16 January 2009
Orthodontist Faces Africa
Consultant Orthodontist Allan Thom, a past Treasurer of the British Orthodontic Society, has recently returned from a charity mission to Ethiopia on behalf of Facing Africa (www.facingafrica.org). Mr Thom helped set up the charity, which sends surgical teams to Northern Nigeria and Ethiopia to reconstruct the faces of children who have survived Noma disease (which in English textbooks, is known as Cancum Ori).
Noma starts as a small ulcer in the mouth. In a healthy, well fed European child it would be no more than a few days of temperature. But in a child who is malnourished, has probably had measles and malaria and whose resistance is low, it spreads rapidly.
Within a few days the cheek will be ulcerated and fungating (malignant). The teeth will loosen. The child will have a fever and be unable to eat. Within five days it will spread to the lips. Within seven days to the nose, palate and/or eye. Within two weeks 95% of the children will be dead from overwhelming sepsis (blood poisoning).There is nothing that can be done for these children.
Mr Thom had thought Noma was an historical disease – but no - it was last reported in Europe in Auschwitz and is prevalent in sub Sahara Africa. There are over 100,000 new cases a year. It is a disease of poverty and malnutrition.
It is the survivors of Noma for which Facing Africa cares. These survivors are left with horrendous facial disfigurement, often with no cheek, lips, palate and nose. They have ankylosis of the TMJ (loss of jaw movement) from scar tissue and are unable to open their mouths. They feed by pushing a mushy pap through the gaps in their teeth and Mr Thom had to feed some of the children a high protein “mush” through a 50 ml syringe. Because of the facial disfigurement and local village taboo the children have no friends, no schooling, no socialising – no life. Some are “mistreated” by the local medicine man by branding with hot coals and sticks. Facing Africa seeks out these children, assessing them as suitable for surgery (taking into account other medical conditions) and brings them into a rehabilitation unit prior to surgery.
Allan Thom was part of the advance team whose duties were to carry out full medical, dental and social assessments, start a high protein feeding regime and a deworming programme as well as clerking, photographing and assessing the degree of loss of jaw movement. It was considered essential to establish a healthy dental environment for surgery and extractions were performed where as necessary as well as plaque removal and oral hygiene. Each patient given their own hygiene pack and toothbrushing was supervised daily. Some had never seen a toothbrush and were used to using, on occasions, a soft twig.
The children had come from remote villages. One had walked for two days just to get to the road where she could board a bus for the 9 hour ride to our unit in Addis Ababa. They needed clean clothes, washing and shown how to use a lavatory! They had always washed in the river and used a dug out trench for natural functions. One day the team found the flush lavatories filled with stones.
News had spread that a medical team were “in town” and prospective patients were arriving by the day. Some were totally unsuitable as they were so diseased or so under nourished that they would not stand surgery.
Two weeks later the surgical team arrived and they took over the operating theatres of one of the main hospitals in Addis Abba. The surgical team were international with surgeons, anaesthetists and nurses from the UK, France, Holland and Norway. Over 50 facial reconstructions were carried out. Anklosed jaws released, facial defects repaired, tumours removed and cleft palates repaired. One patient was discovered on a ward with an untreated hand wound that had turned gangrenous. This was amputated as a short case between the reconstructions.
Facing Africa’s previous experience in Nigeria and Ethiopia has resulted in the children returning to a more normal life with friends, schooling and marriage. The charity plans to support four surgical teams a year to Nigeria and two to Ethiopia; the latter the charity plans to increase as well as opening facilities in other sub Sahara African countries.
Each surgical team costs £40,000 in transport, materials and drugs and carries out over fifty facial reconstructions. A new face and a new life for £800!
As Allan Thom concluded “I have seen pathology the like of which I could only imagine; poverty one cannot comprehend and had the opportunity of giving something to lovely grateful smiling children who can now look forward to a new life. I removed my “rose coloured spectacles” and found more to life than moving teeth!”
If you would like more information about the work of Facing Africa, visit www.facingafrica.org. More information about the BOS is available from www.bos.org.uk.
-ends-
Issued on behalf of The BOS by Positive Communications. For more information and images please contact: Tracy Posner on 020 8566 8811/tracyposner@postivecomm.com or Catherine Domanski on 07738 287764/catherine.domanski@positivecomm.com
