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On the 10th may 2014, The first Facing Africa Noma Seminar and Workshop took place I’m the Royal Armouries Leeds. The day was organised by Kelvin Mizen and LeRoux Fourie.

In attendance

Founders: Chris and Terry Lawrence
Conference Organisers: Kelvin Mizen and LeRoux Fourie
Majj Aerts
Amaia Arana
David Ball
Louise Colignylaan
Michael Coupe
Susan Chriswick
David Dunaway
Judi Fourie
Joanna Gordon
Joanna Haines
George Hamlin
Gro Hotvedt
Doug Johnson
Lynsey Kirkham
Helen Lavelle
Tim Lloyd
Wytske Lunter
Ciara McMullin
Hiroshi Nishikawa
Clare O’Brien
Donna O’Kane
Eloise Phillips
Hinne Rakhorst
Grant Rodney
Helen Ruse
Fiona Stainthorpe
Lesley Thomas
Paulien Wenting
Julia Whiting
R.J. Zeeman



After a very smooth registration process, the audience of forty missioners, old and new, were greeted the founder of Facing Africa, Chris Lawrence.

Following this, feedback from the missions in 2012/2014 were presented. For newcomers this was an introduction and the first real insight into what the missions actually achieve. Hiroshi and Kelvin gave us insight into the types and numbers of cases that are presented and what can realistically be achieved. They summarised local anatomy but were mainly focusing on the follow up of these patients with pictures of returning patients. The many complications and the problems that arose following the operations were discussed; It was questioned whether there was a large enough margin observed when excising the Noma, with so much scar tissue involved in these lesions, the surgeons debated how much was realistically achievable to remove. Good feedback was given from the audience, the language used was understandable.

Communication with the patients was also a topic that was discussed in detail. It is extremely difficult to manage and consent patients with a language barrier. Suggestions were put forward to use WHO questionnaires and picture charts to aid communication.
Mid morning approached and this section was chaired by Bill Hamlin, Tim Lloyd gave an interesting presentation on the management of trismus. He explained use and techniques of physiotherapy post op which was most helpful to the carers in Cheshire house. Kelvin Mizen presented composite cheek defects and Hiroshi Nishikawa and LeRoux Fourie talked about upper and lower lip reconstruction. David Dunaway presented bone grafts and free flaps; success rates and compared them to results from the UK. He created quite a debate with statistics such as a 9% failure rate of free flaps, compared with 2.5% in UK and suggestions of over operating. This highlighted the importance of this event, with surgeons able to discuss and compare techniques and procedures and also the importance of patient selection. It was concluded that we should compare the free flaps done now to the previous Deltopectoral & TPF flaps. With the vast improvement between these it was decided that this 9% was acceptable, with, of course, ever striving to improve. One more important point to improve failure rate is when using Bone grafts, this should only be when there is complete coverage by vascular tissue. Again, this should be addressed with standardising the patients that are operated on and emphasised the importance of communication between each mission. It was admitted that we have a long way to go toward perfection but are on the right track.


After lunch, we broke into four groups; anaesthetic and ODP Group, nursing group, surgical group and scrub personnel group. David Bell then chaired these presentations and concluded on at least one take home message from each.

The anaesthetists decided that it was very worthwhile having a trainee with them, was a great help and a great experience. They look forward to doing it again.

The nursing groups had a few questions and requests of the surgeons; is it possible to decide and stick by a single antibiotic regime? They also decided they would construct a picture chart to help with communication between missioners and patients which will be ready for the next mission in October. They also clarified what notes where required to go from the ward to Cheshire House.

The surgeons decided on 3 days post op antibiotics; 3 IV doses with the remaining being oral. They also discussed excision margin and failure rate.

The scrub personnel are trying to reduce wastage, and have came up with a plan for each surgeon to be able to request materials and they will order and bring what is required.

For the ladies who collect data for research it was insightful, pointers where given of what more specific information is needed and will be used.

Chris then concluded with a small discussion on the future of facing Africa. From the feedback, it was unanimous that this should be an annual event, however, the time of year not everyone was happy with and there were suggestions to rotate the location between the north and south of England. All in all, a very productive and educational day for all.

Issues raised/future conferences

Surgical techniques regarding the removal of Noma

Standardisation of communication between patients and missioners with different languages

Collection of data after each missions

Historical operations

Standardisation of post op care

Reduction of waste


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