Week 4 - All the surgery has now finished. Spent yesterday in theatre watching the 3 last patients have their ops, fascinating as always. Even more so because there was some building work going on above theatre which resulted in a large crack appearing in the roof . As fate would have it, this occured just as the surgeons had got to a critical phase in the operation using the microscope to reattach the patients artery/vein in their neck. The general comment from everyone was 'only in Africa'!
As requested, a bit about the disease that we are here to treat:
NOMA is a rapidly progressing fungal infection that usually affects the face. It is a result of severe malnutrition, poor drinking water, poor oral hygiene, and proximity to unkempt livestock. Most of our patients come from the country. The disease will have manifested itself during their childhood and they have had to live with the effects since then; usually affecting one side of their face and prohibiting them from eating and talking normally. Many African's believe it is as result of the 'devil', and consequently many of our patients have been subject to tribal witchcraft and acid attacks by their families.
The treatment by the surgeons is complex and different in every case. First of all the NOMA has to be removed, then the surgeons can begin reconstructing the face. Many of the techniques used have been developed specifically for this disease. Such as a submental flap, which takes tissue from the neck and swings it up to form a chin. A skin graft from the leg or arm is used to replace the tissue loss in the neck. Similarly, naso-labial flaps use tissue from either side of the nose, which swings down to form an upper lip. By keeping the flap attached to the original blood supply and twisting it into position, the idea is that it is less likely to fail, as the body should not reject it, and the blood supply is intact.
The general concenscous by the surgical team here, is that we are aiming to optimise the function of the mouth as well as cosmetically improving their appearance; as without a functioning mouth they will die from starvation.
The aim now is to look after the patients with wound care twice a day and antibiotics. Because their homes are so basic, we have to be absolutely sure that the wounds have healed and they are 100% better before they can leave, as they cannot easily get back to us, and will likely die if there are any complications. Therefore the next 3 weeks are critical.