How 500 Miles charity has worked to develop a prosthetic service in Malawi that will become part of its national health service – Olivia Giles

Everyday life can be very challenging in sub-Saharan Africa. Things that we take for granted – running water, electricity in our homes, universal health care – are out of reach for most people.

From the outset, charity 500 Miles wanted to help establish a professional prosthetic and orthotic service in Malawi that would become part of the country's national health service (Picture: Paolo Patruno Photography)

Governments struggle to provide even the most basic public services because their tax base is so low, forcing millions to depend on international aid for everything from micro-loans for business start-ups to drugs to combat HIV Aids.

And the high prevalence of diseases such as malaria – which killed more people than Covid-19 last year according to the World Health Organisation (WHO) – puts an immense strain on even the most efficient public sector. It is understandable that expensive prosthetic and orthotic services can’t be high priority.

But they are and will continue to be absolutely essential for nine-year-old Charity Msowoya from Karonga, northern Malawi who was born with a short, weak right leg. Her mother literally had to carry her everywhere and she was not going to be able to start school.

Similarly, they are needed by teenager Malengo Phiri, a bright, sociable girl who, at 14, had never been to school. Malengo was born with badly contracted knees, meaning she had never been able to walk. Her primary school was too far away for her parents to carry her there every day, so Malengo spent most of her time sitting outside her family home, her future bleak.

Three years ago, a torrential storm forced 18-year-old Alinafe Isaac to cook her family’s evening meal inside her small home. Frightened by a sheet of lightning, Alinafe, who was pregnant, fell onto the open fire and sustained severe burns on her upper limbs, back and bottom. At the nearest hospital, the only treatment available was to amputate both her arms above the elbow.

Today, thanks to the 500 Miles team in Malawi, these three young women have a much brighter future. Charity is walking to school on her ortho-prosthesis like any other little girl, Malengo has special prostheses that help her walk without support using her thighs, and Alinafe has been fitted with adaptive devices which help her care for herself and her baby.

And for several years now, 20-something seamstresses Mary Chana and Susan Banda – who are both dependent on their prostheses, Mary’s below the knee on both sides and Susan’s above the knee on one side and through the knee on the other – have been enjoying full and active lives, earning a living from dressmaking and participating in their communities.

They are just a few of almost 10,000 people that 500 Miles has helped since we opened our first clinic in Lilongwe, Malawi’s capital, in 2009, and a second in Mzuzu, the most northerly city, in 2012.

Money raised here in Scotland has been used to develop Malawi’s prosthetic and orthotic services, from training 11 clinicians to international standards as well as technical staff, to building two bespoke clinics.

On Thursday, the Mzuzu clinic will be handed over to the Ministry of Health for the government of Malawi to run, and within four years our flagship clinic in Lilongwe will also become part of Malawi’s mainstream health service. 500 Miles will continue to support it, but the prosthetic and orthotic service will belong to the people of Malawi.

The Honourable Khumbize Kandodo Chiponda, Malawi’s minister of health, said: “We are very happy to take over the busy prosthetic and orthotic centre that has been established by 500 Miles at Mzuzu Central Hospital so that the Ministry of Health can continue this important work sustainably, for the benefit of the people of Malawi. This is a welcome step in the right direction.”

Thirteen years ago, 500 Miles was a novice in international development, but we were clear about one thing. While we were determined to help establish a professional prosthetic and orthotic service in Malawi, it had to be sustainable. It had to become part of Malawi’s national health service, to belong to Malawi.

Every country in the world has at one point depended on investment from another to survive. In 1947, Britain received the biggest share of America’s Marshall Aid package to help it recover from the Second World War. But no country should have to depend long term on charity for its essential services.

That’s why, from the outset, much of our effort at 500 Miles has gone into developing a quality prosthetic and orthotic service that, whilst meeting the immediate needs of people like Charity, was designed in such a way that Malawi could meet its own needs in the future.

From the outset, we worked directly with the Ministry of Health and the central hospitals to shape the service. We have paid for all of our patient-facing staff to be professionally trained, in Tanzania or Cambodia, and we have funded the new manager in Mzuzu to obtain her degree through a German blended-learning programme. We are also very proud of our quality management system which is designed to secure and sustain quality by systematising every aspect of production, thereby providing a robust framework for the future.

And we have cemented partnerships with Malawi organisations, national and local, to develop an extensive outreach programme, essential in identifying people in rural areas who could benefit from our life-changing services.

As a small charity, we could not have achieved any of this without the people who have supported our work over the years, from the toddlers who took part in our Miles for Smiles fundraiser in 2009 to Johnson & Johnson who funded the development of our quality management system.

The generosity of all of our supporters has changed the lives of thousands of people, but more importantly, they have contributed to building a service that will last. Sustainable development has been 500 Miles’ objective from the very start, and we are about to take a major step towards achieving our goal.

Olivia Giles is founder and chief executive officer of charity 500 Miles.

Find out more about its work and its final fundraiser, the Big Dinner 2.

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