Surgeon's mission of hope for disfigured children

COSMETIC surgery performed by plastic surgeon LeRoux Fourie at his busy practice in Yorkshire is typical of many in his field as patients seek his expertise for operations to enhance their breasts, work on their noses, or carry out facelifts.

But their concerns were a world away when he was presented with altogether different challenges during the latest of a series of missions to treat patients with terrible disfigurements in Ethiopia.

Principally he was there to see patients suffering from noma – a gangrenous infection that can rapidly develop to severely affect the faces of weak and malnourished patients.

The condition kills nine in 10 people it infects but survivors are left with the often horrendous consequences of the disease including deformed faces and severe difficulties eating and drinking, as well as being trapped in a cycle of poverty living as social outcasts.

This was the fourth time Mr Fourie, formerly of Pinderfields Hospital in Wakefield, and now working at the private Methley Park Hospital, near Leeds, has travelled to Africa to treat patients with such terrible disfigurements.

But it was the first the team involved was able to carry out the latest surgical techniques on victims of noma and those suffering from other conditions ranging from trauma injuries, including some who had had their noses bitten off, to others ravaged by illness.

His work, carried out in tandem with specialists from Great Ormond Street Hospital in London and the charity Facing Africa, will reach a wider audience when it is featured next week in a BBC2 documentary.

In total, the team carried out 52 operations on 49 patients over a two-week period in Addis Ababa.

Workers from the charity had spent the previous months scouring the country looking for those who might benefit from treatment.

As more equipment has become available and facilities have improved, the specialists were able to use advanced microsurgery which involves taking living skin from a patient's arm or leg and connecting it with the blood supplies in the neck – although the operating environment remained basic compared with those in Europe.

Mr Fourie said 60 patients were brought to the hospital and assessed.

About half of those suitable for often complex reconstructive surgery had noma and the remainder suffered from complaints including cancers of the jaw, burns, or severe animal bites.

"On the first day we saw all the patients together as a team to look at their problems and decide what we could do to draw up a surgical plan," he said.

"Many of them had veils on. When the veil came off one patient, you could hear our jaws drop, it was like something out of a horror film."

Despite the type of surgery being very different, he said his experience carrying out facelifts in his practice in Yorkshire helped in dealing with the difficult procedures involved because of the expertise he has developed about the blood supply to the face.

"What it does do is bring me back to earth, more than anything else," he said.

"This is real surgery, it really makes a difference. What is difficult is coming back and for instance seeing a patient who wants a facelift aged 32."

Mr Fourie trained in South Africa where did not see cases of noma but in a worrying development it is now emerging there, mainly in patients entering the country from neighbouring Zimbabwe.

"These children with noma are so malnourished they don't have the defences to deal with infection and so they get it in their gums and within days it will eat their cheeks away," he said.

Mr Fourie said he plans to travel to Ethiopia again in 18 months and hopes to put together another team of experts from Yorkshire and Lancashire.

The programme Make Me a New Face: Hope for Africa's Hidden Children will be shown next Wednesday at 9pm. Presenter Ben Fogle himself caught the flesh-eating disease leishmaniasis in 2008 which, if untreated, would have destroyed his face.

The film focuses on three children who lives have been blighted by noma. They include teenager Rashid, forced to hide his face in public, Asnake, 11, whose misshapen mouth makes him dribble constantly, and 10-year-old Mestikma, abandoned by her family because of her deformity.

Disfigurement creates outcasts

The disfiguring condition noma affects the face and mainly hits children under the age of six.

Those affected are usually malnourished and prone to the infection that begins in the mouth with ulcers and rapidly eats away the face, leaving a gaping hole in those that survive.

If quickly diagnosed, the condition can be halted with antibiotics and better nutrition.

But those whose lives are spared by the disease are unlikely to ever speak or eat normally again.

Their extensive disfigurement often means they are hidden away by families or left socially outcast.

The World Health Organisation estimates that about 140,000 cases occur each year, mainly in sub-Saharan countries but there are growing concerns it is on the increase in Africa.

First described by doctors in the 16th century, the condition had been virtually eliminated in Europe by the end of the Victorian era mainly primarily because of improved nutrition.

The last case in the UK was in the First World War but there were victims in the Nazi concentration camps.