Delivering orthopaedics in Burundi: a model for humanitarian surgery in resource-limited settings

Burundi remains one of the most socioeconomically challenged countries globally, facing profound limitations in healthcare infrastructure, workforce, and access. In this context, the Italian Medical Foundation for Central Africa (FIMAC) has conducted humanitarian orthopaedic missions for over two decades in Bubanza, addressing critical musculoskeletal conditions in both paediatric and adult populations. This essay provides a comprehensive overview of the operational, clinical, and ethical dimensions of these missions. Commonly treated pathologies include chronic osteomyelitis, neglected fractures, open injuries, and congenital or acquired limb deformities-conditions frequently encountered in advanced stages due to delayed access to care. Resource-sensitive protocols guide interventions and rely heavily on collaboration with local healthcare workers, who receive targeted training in trauma management, postoperative care, and basic surgical techniques. The aim is not just to deliver urgent care but to foster sustainable improvements through capacity building and knowledge exchange. Major challenges include a lack of surgical infrastructure, limited availability of diagnostics and sterile equipment, as well as sociocultural barriers to care, such as language and traditional beliefs. Despite these constraints, the missions yield significant functional and psychosocial outcomes, particularly among paediatric patients. Ethical considerations, including informed consent, scope of practice, and cultural humility, are central to responsible practice in this setting. The personal and professional impact on participating surgeons is profound, often reshaping clinical priorities and reinforcing the humanistic foundations of the medical profession. The paper concludes by advocating for the establishment of permanent surgical facilities, structured deployments, and scalable innovations to enhance the continuity of care and address surgical inequities in low-resource settings.