Dr Borgstein’s driving philosophy has always been to work in the existing national health system, without creating an NGO island in the country. Dr Borgstein moved with his parents, both doctors, to Malawi when he was 6 years old. After already more then 30 years of working experience in the Malawi health and education system, he knows the system inside out. Dr Borgstein cooperates in East African research as a member of the East African paediatric surgeons group. The programme trains and supports medical officers in shunting and allows them to work under supervision of a local surgeon. Efrida Kaunda, the Spina Bifida nurse in the project, is doing a great job, following up children and focusing on CIC management. She is also attending the coming workshop on bowel management in Kijabe later this month. The team in Malawi believes in the impact of the parent work and the project regularly visits the parent and children through out reach clinics. Dr Borgstein expressed his appreciation and told us that the project really makes a difference for the target group in his country.