Once we have all eaten, we get into the mini buses and travel 40 minutes West of the City to Facing Africa House which consists of 3 modern buildings funded by Facing Africa within the grounds of the Cheshire Home. As we arrive, we can see the potential patients sitting waiting for us to assess them. There is a large U-shaped building to the left where there are three dormitories, showers with hot water, toilets, recreation and dining room with a TV and DVD player, and straight in front of us is the assessment unit. On the right is a separate building which is the Cheshire Rehabilitation Centre for polio patients. Outside there are swings and a play area with children playing. These children have all suffered Polio and are there to be rehabilitated and reintroduced to the community. As soon as they see my camera, they want me to take a picture. They are so happy and friendly, it’s very heart warming.
We all gather in the assessment centre to discuss the next steps. The surgeons and anaesthetists meet the nurses from the Cheshire to discuss the potential patients. Facing Africa sends 2 skilled wound-care nurses and a doctor who work closely with a team of 6 Ethiopian nurses.
Patients consist of a mix of returning patients who have had previous reconstructive surgery by FA teams and now require further procedures, and new patients. Some patients need 3-4 operations in order to make a full reconstructed face.
Facing Africa organises and funds the transportation of all the patients who come from distant rural areas of Ethiopia. Facing Africa has a small staff of Ethiopians who spend their time between the 2 missions sourcing new Noma patients from all over the country and a few also come from neighbouring countries (South Sudan, Somalia, Eritrea). Chris goes to Ethiopia once a year to explore remote rural areas to look for Noma patients and to establish links with local health workers, hospitals and clinics. Noma is caused by malnutrition and extreme poverty the children who get this flesh eating bacterial infection are usually hidden away by their parents because the disease is considered a curse.The language barrier is also challenging as 80 different languages are spoken in the country. Facing Africa’s local staff work closely with other local and international organisations (Medecins Sans Frontiers, Save the Children, Red Cross, UNHCR, UNICEF, Mother Teresa and many others).
By the time we get to Facing Africa House, the patients have been there for 2 weeks, where they have undergone tests for HIV, pregnancy, TB and other conditions that may not allow them to undergo lengthy and complex surgery, taught the basics of hygiene, clothed and fed special supplements to try to put weight as some of them are suffering from malnutrition.
Once the cases have been discussed, the patients are called in one by one and sit on a chair in front of the panel of surgeons and anaesthetists.
Alganesh is first in. She is ‘28’. She looks more like 16, but they have no idea what their age is and just make up a figure. There are no records of births, deaths or marriages in rural areas, so the patients do not know their ages. She, like all of the women, is wearing a headscarf to cover her disfigurement. Alganesh has had surgery before, but she is still struggling to open her mouth to eat properly. The surgeons assess her to see whether it is wise to operate on her or not. Once they have agreed, Alganesh then goes to the Anaesthetists where they measure how much she can open her mouth so that they can work out how they will intubate her for surgery. We then give her a few sweets and tell her that we’ll see her in a couple of day’s time.
This is the typical protocol for each patient, and all are so desperate for the surgery. One lady called Dara comes in. She has had surgery twice before, but needs a further operation to fill in a final gap in her cheek. She is so grateful for the help that she has had so far. Following her last surgery, her village accepted her and she has even got engaged.
Another candidate removes her scarf and half of her face looks as though it has melted away. Apparently, Noma sufferers seek help in their communities, but are often seen as being cursed and pouring battery acid over the face is seen as a cure by rural traditional healers.
All but 2 patients are to be operated on. The 2 that are turned away have got to the point where the surgeons do not feel that they can do any more to benefit them. Next, the new cases come into the room.
These range from a couple of suspected new Noma cases, to lumps and bumps, to a brain tumour, which unfortunately they cannot help with as this requires a neurosurgeon. A couple of cases needed cranial specialists, or a type of surgery that these surgeons were unfamiliar with. One lady had a road traffic accident and is unhappy with the surgery she received at the Ethiopian government hospital (as she has a lot of scars), however, the surgeons decide that surgery would be purely for cosmetic reasons, and not to help a physical disability, so she is turned away. One young boy, who looked about 6, has a large lump on the side of his face. The surgeons agree to remove this, as it will be a relatively quick procedure but will benefit the child hugely.
We break for lunch and are presented with meat, lentils, rice and Injera. Injera looks like carpet underlay and tastes as you would expect underlay to taste. It is made with teff flour and is the base to any Ethiopian meal. I struggled with lunch.
We then have a walk around the Centre and I am shown where they live and sleep during their stay. All under 16’s can have a guardian with them, and if they have a baby, a carer is allowed to stay. Following surgery, they will be brought back here to recover and will not be allowed back to their communities until the nurses are confident that there is no infection. The nurses are made up of 3 English nurses who Chris and Terry employed to come over for 8 weeks, and 6 Ethiopian nurses who are based at Facing Africa House.
The afternoon is spent sorting out the store room and unpacking the boxes which we flew over. Hospital supplies are kept separate to be taken to the Hospital tomorrow.
We all travel back to the Hotel. There is a lot of head bobbing happening as it has been a long day. We have an hour to freshen up and all walk to the Blue Dream for a meal. This is where the iPhone torch came in useful, as there are no lamp posts, and lots of pot holes!
Check back tomorrow to find out what Heather’s first impressions of the ward are…