Donate Form
Facing Africa Noma
Share This Page

Here is a reflection on his experiences in Mother Terresa Mission, home for the poor and dying, in Addis Ababa by one of our volunteer surgeons, Hiroshi Nishikawa, consultant craniafacial surgeon from Birmingham Childrens Hospital.


Nuns Story
Once or twice a year I travel to Ethiopia to operate on children and adults with severe facial deformity. These trips are funded by a charity known as Facing Africa. The CEO of the charity is Chris Lawrence. Chris, his wife Terry and their very able, hard-working team organise everything so that the surgery that is carried out is equal to the standard of the developed world. This means transporting, high quality equipment, well-trained and experienced surgeons (plastic and maxillofacial), anaesthetists, ward and theatre nurses to Ethiopia. Facing Africa also to puts into place everything needed to care for the patients before and after surgery. The paradigm is the brief transplant of surgical expertise and conditions of the developed world into the under-developed one to allow us to perform complex surgery. Facing Africa ensures that nursing and plastic surgery care is provided for the patients several weeks after we have all left. The logistics are complex and arduous. The charity primarily seeks out patients with Noma. This is a disease affecting mal-nourished children and is a condition only seen in poor countries. Noma starts as an intra-oral ulceration that quickly spreads to the rest of the mouth and face causing devastating destruction of both soft and hard tissue. There is a range of facial deformities that results from Noma such as missing lips, cheek and nose, loss of supporting structures that hold the eye in place or a total fusion of the jaw so they cannot open their mouths. In some unfortunate cases all these elements of deformity can be present in one patient. It is estimated by the WHO that there are about 140,000 cases of Noma a year in the world. The mortality rate is probably well over 90%, so only a small percentage will eventually be treated by Facing Africa. The charity searches for patients in cities as well as in remote parts of Ethiopia and although the primary aim is to find men, women and children with Noma, inevitably patients with facial deformity due to other diseases such as neurofibromatosis, vascular anomalies and facial tumours are also selected. This is because, for a short while during the duration of the mission, specialised surgical and anaesthetic expertise is available to help manage these difficult cases.

The surgical phase of the mission lasts for two weeks although patients are pre-treated for several weeks before we arrive. Their general condition is improved and on the day of our arrival we hold a major outpatient session. All the patients are examined and a management plan confirmed. The surgery is carried out in central Addis at a large, modern Korean Christian Mission hospital. This year we operated on 34 patients. For the first time I led a Facing Africa mission clinically. I felt privileged but also a little daunted. However I need not have been anxious because the team had a natural unity and it was a so good to be working with such dedicated, skilled, happy and positive colleagues. I will describe some of my surgical experiences in my next newsletter but I would like to relate one incident, which had a profound effect on me.

Shortly after the mission started, two nuns visited me. Contrary to my own ignorant pre-conceptions about nuns, they were young and attractive. In a charming French accent the senior nun requested that I treat her younger colleague who had a skin condition of one of her ears, which required minor surgery. I of course agreed and she had surgery within the hour, which was a service better than most healthcare delivery systems in the world! The next day the same senior nun came to see me with another junior sister with exactly the same ear problem. Again, I greed to help. The third day the nun came again with her driver with another kind of skin condition on the ear, which needed surgery. By this time I had become the butt of a few jokes from my colleagues that I had become the personal plastic surgeon to God’s servants on Earth. After treating the driver the nun asked me in her delightful French accent.

“Dr Hiroshi. Thank you very much for your help. Is there any thing that I can do for you?”
I thought for a moment and very diplomatically I answered, “ Please pray for the success of our mission”.
This was obviously the correct answer as she replied that she most certainly would and invited the team to visit her convent. On the last day of our mission we had time to visit the nun in central Addis Ababa. As our transport van entered the gates there was a sign overhead, which read:

Mother Theresa Hospice for The Incurables and The Dying.

A premonition ran through me similar to that which befell Dante as he entered Hell with the poet Virgil. The nun met me and explained to us the nature of her work. She explained that there are six hundred patients in the hospice. A lot of them are indeed incurable or dying. About forty patients die every month. “We care for them as much as we can”, she stated in a matter of fact way. She showed me the wards and I truly felt that if I had entered one of the circles of hell. Row upon row of sick men lying in beds arranged close together. Amputees, paralytics, terminal HIV and typhus cases along with some patients with the worst fungating tumours I have ever seen on their faces and bodies. The golden light of the late afternoon filtered through upper windows, casting an ethereal glow interrupted by black shadows flittering on the dying. Some had empty dark eyes where all hope and life seemed to have evaporated. Yet interspersed were men burning with the desire and a desperation to live. The nun asked my opinion on some of the gigantic facial tumours. I answered that we would need a biopsy diagnosis before I could be sure but even in my World, their chances would be slim and treatment would most probably be palliative.

The drugs to treat TB and HIV are free in Ethiopia. The TB wards were full of patient in various stages of convalescence. The nun informed me that one of the problems treating TB at the Hospice was that anti-tuberculous medication takes at least six months to work so some patients will abscond when they feel better. Many do not understand that the disease will return if their course of drugs is not completed. The female wards were just as extreme and crowded with HIV and TB patients. I will never forget the poor woman who was clearly insane raging against the world and wandering aimlessly around. Then in the final ward I saw hope. The nuns take in mothers who have babies born illegitimately (probably from abuse, rape or prostitution). Their families and society have rejected these young women. The nuns take care of them for about three months. During this time they teach them skills such as sewing or cooking so they have some chance of supporting themselves.

The nun suddenly excused herself. It is time to pray. We have to do this several times a day. They let us observe their prayers, which was held in a small chapel. There were about eight nuns chanting The Lord’s Prayer. They all knelt as one in front of a wooden Christ nailed to a cross. It was mesmeric. I have never felt such unquenchable faith and power. As our transport van rumbled out of the hospice on the first stage back to our own World we were all stunned into silence. The patients in the hospice were the “lucky ones”! Were we all just scratching the surface? There must be thousand out there who never make it to the nuns or to Facing Africa. What did this all mean? The human condition and the vast extent of its misery? Or the presence of immense beacons of charity and hope? I have to believe there will always be both. Its up to all of us to ignite the beacons…… and finally this experience has totally changed my attitude and understanding of nuns and the true meaning of their calling.

Hiroshi Nishikawa
June 2015





This entry was posted in News. Bookmark the permalink. Follow any comments here with the RSS feed for this post. Both comments and trackbacks are currently closed.
News & Events
Daniel Mullane, Patrick Seigne and Peter Lee, Cork – Addis Ababa Cycle

Dr Daniel Mullane, one of Facing Africa’s volunteer anaesthetist has decided to take on a massive challenge in aid of […]

Facing Africa October 2017 Mission video

Presenting Facing Africa October 2017 Mission video with a special thanks to Claire, our wonderful anesthetist, who managed to capture […]

Facing Africa on Savoo Search

We’re excited to announce Savoo Search, Save and Raise as our new fundraising partner, and we’d like to introduce you […]