Who gets surgery?

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Today we will welcome the surgical team to Ethiopia. They are comprised of the UK’s most skilled and experienced maxillo-facial surgeons, anaesthetists and theatre nurses. They flew overnight and will drive straight to our Cheshire home where we will present the medical and surgical details of the adults and children to whom we have grown so close over the last two weeks. The questions on everyone’s lips is ‘who gets surgery, and who doesn’t.’ The anticipation of the patients is immense. Most have been living with this stigmatising condition all their life, and here was a dream opportunity to have it fixed by the best surgeons in the world, and for free. Some have travelled across borders, having never left their home village and surroundings. They have spent two weeks meeting others who have seen the benefits of surgery, talking about the new life that awaits them after an operation. Unfortunately not all cases are amenable to surgery, and not all the cases have been caused by noma. Some of our patients are inevitably going to be let down.

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Bekalich who feeds us every day

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The girls having fun

Who would you choose between these two cases?

Deshio is from South Sudan. She doesn’t know her age but from the profile of the unaffected side of her face she looks about 25. The damage to the left side of her face is extensive. The whole upper jaw has been destroyed and I can see deep into her oral cavity and the long tongue extending to the back of the throat. The roof of her mouth has also been destroyed and clearly in sight are the moist spiral conchi of the inner nasal cavity against which the tongue rests. It reminds me of the faces that have seen dissected for display in the anatomy demonstration lab, except the parts of Deshio’s inner face move as she talks. I am fascinated from a scientific point of view, but the face is unattractive. One would think that this woman was outcast from her village but in her arms is an 8 month old baby, and by her side is her husband, a striking tall man with a face covered in beautiful tribal scarifications. I take the history through two translators. I want to find out about both the functional impact of her injury, and the social impact it has on her life; she can eat everything normally, including solids; she has no trouble speaking or breathing; she is accepted in her village and does not cover her face; she is married and this is her third child; her primary concern is the aesthetics of her defect. She is likely to need a series of four major operations to repair the damage. We must consider that with four major operations there is a risk of leaving her three children orphaned in rural South Sudan. It seems like she is achieving a lot of her life goals, but the people have donated money to treat Noma, and here is a classic case.

Mascaram is a 17 year old girl from Northern Ethiopia. She has had a disorder of the jaw since birth. Her lower jaw, or mandible, has not grown in the normal way and remains very small in comparison to the rest of her face. The jaw does not function properly and is clamped shut but for about 3mm of movement. She’s only ever been able to eat a soft diet, hence a remarkably low BMI of 14.0. She is not married and has no children. When asked if she suffers bullying she becomes visibly upset. This disorder has plagued her childhood, and now it’s stopping her in all the social discourse that make up the transition into adulthood. An operation could successfully open her jaw, but previous experience shows that without quality post-operative jaw physiotherapy the jaw is likely to clamp shut again. Do we know this girl well enough to ensure she performs daily physio in the community with no professional follow up? An operation could change this girl’s life, giving her all the opportunities of marriage and children that may otherwise be out of her reach. However it was not noma that caused this jaw defect, and the money we are spending was given to us on good faith for the treatment of noma. The typical face of noma seems to generate a lot more money than a picture of a small chin.

These are the sorts of decisions that await our surgeons and anaesthetists later today. Between them they have many decades of experience, and for many this is a return trip with Facing Africa. We trust they will bring all their wisdom to the meeting. Let’s hope they got some sleep on the flight.

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Julia, Sue and Gez, covered in holy water (they claim..)

We continue to enjoy life at the Cheshire home. Last weekend Ethiopia ground to a standstill to celebrate Epiphany. There is no doubt in any of our minds that The Ark of the Covenant does indeed rest in Axum! Julia and Sue went into Addis to experience the celebrations and were covered in holy water. They even bought some back in a bottle for me. Here’s some of their photos from the day.

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There has been lots to explore in the surrounding area. There’s normally time for a walk in the evening around the farmlands that encompass us here, and time to meet some of the locals. Meetings comprise of two of three words of Amharic (impossible language…), several round of handshakes, and lots of smiling. There is nothing to complicate the simple experience of human beings spending time together, from different worlds, enjoying each other’s company.

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“There’s nothing I like more than a gin and tonic and a roll around in the hay.” – Susan Criswick, January 2014

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No pictures of birds yet and I can feel the birders getting twitchy. Pictured here is the stunning blue-breasted bee-eater, the most agile of birds in flight, with the distinctive ‘click’ as an insect is caught. Below our colourful friend are a pair of timid Erckel’s francolin, caught sneaking about during an early morning stroll.

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Blue-breasted bee-eaterImageA pair of Erkel’s francolin

I’ve been having a wonderful time with Julia and Sue, and I’m glad to hear that their friends and family have started following the blog. They are both very special people. Their kindness and energy is an inspiration, and there is hardly an hour that goes past when we are not all laughing together about something. I couldn’t wish to be here with two more joyful people. Slushy stuff over..

Many thanks to Julia who must take credit for all of the photos that I’m including in the blog.

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