The Central African country of Malawi is situated at the southern end of the Great Rift Valley, bordered by Tanzania in the north, Zambia in the west and Mozambique to the east and south. It is a poor central southern African country with a population of approximately 12 million.

The ratio of doctors to the population, of 12 million people, is one of the lowest in the world. It is estimated that there are 5000 children with untreated clubfeet in Malawi with 500 more born each year.

The incidence of clubfoot in Malawi is three cases per thousand live births; three times higher than in the UK. Most often these cases are undiagnosed at birth, and even if they are diagnosed, treatment is unavailable, or local belief systems hinder treatment options.

Some of the district hospitals in many less developed countries including Malawi have no qualified doctors, with the majority having only one whose role is largely administrative. Most district hospitals have only one or two OCO’s (Orthopaedic Clinical Officers) appointed to them and these individuals are responsible for the care of all orthopaedic and musculoskeletal patients attending that hospital.


OCO’s are not doctors but they are trained in the basics of operative wound care and in fracture management along conservative lines, using plaster of paris or traction. They also have limited training in the use of external fixation methods for treating severe compound fractures. Many of the burns contractures are left untreated.