Mr Marwan Al-Dawit

Patients clean and ready- check.
Patients admitted and medically & dentally fit- check.
Presentation finished and copies printed- check.

It was the day everyone had been waiting for. The day the patients would find out their fate. Some would be told they were going to die and that nothing could be done for them. Others told they were going to get a new face. It was a day that everyone would remember for different reasons and from varying perspectives.

Dawit’s dirt-stained white Toyota Landcruiser rolled up the driveway on yet another glorious sunny day in Menagasha. The 4x4 car was met by a similar response to any vehicle arriving at the Cheshire- swarmed by tens of patients, peering into the dusty windows to see who or what lies behind the glass. Out stepped three world-renowned European surgeons; Dominique, Brigitte, and Larry. One was the first to perform weightless surgery in space, the other with over 60 publications to her name and the third with his own private plastic surgery business in the UK, on his third visit to Ethiopia with Facing Africa. All different personalities in their own right, they were united by a lovingness to offer all that they can to these misfortunate people. The surgeons were accompanied by two Anaesthesiologists; Bill and Patrick, and two project managers/ theatre nurses; Anthea and Mick. As soon as the surgeons stepped foot onto the Cheshire soil, making their way to the guest house where lunch was prepared, they got cracking and began pushing and prodding at the patients faces, discussing what kind of operation they might need to perform together and how.

After lunch, we started our powerpoint case-based presentation with each patient coming in the room, introduced and examined by the team. After a discussion (some lasting 1 minute, others 45!), a decision was made whether to operate or not. The team was limited due to equipment, time and relevant expertise. Unfortunately one of the surgeons who deals with tumours had cancelled at the last minute, meaning that these types of cases were automatically excluded. It was a long day and by the end of it we were all exhausted. The surgical team all headed off back to their hotel in Addis whilst we stayed at the Cheshire, ready to start operating after the weekend.

On Monday we got cracking and started operating- first up, our little princess; Mistikina- for eight dental extractions to be done by Dr Hiba. The patient was to have a short burst anaesthetic, so Hiba only had ten to fifteen minutes to do them all. As it was the first patient, the operating theatre was packed full of all the surgeons, anaesthetists and staff with all eyes on Hiba. Naturally, I scrubbed up to assist in her monumentous task and together we prepared ourselves for Hiba’s toughest challenge yet. Bill, the anaesthetist, injected the magical white potion into Mistikina’s veins and her eyes began to glaze over. After a few seconds, she was out cold. “Get going, you haven’t got long”, Bill said. Like a poet in motion, Hiba began preparing the mouth with her dental instruments then with one flick of the wrist, out popped the teeth, one by one. After they were all out, some required stitching up and as Hiba struggled on the final stitches, Bill reminded us that we didn’t have long and the anaesthetic would rapidly be wearing off. I gave Hiba a hand and put in the last remaining stitches but as I started the final one there was a hand movement from Mistikina, followed by another. She was waking up, fast. With the sweat building up on my brow, I put in the final stitch and the job was done. During the daily surgical schedule, two teams of surgeons were operating on patients at the same time in two different theatres, so Hiba and I would spread ourselves in between them and try to learn as much as possible by watching, listening, practicing and assisting. I even managed to intubate two patients.

After operating, we would head out to dinner with the surgical team. It was a real honour to be in company of so many diverse and interesting people, each with their own unique stories and achievements. We would talk about each others stories and how we came to be out in Africa doing what we were doing. The surgical team were interested in our own particular story and why we have decided to take a year out of work in the UK to come and work in Africa. I think the fact that we’re Muslim also adds to people’s curiosity as perhaps they wouldn’t normally come across Muslims being involved in such matters and experiences. I therefore feel it more important that Hiba and I continue to work hard, travel and be open to new ideas and concepts as these experiences contain a knowledge hidden like pearls in the ocean, requiring more effort than just picking up a book and reading.

Having had their surgery and in a stable state, the patients would return to the Cheshire home for post-operative care and attention. My daily routine would start with a ward round at 08:30 which would mainly comprise of wound inspection (for infection and healing), pain relief and nutritional issues. This would be followed by wound care and removal of stitches when the time was right. After all this was done for each patient (roughly 38), I would have time to relax and enjoy the clear blue skies, strong sun and fresh breeze. I managed to come across an old acoustic guitar that I re-strung and tuned, and I would sit on the freshly cut grass and play songs for the children. At first, they were shy and I played alone, but soon they became interested and one by one they sat down and listened to my tunes. After a short while, a small crowd of some twenty or so patients sat round in a little huddle, listening intently to the notes my hands strummed away. The mother of one of the patients, a woman in her forties, stood up and started singing an Ethiopian version of Hallelujah. She closed her eyes, clutched her chest with both hands, looked up to the heavens and began to sing and dance. She was followed by one of the noma patients, and everyone got involved and began to clap their hands together to the beat. It was great to see all the noma patients smiling together and really enjoying themselves getting stuck in the moment. I passed my guitar around the circle and each patient had a go at playing it, laughing and giggling as they made their attempt. As we sang and enjoyed the music, the sun set on our priceless day.

Interestingly, I found out that Dawit in Ethiopian corresponds to Dawoud in Arabic, which is David in English. I just knew there was a connection with our friend Dawit...

Marwan

A sports day accompanied by bats and monkeys, seasoned with Mary’s freshly picked British Consulate Rose

Rosemary, Rosemary, where for art thou Rosemary? That is the not the question! Once an elegant herb instilled in our minds as a quintessential roasting accompaniment, now a weed in our mouths tying knots around our tongues.
Tongue tied?
No.
A tad melodramatic?
Perhaps.

To put things into perspective for those of you who have no idea what I’m talking about, we are blessed to have all our meals lovingly prepared by a pleasant and hospitable cook, Feloku. She will cook us whatever we want and has even provided a timetable to fill in so we can advise her as to what meals we would like on certain days. The first few had sprigs of Rosemary delicately laid on top and several strands lightly mixed in with the sauces. The aroma and flavours were delightful and was a subtle reminder of back home in England. Feloku must have sensed our pleasure and carried on adding more and more Rosemary to each of our meals so that in turn, every dish was loaded with the stuff and ended up tasting the same with only variations in texture! We would now long for the day where our taste buds could actually appreciate some traditional Ethiopian cuisine and not be reminded of our lovely Rosemary. This day eventually came and Rosemary now rests in peace in our stomachs.

Monday brought about a second invitation to a coffee ceremony by a local neighbour, Ayo. Ayo is a social worker working at and living in the Cheshire. She was once affected by Polio, and offers the children counsel as well as general esteem support. She is a short lady, wearing a big smile and walks with a limp using a crutch as an aid. This ceremony was similar in essence to our first experience except the fact it took place outside under the crystal clear star-lit night sky and that the actual coffee making and serving process was carried out in the background by a maid whilst we all sat round a small warm fire. We were joined by Daniel, a manager at the Cheshire who has always been very welcoming to us and teaches us a lot about Ethiopian culture and re-iterates the fact that the origins of man are from these lands. We also became acquainted with a guy who originates from Ethiopia but immigrated to the US, DC. He is a graphic designer who was visiting family here and spoke of his hardships starting from the bottom of the food chain and working his way up to where he is now; waiting for a lucky break. He describes that the life there isn’t as rosy as it’s made out to be, and to our surprise, his desire to return to Ethiopia once he can.

The sports day finally came with a little push and shove here and there. I’ve organised things like this before back home, but here it was a totally different kettle of fish! Language barriers, new concepts and organisation were all obstacles I had to overcome in order to make this the huge success it eventually became. I had employed the services of one of the local teachers, Hailu to act as interpreter, instructor and authoritarian. After painstakingly arranging all sixty or so boys and girls into ten teams with their own chosen team names, I began explaining the games each in turn, beginning with the egg and spoon race. To be satisfied that I had tried my hardest to explain the game, we would show them a live example between us guys. Nothing got the kids laughing harder than watching me jump up and down in a potato sack 50 meters across the grass and back! After a sunshine-filled morning of activity and fun we eventually announced the scores and the final team standings. So what of prizes? The previous day a lady called Marie had arranged for us to collect clothes from the British Embassy, donated from the UK. There was an array of high-street wear ranging from Pierre Cardin suits to Ralph Lauren Polo t-shirts to Diesel dresses to Clarks shoes and even Arsenal football shirts still bearing the £45 UK price tag! We sorted the clothes out into male/female, children/adults and types. The winning team of the sports day (named ‘Aklilu’ due to three members of their team bearing this name) earned first choice of two items to take from our end of rainy season collection. The first two items to go were the Arsenal shirts! For your info, the English Premier League is followed religiously here and the nation’s two favourite teams are Arsenal and Manchester United. After everyone from the winning team had taken two items, the team in second place got their turn and so on until all participants in the sports day were fully kitted-out in designer gear, ready to walk down any cat-walk.

The day was completed when I beat my once table-tennis rival Dawit a much to be desired 4-0, finding a new nemesis in Gezahegn (pronounced Gezahin), one of Dawit’s friends who shares duties with him in transporting members of Facing Africa around town to the various hospitals and centres. However, no day could be complete or even begin without mentioning our new found friends at the Cheshire, the ever-inquisitive, adaptable and widespread Vervet Monkey. They surround our home, based on tree-tops, roofs and anything up high, waiting for the chance to ambush an avocado skin or left out stale bread piece and are a source of great amusement for myself and Hiba.

The monkeys have just recently been out done when one night after returning home after a long day at work we were met by two challenges. The first being the regular but short-lived occurrence of a power cut; no big deal. So we continued preparing and eating our candle-lit dinner for two until whilst chatting to Hiba I saw something whiz past her head. At first I thought nothing of it and continued our conversation. I then wondered what it might have been and whether I should mention it to her. This time I thought that it was probably a moth or some kind of small insect flying past and didn’t want to worry her. But my mind wouldn’t accept this and I told her that something flew past her head. I quickly shined my torch to the ceiling across the room to find a bat ducking and diving through the darkened air! After a brief unsuccessful spell of trying to force the bat out the window, I resigned myself to calling the local guards to come in and give me a hand in trapping the bat in an envelope and releasing it back into the wild. The next day we discovered a gap in the wall/ceiling and had it plastered up, allowing our minds to be at ease.

The surgeons arrived on Saturday and operations have already begun, but this will follow in my next post.

Until then.

Marwan

Surgeons...Here They Come

Another week in and we're now into the second stage of our project here. On Monday the surgery begins. We spent last week making sure each patient was upto speed with their toothbrushing and medical checks. Betty, a second dental student from Addis spent the week with me helping scale all the patient's largely grotty teeth in order to make them ready for the weekend. On friday, the first of our team mates arrived, Anthea and Mick. We met them in the evening and enjoyed a meal at Serenade along with Roos, a dutch doctor who has been on many previous Noma projects in Ethiopia and will be a great source of advice and help to us over the coming weeks. And finally the day they'd all been waiting for.......Saturday which brought the arrival of the surgeons, Larry, Dominique and Brigitte. As a punishment for them being upgraded to business class, they were only allowed to drop of their luggage before being driven up the hilly road to the Cheshire where they were greeted by all the excited and eager patients. After a brief introduction and a traditional ethiopian lunch, the long and tiring afternoon began where each patient was seen by the surgeons and a decision made whether surgery would be done or not. This process was further slowed by a 3 hour powercut, which was eventually resolved but still meant we finished after the sun was long gone. Having sent the surgeons back on their way, the pain-staking process of breaking bad news began, having to tell some of the patients that they would not be having any surgery. Having spent 2 weeks feeding, entertaining, playing and bonding with some of the most lovely people ever, this was a truly heartbreaking thing to have to do. Having said goodbye to Abiot and Dawit, 2 of the safest guys ever, who did so much translating and rounding up and handing out milkshake for us, the tears were impossible to hold back. We were exhausted and decided to leave this for a day, they already had an idea from their talk with the surgeons and saying goodbye to so many was too much for anyone after a long day like that.

Three cups of coffee

It’s been a busy week running clinics at the CURE hospital as well as organising things on the ground here at the Cheshire. Patients from across the land have now heard about what we’re doing and they all see this as their one and only chance to get the help restarting the walk on normal life they deserve. Each day we’re inundated with calls from various medical personnel dispersed across the country, finding people of every age and every disfiguring condition, willing to travel days in the hope of a cure to their ailment. I’ve been visiting children at the eclectic and saintly Mother Teresa hospital, an institution run by nuns from across the world, harbouring images and deep symbols of Christianity and Christ. The work done there is a great inspiration to all humanity.

The total bed capacity of the Cheshire (forty) has been reached and now I am beginning to appreciate the pain staking role of the ‘bed mangers’ back home in our wonderful NHS. It has become a balance between those who desperately need the close attention here and transferring whom would still benefit from surgery but are in more stable conditions to other institutions/ centres. The problem is that the number of days and hours our surgeons will be operating is limited (14 days) and as the number of cases increases, the likelihood of eventually turning people down is steeply rising.

One night we were invited to a coffee ceremony by a lady called Meraf, an Ethiopian dental student who’s on her elective working with and aiding Hiba. The ceremony began by setting the scene; candles dotted around the room (due to a power cut, not tradition!), a hand-made straw-like rug, fresh coffee beans with a coal stove and raised tray housing multiple small china coffee cups and saucers. We dry-fried the coffee beans turning them from a yellow/grey to the deep totally-cocoa colour we know and love. This was followed by crushing the beans up using a pestle and mortar to transform them into a fine powder. The powder was spooned into a traditional Ethiopian coffee pot, water added and then placed back onto the smouldering coal pieces, allowed to boil and then cool before serving. The coffee tasted fantastic, although bitter and traditionally one should drink three cups, the third being the most important and known as the Barika (blessing) cup. The night was spent laughing and joking, talking about culture and tradition. It’s great to see age-old customs valued and practiced and not swept under the carpet of capitalism. A night never to forget.

Yesterday we visited Menegasha National Park, a forest with multiple vibrant and lively trails full of wildlife leading to waterfalls, hilltops and mountain paths. We were joined by Meraf (the dental student) and Dawit, our personal driver/guidebook/ATM/translator and friend. He’s a truly wonderful guy who’s just had a healthy baby boy born today (congratulations to him) and bears a sneaky resemblance to my uncle Amir from Canada. He’s a local producer and works with Facing Africa as a local manager/ fixer and has now become my table tennis rival at the Cheshire (!). The National Park was about 18km from the Cheshire and the route there was one passing tiny little villages housing farmers, cattle, waving children and women with their daughters carrying bunches of straw and sticks on their backs, walking back home from a hard days work. We arrived at the park to be met by a timid baboon and began our trek through the forest, making our way through winding dirt tracks cloaked by tall ancient colourful trees and a plethora of birds, warthogs, monkeys and insects! We eventually reached the dainty waterfall and enjoyed the fresh cool down.

This new week we plan on having a ‘sports day’ for our patients at the Cheshire, boasting the good-old egg and spoon race, three legged man and relay sprint.

Join us!

Marwan

An ode to a little princess...

It’s been a week now since we arrived here and a very busy one too. We’ve tried to get through all the patients but more and more keep turning up every day. Arranging logistics and admin as well as our own medical clinics make it a round the clock job since we spend a lot of our evenings discussing, planning and organizing the whole project. At the moment we are the only representatives of the charity here so all the locals assume we have all the power and influence in decision making and all the knowledge of past, present and future. It’s a big responsibility but I think we’ve taken to it well. (Chris has given us Power of Attorney on most things, bless him but unless you feel fit to make these all important calls it’s quite overwhelming!)

The patients are brilliant! They make it so worthwhile. We’ve got almost 50 now and some of them are ever so lovely and helpful. We’ve gotten to know them really well now through football, milkshake time and clinics. We’ve been giving them this super calorific milkshake made from bananas, full fat milk, full fat milk powder, peanut butter and honey to try fatten them up a bit before surgery, the ultimate body builder!! It’s gone down a treat with most although some of the girls aren’t so keen; perhaps they clocked onto the calorific content!!!! And the hats……Terry and Chris gave us some wooly hats to bring over from England which some old ladies had knitted for the patients and boy were they popular! We offered them to everyone on the first day, and they all took one and haven’t taken them off their heads since. What’s more all the guys inc. fully grown adult men always seem to go for the fluorescent pink or lilac ones!!!!

Emotionally it’s been somewhat challenging but I guess I’ve found a way to keep focused on the job and remain professional and slightly distant during clinic to prevent lacrimal overspill! Maintaining a professional attitude helps get the job done, which in the long run is more beneficial to them anyway, although naturally there is an emotional amount of empathy expressed when you hear about some of their endurances and stories. One guy had his nose bitten off by a tiger when he was trying to save a friend under attack by the wild cat. Another was kicked in the face by horse, another burnt by an oil lamp! Outside of clinics is when we get chance to really bond with them through sports and playing and chatting to them in broken English and Amharic. I know we’re not supposed to have favourites and I’ m trying hard to remain neutral but there’s this one little girl who’s stolen my heart and crushed it up into tiny little pieces. My little Mistikigna……she is really, the most adorable, cutest little girl ever. She’s so pretty and has the sweetest little voice and the most beautiful smile, but of course that’s only one side of her face. The other side she keeps covered with her bright little scarf; you wouldn’t want to see the other side of her face; the side that poverty destroyed. She really gets me every time. The thing that angers me so much is that she would have had to be so, so malnourished for this terrible disease to have been able to take over and for so long to have let it get so far and to have consumed so much of her beautiful little face. And surrounded by such ignorant or uniformed people, or even neglected by them for them not to have known where to find any help until now. (Not that it’s their fault, some of the simpler rural communities here are so isolated and truly a million miles away from any of the common knowledge or advances that we in the West have come to take for granted.) That’s my little Mistikigna…..In Arabic the word “Miskina” means poor girl and is colloquially used to say “awww poor thing”. Her name sounds so close to it and she really does fit the phrase poor little thing. I’m counting down the days until I’ll be able to see her reveal the other half of her face and pray that we can do something to help her and that she recovers well. Please pray with me.

Hiba

First impressions

Wow, it’s certainly a million miles from home. Whether it’s the shanty corrugated houses or the cute loaded donkeys casually crossing the street, you won’t see anything like it back in the UK. Addis Ababa itself is a very big, vibrant, bustling city, with so much going on, so many sounds, smells, sights and people. It really amazes you how hard people work, everyone is either carrying some kind of local produce e.g. firewood, vegetables, livestock or hopping on a bus to school or college. And so many have to walk so far in the morning, especially the farmer kids who live outside the city and have to walk a good 10-20km to get to school! But we’re not actually in Addis itself. You've already got an idea of our beautifully scenic location in the hills of Menagasha. We're very busy and are having a wonderful time with our patients and are getting to know our surroundings well.

Hiba

Hi everybody,

Missing you all so much already. this place is great....work is very intense though so not had much time to ourselves yet. Very vibrant and bustling city though we're in the equivalent of the yorkshire dales here-good fresh air and lots of animals!!!! Hope you're all doing well.

Mama and baba i love you lots and am thinking of you all the time.
Boys-i miss you guys so much, you're the best Bros ever and am so grateful for all your help in the mad rush last week.
Al Dawouds: every single one of you including Victoir and the pets, miss you all so much and very happy to have shared some mad moments with you all last week. Send my love to Bibi.

Take care of yourselves and we'll try be in touch as much as we can, but be aware that getting internet here is a slow, laborious and sometimes disappointing process, but we're trying our best!!

Hiba and Marwan

First stop- Addis Ababa, Ethiopia with ‘Facing Africa’ www.facingafrica.org

So……Africa……

Every part of the journey getting here has been fascinating. From the flight, full of Westerners going to climb Mount Kilamanjaro to the culture shock when driving through the city, seeing people working and living around shanty-villages and mud huts. We arrived at our home, the Cheshire home- built by Leonard Cheshire after the Second World War, met with swarms of smiling and waving little children, all with varying deformities affecting their legs, feet, hands and faces. They had been expecting us and everyone at the home, some seventy people, were there to receive and show us around the unit and our quarters; a one-hundred year old magnificent guest house, built for the infamous emperor Haile Silase as a retreat. The home is set in the lush green countryside with small mountains and trees in the horizon, with wild animals roaming free aplenty. After a brief rest (deep sleep for Hiba!), we got to work and started organising and preparing our patients that had arrived from the most remote parts of Ethiopia. These humble and friendly people, with horrific disfiguring conditions affecting their faces would follow every misunderstood English word we uttered and action we demonstrated as if their lives depended on it. That night was a bonfire celebration for Meskel, an Orthodox Christian festival. The children and adults danced around the fire singing songs in Amharic and the horizon was filled with scattered flames in the distance reflecting the nation celebrating this festive day.

Communicating with the patients is very challenging as they do not speak any English and the fact that Ethiopia has around 80 different languages, so even learning a few words only aides a small amount! The one thing that every boy knows around the world, and now I really know it’s around the world is….’FOOTBALL’!! As soon as I mentioned it, they all began to jump up and down and got ready to play on the grass, organising themselves into two teams and making goal posts from bricks. Luckily, I had come prepared with proper footballs and a pump and we all soon got into a great match, which would instantaneously become a daily ritual.

The new week brought upon serious work where we set up and ran our own clinics, assessing the patients from a medical and dental perspective. Using the nurses as translators we tried our best to get as much information from the patients as possible. If the nurses didn’t understand the patients dialect/ language then we even had to do four-way translations with myself asking the patient a question via the nurse, who asks the same question to the second translator in Amharic, who then asks the patient the question in the dialect they understand. The patient would respond and then bounce the answer back via the chain eventually to me, who perhaps hears a completely different response to a completely different question that was originally asked!!! (hope you followed that!).

So the rest of the week promises to be a busy one, seeing all the patients, playing football (how tiresome!), and also starting work at the CURE hospital, where the patients will eventually be operated on.

Finally, apologies for the delay in getting this post up (I wrote it like 3 days ago but internet access is hard to find and terrible when it comes!)

More to come….

Marwan