Medical care in Ethiopia
Project Harar Ethiopia is first and foremost a children’s health charity but we will not refuse anyone with a treatable facial disfigurement.
We work with skilled medics from Ethiopia and Europe and try to help improve the capacity of the Ethiopian health system.
We care for people with a range of conditions, disabilities and injuries, including:
• Cleft lip and/or palate• Noma, a devastating form of gangrene that attacks facial tissue
• Tumours and ameloblastomas
• Animal attack, accidents and burns victims
What is a cleft lip? What is a cleft palate?
Cleft lip and palate is a developmental problem in babies where the upper lip or palate (roof of the mouth) is not correctly joined, leading to a gap in either the palate or lip or both.
It is estimated that one in every 500-750 live births result in a cleft lip and/or palate. Babies can become severely malnourished as they are unable to breastfeed. Without a palate the child cannot speak properly. Teeth often develop at unusual and unsightly angles. Clefts may impede hearing and, if untreated, leave children prone to choking and diminished self-esteem.
Babies who are born with this condition in the UK are operated on soon after birth, but in most of Africa it is ignored. In Ethiopia the routine operation which rectifies the cleft is too expensive for most families. Project Harar can secure treatment in Ethiopia for less than £200, including travel and support for a guardian.
Noma (cancrum oris) is an acute gangrenous infection affecting the face. Its victims are usually young children aged 3 – 8 years. Noma was eradicated in Europe and the United States a century ago, save for outbreaks in Nazi concentration camps.
Noma persists in those countries, such as Ethiopia, which border the Sahara, the world’s ‘noma belt’. Noma is not contagious. The victims are mainly young children living in extreme poverty, with chronic malnutrition and lacking immunisation from common childhood illnesses such as measles.
When children have a high fever in a developed country, antibiotic medicines are available. This is not the case for many families in Africa. The children's antibodies that normally protect and fight a virus become 'confused'. They turn on their host body, attacking the soft tissue of the cheek, mouth and nose and causing terrible facial disfigurement.
Some 90 percent of its victims die within weeks of contracting this painful disease.
Though scientists cannot be sure of the prevalence of noma, the World Health Organisation estimates that there are approximately 770,000 survivors of noma, with 140,000 new incidences per year.
Working with our European partners and Ethiopian medics from the Yekatit 12 hospital, every year we organise patients from the poorest and most isolated areas to travel to Addis Ababa with guardians for treatment. The annual noma mission treats between 12 – 20 patients with the most devastating facial injuries.
Project Harar Ethiopia, the noma charity Facing Africa, the Dutch Noma Foundation and medics from across the UK have plans to organise additional noma missions from 2008.
Tumours and ameloblastomas - what we can do
Project Harar Ethiopia is finding a growing number of patients with prominent tumours effecting the face and neck. There are many forms of growths which affect children aged as young as two years. Ameloblastomas, a growth in the base of the tooth which can grow aggressively into the jaw and neck, tends to develop in teenagers and young adults.
The Ethiopian and Europeans doctors we work with have enjoyed great success tackling benign tumours. And we do all that is possible for young people with a cancerous tumour where the rewards outweigh the discomfort caused by surgery.
Sadly, Project Harar has identified that on some occasions children and young people with even benign tumours are inoperable due to the sheer size and extent of the growths and the implication for the brain and the blood supply.
This is why Project Harar is doing everything possible to enable and encourage patients to come forward and be treated long before growths become inoperable. We are also working with our partners to build surgical teams able to treat an even wider range of conditions.
Animal attack, accidents and burns victims
Children face a great deal of dangers living in hot, dry, farming areas of Africa, from attacks by wild animals to burns and other accidents.
In Harar, hyenas are a menace especially during droughts when, desperate for food and water, these predators go foraging in areas inhabited by humans.
Electricity for light, heating and cooking is rare in remote areas of the country so the people rely on open flames. Fires can quickly become out of control in the dry conditions near mud and wooden huts.
Sadly, terrible burns from accidents are seen regularly. Each patient requires a long term and painful course of treatment including skin grafts.
Project Harar is discovering a legacy of untreated facial injuries , including a man with a gunshot wound to the mouth received during the Ethiopian civil war, which ended in 1994.
Project Harar Ethiopia is determined to do all we can to ensure people with severe facial disfigurements receive effective medical care at the earliest opportunity. Please support us.
The Ethiopian health system and how we help
Doctors in Ethiopia
Ethiopia is one of the poorest countries in the world and its children suffer from all the associated impacts on health. According to the Unicef report, “The State of the World’s Children”, some 509,000 children aged under five years die every year in Ethiopia.
There is a lack of affordable, accessible medical care, especially outside the main cities.
As well as meeting the costs of a place at hospital and prescription medicines, Project Harar Ethiopia helps children in need whose families cannot afford to travel to hospital. Over 80 percent of the population lives in rural areas and some subsistence farmers cannot even afford the time away from the land.
“More Ethiopian doctors are practising in Chicago than in Ethiopia.” Population of Chicago: 2.9m According to the Ministry of Health there are just 144 surgeons and 31 anaesthesiologists. There are just eight plastic and reconstructive surgeons in the whole of Ethiopia. |
Ethiopian medical professionals are very skilled and can carry out many routine operations for our patients, such as the cleft lip and palate programme. However, they are unable to carry out more complex procedures so we work with European doctors who treat our patients requiring the most complex surgery and provide advanced training and better equipment to the Ethiopian doctors. The Ethiopian doctors are then able to offer even better surgical care to Project Harar patients throughout the year.
There are a number of major hospitals in Addis Ababa, the capital city of Ethiopia. Among them is the Yekatit-12 hospital – a basic, well-managed and peaceful hospital renovated in the past decade by the Government of Norway. The hospital is the leading centre for reconstructive surgery and paediatric burns treatment for the whole of Ethiopia.
Even this hospital lacks the basic equipment typical to a European hospital, from medical instruments, materials used by anaesthetists to simple suture products.
The main difficulty faced by patients from impoverished and isolated areas is the lack of affordable access to the capital city’s improving facilities. Some families do not understand that anything can be done for their child. As the vast majority of the population live in rural areas, Project Harar Ethiopia fulfils a vital role providing outreach into the remotest areas so that many more Ethiopians can access the national health system.
The young patients we care for all have one thing in common - they have serious facial disfigurement. But the operations they require couldn't be more different - ranging from the simplest to the most complex.
For children with a cleft lip and/or palate, all that is required to fully repair the lip is a remarkably simple and quick operation costing £200 and taking less than forty minutes. It can, if necessary, be completed under
local anaesthetic. The palate is treated in a separate operation six months later. Project Harar manages this follow up.
In contrast, patients with conditions such as noma, tumours, animal attack wounds and other conditions provide surgeons in the developing world with some of the greatest facial rebuilding challenges imaginable.
The survivors are grotesquely disfigured, often suffer total locked jaw (trismus). Incredible feats of reconstructive medicine are required.
Skin must be stretched, grafted and grown. The doctors must harvest cartilage, tissue and bone from one part of the body to repair and give function back to another. It is like rebuilding a delicate facial jigsaw
with half the parts missing. And it is the function that matters – the surgery is not cosmetic. Our surgeons always want to give good appearance back to the patients, but the greatest priority is giving back daily independence and dignity to our young patients.
