up’ following a resounding ‘yes’ to my question.
Pre trip organisation included an armful of vaccines, purchasing of malaria prophylaxis tablets, filtration water bottles (an absolute game changer which meant we could drink from the taps without endless purchasing of plastic bottles) and gathering as many donations of equipment and supplies as we could.
Fortunately, the luggage allowance with Ethiopian airlines was generous, so most of us took personal items in hand luggage and 2 enormous suitcases of donations ranging from PPE (personal protective equipment) to wrist splints, needles, moonboots, knee braces, plaster of paris, uniforms, hand therapy equipment and anaesthetic supplies. The charity had also purchased various screws, pins and surgical equipment as well as anaesthetic drugs to use and donate. We all had Project Kuyenda branded scrubs and polo shirts which we wore during the trip and donated to the staff at the end.
Despite 11 of 14 suitcases in the first wave of arrivals not making it to Lilongwe – the capital of Malawi and airport arrival point, we successfully started work on the Monday morning with a weekly ward round with the resident and only orthopaedic consultant, Bitiel.
The multidisciplinary team of orthopaedic specialists who travelled to Malawi as part of Project Kuyenda.
Personally, this was eyeopening. The male orthopaedic ward alone had approximately 40 patients with fractures – mainly lower limb, waiting for surgery. The stories behind the accidents were horrific. There are very few health and safety rules, if any, meaning that the lack of seatbelts, airbags and headrests, drink driving, overloading pick up trucks with workers, road rules (or lack of) combine to produce some severe orthopaedic trauma. Often these fractures are open, meaning the broken bone protrudes through the skin, increasing the risk of infection, particularly with the delay in getting a patient to theatre. Remember, there is only one orthopaedic surgeon in the north of Malawi.
During mango season, many injuries are seen in children ‘falling out of a mango tree’ whilst trying to pick the fruit. One of the patients I saw was 18, had been hit by the Presidential convoy, sustained injuries so bad, that he lost one of his legs above the knee and the other suffered a complete degloving of all the skin potentially requiring skin grafts. There are no plastic surgeons in Mzuzu, so his outcome is likely to be very poor.
The Physiotherapy department has two qualified physiotherapists and several ‘interns’ who have had some basic training, who rotate between different specialities every two months. Undoubtedly in 2 weeks it was difficult to learn all the systems and processes being the only physio in our group and certainly ‘in at the deep end’. The staff were so welcoming and keen that I treat patients from the start, that I had to make a conscious effort to balance ‘fishing’ with ‘teaching how to fish’ – the latter being ultimately more sustainable.
There was immediate post op work – patients who had been immobilised on traction or with external fixation whilst awaiting surgery, inevitably had stiff, poorly functioning joints near the fracture site, made worse by the delays. They needed checking for immediate post op complications and encouragement to move the affected limb to allow some initial regain of function. Serious fractures need to be fixed to allow them to heal and help prevent deformity, but joints need to be moved, and muscles strengthened to regain function as much as possible.
One of the many challenges was the language barrier. The staff spoke English but few of the patients did. Trying to find patients on the ward, involved the physio walking between the different bays calling out the patient’s name until we found them.
There is undoubtedly a role for more pre-op physio here.
Outpatients comprised a mixture of post injury/fracture patients and those being referred following orthopaedic outpatient follow up eg post cast removal.
At times it felt like an endless queue of patients sitting in the corridor waiting to be seen – I am still unsure of the exact ‘booking’ process.
Down time after a working day was both appreciated and required. A bit of a de brief over a beer, some data gathering and planning for the next days work/operating followed by food, some low level pilates in a group on the grass with a beer in hand (!), the odd phone call home when Wi-Fi allowed, card games and an early night was the general pattern. Being away for 2 weeks, working, eating, sleeping (well, room sharing) with essentially strangers, was tough at times, although our team gelled extremely well – these sorts of trips are self selecting- those with a good work ethic, enthusiasm, skills and an easy-going nature are likely to do well! At the end of the day, we were all there to do what we could to help orthopaedic patients whose access to health care is extremely limited compared to the luxury we have in the NHS.
After the charity funded an extra operating list at the weekend, we headed down to beautiful Lake Malawi for some R&R. This is stunning, and despite the risk of schistosomiasis (prophylactic tablets suitably obtained), was well worth swimming in, padel boarding on, and watching fish eagles swoop down to catch their pray from the lake.
On reflection, charity work trips such as this would not be for everyone, but personally it was a fantastic opportunity to travel to a new country, use a career’s worth of life and physiotherapy skills to, in a small way, help some of the warm, welcoming, kind patients’ and staff at Mzuzu Central Hospital in their management of some of the worst orthopaedic trauma cases I have ever seen. Hopefully we can continue to build on this work in future trips.
In order to continue to fund the work of Project Kuyenda, there is a fundraising Gala Ball on Saturday 28th March 2026 at Prestonfield House Hotel, Edinburgh to which anyone is welcome to join and buy a table. Read more about the Gala HERE.
Alternatively donations are very welcome you can Donate Now — Project Kuyenda Donations.
Tales and more photos from the recent trip can be found on Instagram @projectkuyenda.
Thank you for reading.
Juliet Gold
