A complicated business

The Facing Africa Team

Finally pulling their weight. Sorry, couldn’t help the caption… They pulled their weight all week. This was Bill Hamlin’s (right) TENTH mission with Facing Africa in Ethiopia as head anaesthetist.

As soon as they were here they were gone. A big thanks to the surgical team, primarily coming from Great Ormand Street, for all their hard work over the last couple of weeks. Thank you for giving up your annual leave and private surgical lists and working for free. It was a busy week with two theatres performing more than 30 operations. It was a stressful couple of weeks for the patients who were watching each day as more of their friends were taken into the unknown. A little disconcerting when you still have your scheduled op and your friends come back swollen, in pain, and dribbling a mixture of saliva and blood.. Some of the operations performed are at the forefront of surgical technicality. The techniques are far from perfected and complications do arise. The next few days are critical in the long term success of the operations.

Hiroshi Nishikawa and Anthony MacQuillan on the left – the plastics team. David Dunaway from the maxfax team on the right

It has been amazing to see some of the transformations that have occurred. Ayesha is about 15 and been confined to the house all her life, with a clamped jaw and a non-existent self-esteem. Today she looks another person, and she seems like another person too as she sits with the other children. The graft from her arm is healthy and she is looking at a different future than she had before her a couple of weeks ago.

Ayesha – second from right – on the mend

Unfortunately this isn’t the case for all. Bekalich is about 25 and from South Sudan. She has three children including an 18 month old baby who is now in our care. There was some discussion as to whether a major reconstructive operation would be appropriate in her case; she was still breastfeeding a dependent infant; she was very slim with a BMI of 14; she had achieved important life goals of marriage and children; and she didn’t cover her face in her home village. In the end she went to theatre to have a forearm graft to replace her facial deformity. The first concern was the baby. The child was malnourished and not behaving normally for an 18 month old baby. He would cry whenever he was taken from the mother, at which point she would scoop him back up into her arms and to the breast, signifying attachment issues. The child would not take any interest in the world around him, and wouldn’t even react to loud noises. In the UK this behaviour would immediately be flagged as secondary to neglectful abuse. He received no stimulation from the mother. She did not play with or talk to the child who just sat silently in her arms. The child did not crawl and made no effort to move, and there was hardly any muscle mass on the legs. The child was socially and developmentally delayed, most likely secondary to the social exclusion that her mother has suffered due to her defect. Most obvious was that the child didn’t smile. His mother’s facial disfigurement was such that she couldn’t smile herself and I suspect this child had not had contact with many other people in his short life. We would look after the baby during his mother’s operation. We saw this as a valuable opportunity to feed up and stimulate the baby.

Almost two weeks later and we are looking after a different child. This is due to an amazing effort by all the nurses and the patients here who has been stimulating the child around the clock. It has seemed like bullying some of the time but with positive results. As I look down the gardens I see him sitting up on his own. He is playing with a ball and moves onto his front to crawl at his own accord. I run down to get a closer look. I tickle him behind his ears and he squeezes his mouth together into a pout. We all tickle the baby a bit more and to our amazement a huge smile spreads across his face, milk teeth and all. This is the first time the baby has ever smiled, you can imagine the elation. As you would expect we kept tickling him until he cried…

The original version of this blog then went on to outline what has happened since. I must admit that the version I originally posted probably crossed patient confidentiality boundaries. As such it has been moderated. However the dilemma is till the same – what happens when advanced technology meets those that are not understand the basic principles of modern medicine, and how can one possibly obtain informed consent? This is an issue that the surgeons here are constantly debating. It behoves Facing Africa to be self-critical of their own work, a responsibility that I feel they take up with great wisdom.

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Right then onto the fun stuff. First of all it’s your favourite section – BIRDING NEWS. Two weeks ago saw the construction of a new bird table, FAs first foray into the world of conservation. It has to be said that the table was not built exactly to the specifications and design that I had drawn up, but TIA and it works. It took a couple of days for our beaked buddies to work up the courage to visit, but now they can’t get enough of the stale crumbs and dirty water. Here are a few of the highlights.

A Ruppell’s robin-chat pays a visit. Acts like a robin but interestingly not actually in the same family as the well known red-breast

If you see a flash of iridescent blue then it’s probably our metallic friend the blue-backed starling

A small siskin sitting in a tree

Photographed AT LAST – the elusive white-cheeked turaco in a rare moment of stasis. In flight this turaco reveals brilliant crimson patches beneath the wings.

Not a bird. Sue took us on a lovely walk to investigate these rat-like meerkat type animals. Anyone know what they are?

Last week also saw the first bonfire party for the kids (and mainly the adults). Coca-cola, crisps and chocolate, and very distorted music playing very loud on a speaker that was too small and couldn’t cope. One child was sick within an hour from excitement and was found with chocolate stuffed away in all her pockets and then cried at the end because whe was over tired, a ubiquitous occurence all over the world at this type of event. Here’s a who’s who of the night. Well done Julia and Sue for some inspired packing of animal onesies..

All smiles from the team, blood sugars rising rapidly

Two of the children get this classic party game going. You’re meant to balance, not hold, the pillow on the head.

Nurse Meron forcing a smile having expected to come onto a nice quiet night shift. Hands up if you’re at least two fantas down!

Carnage on the dance floor

“There’s nothing I like more than a strong gin and tonic and a dance with a nice young man.” Julia Whiting – Feb ’14

Hanging out with the seniors and Midiwe who stuffed her chocolates in the piggy bag

My two friends