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Increasing the number of health workers trained in treating trauma and musculoskeletal impairment in East, Central and Southern Africa.

Primary Trauma Care Training in Rwanda © University of Oxford
Primary Trauma Care Training in Rwanda

COSECSA Oxford Orthopaedic Link (COOL) is a multi-country partnership programme between Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford and the College of Surgeons of East Central and Southern Africa (COSECSA). Covering a region of ten countries in sub-Saharan Africa, COSECSA fosters postgraduate education in surgery and provides surgical training throughout East, Central and Southern Africa.

The five-year programme (2012–2017) combines research and training in primary trauma care and musculoskeletal impairment across Burundi, Ethiopia, Kenya, Malawi, Mozambique, Rwanda, Tanzania, Uganda, Zambia and Zimbabwe. COOL aims to meet the critical need for more health workers trained in treating serious injury and musculoskeletal impairment.



COOL is directed by Prof Chris Lavy , Prof Hemant Pandit and Prof Godfrey Muguti (University of Zimbabwe).

The COOL programme is funded through two grants from the Health Partnership Scheme, which is funded by the UK Department for International Development (DFID) for the benefit of the UK and partner country health sectors and managed by the Tropical Health Education Trust (THET).


COOL aims to:

  • Increase survival rates from serious injuries and road traffic incidents
  • Prevent disability associated with untreated or poorly treated traumatic injuries
  • Improve care for children affected by musculoskeletal impairment, including club foot, angular limb deformity and infections of bones and joints


With help from  Primary Trauma Care Foundation and over 70 NHS consultant volunteers, we have taken the Primary Trauma Care course to the 10 countries making up COSECSA. These are Ethiopia, Kenya, Uganda, Tanzania, Rwanda, Burundi, Malawi Mozambique, Zimbabwe and Zambia. In each country we work with local clinicians in delivering the course to doctors, nurses and paramedics, stressing the importance of training new local instructors to continue the work.

Since 1997, PTCF have trained medical professionals in around 60 countries worldwide in the management of severe injury, working to establish a locally sustainable training model in each country. 


Surgeons from the Nuffield Orthopaedic Centre have gone to the COSECSA region to run week-long courses for trainees in Paediatric Orthopaedics, Hip and Knee Replacement, Spine Surgery and Tumour and Soft Tissue Reconstruction Surgery. The demand for places is overwhelming demonstrating the need and desire of the local trainees for an understanding of modern orthopaedics and constructive links with colleagues in the UK.


We have arranged and funded over 40 clinical fellowships in paediatric orthopaedics in CURE International orthopaedic hospitals in Malawi, Zambia, Kenya and Ethiopia. Again the demand for these by local trainees has been enormous, and several of the fellowships have been divided so that the training can be shared by more than one person maximising the opportunity for hands-on training. 


Over the last two years we have worked with colleagues at the London School of Hygiene and Tropical Medicine to run an epidemiological survey of the musculoskeletal needs of children in a population of 1 million in Central Malawi. Orthopaedics was our interest but we shared the project with the London School as there were researchers there who had interest in children's hearing, vision and intellectual impairment, and the survey was an appropriate vehicle to cover all these disciplines. 

We have also surveyed the volume of trauma that presents in Malawian hospitals over a year, which is published in Injury, and we have surveyed the capacity to manage trauma in the 990 hospitals that cover the COSECSA countries. This work was presented at the Launch of the Lancet Commission on Global Surgery in April 2015 ahead of publication.

Links to the research outlined above are available here.


Find out the latest news from the COOL programme here.


Selected Publications