What an amazing surgical mission we have just had to Rwanda with the Face the Future Foundation!
My Foundation was established in 1994 and to date we have had missions to Russia and Guatemala. In February I was Chef de Mission of our first major mission to Kigali. Dr. Ife Sofola of Houston was Team Leader. Other facial reconstructive surgeons who donated their experience and time included Anthony Brissett (Baylor University, Houston), Daniel Alam (Cleveland Clinic, and surgeon who performed the first American face transplant), Kofi Boahene (Johns Hopkins University, Baltimore), Jose Barrera (United States Air Force, San Antonio), Sydney Butts (SUNY, Downstate New York), Joseph Kuang (anaesthesiologist, Houston), Joe Rohrer (United States Air Force resident surgeon, San Antonio), and Myriam Loyo (resident surgeon, Johns Hopkins University).
From Europe to Kigali was 4,000 miles into the heart of Africa. Following the terrible genocide in 1994 when over 800,000 people were killed in three months, Rwanda has made an amazing recovery. The 13 million citizens enjoy democracy with over half the members of government being women. Each provides one day a month of public service, and universal healthcare has been instituted. Agriculture, especially coffee and tea, provides 90% of the GDP, and per capita income is up to about 1,300 USD per year. Seeing the local gorillas in the wild is the major tourist attraction.
Rwanda has one plastic surgeon (and only 47 medical specialists of all types), and so it is impossible to treat all children and adults who need care. And although we were very impressed with the general quality of care provided by local surgeons, they simply cannot acquire the expertise, let alone the equipment, supplies and facilities, for the more complex cases. The result is many patients with severe facial deformities from birth, trauma or cancer remain untreated.
Dr. Charles Furaha, Rwanda’s plastic surgeon, identified 38 such patients on whom we consulted, many of them electronically even prior to our arrival. Our team operated on 17, and created plans for surgery on our next visit for several others. Our patients suffered from a wide variety of problems: congenital facial clefts; severe post cancer ablative deformities; major cheek, jaw and upper facial traumatic bony deformities with tissue loss; and a hand grenade explosion in the mouth destroying the lower half of the face, etc.
For the more major cases, some lasting 10 to 12 hours, two teams of two surgeons worked together harvesting donor bones and tissue from the arms and legs for the microvascular reconstruction to follow. Meanwhile, the other team removed tumour or made the bone cuts and applied screws and plates to create the essential new skeletal structure to receive the donor tissue to sculpt the new face. Happily, and with a great feeling of accomplishment, all of the cases proceeded smoothly with good results.
There was mutual agreement from our Rwandan colleagues, the Ministry of Health and our team that the mission was an outstanding success. Plans are already underway for a return visit next year. You can visit our Face the Future Foundation at http://facethefuturefoundation.ca for more information.
Peter A. Adamson, MD, FRCSC, FACS
President and Founder
Face the Future Foundation