An evening with one of AMREF's famous Flying Doctors
By Kitty Reddington and Sam Hindels
On October 25, 2011, AMREF USA hosted a reception featuring Dr. Asrat Mengiste, Head Surgeon of AMREF’s Flying Doctors. Introductions were made by AMREF USA’s Executive Director Lisa Meadowcroft and Chair of the Board, Carol Jenkins. Dr. Mengiste started the evening by extending an invitation to everyone at the event to come visit Africa and see all that it has to offer, as he said the “memory will stay with you for a long time.” He then spoke about the work of the Flying Doctors and how in 2010 their clinical outreach program provided services to more than 20,000 patients in remote locations across Eastern Africa.
The main focus of Dr. Mengiste’s discussion was on reconstructive surgery, particularly cleft lip and palate. Dr. Mengiste, and his team perform a large majority of these surgeries in very rural and hard to access areas. The conditions that the doctors operate in are very extreme; the doctors are responsible not only for the surgery, but also for the local anesthetic and post-op care. There are limited medical supplies and often the conditions are not very sanitary. The doctors travel out to remote locations, and then spend up to a week doing surgeries from early in the morning until late at night. While they perform the surgeries, they are also training the local physicians to do the same. This creates an important multiplying effect.
Cleft lip and palate surgeries are important particularly in Africa for at least two reasons. In many communities deformities are not recognized as simple birth/genetic anomalies, they are seen as taboo, or a punishment for an ancestors bad actions. This leads to the person with the cleft lip/palate being ostracized by their community and often leads families to hide children effected in the home, not letting them go outside. If they are not treated at a young age, many children can die because they are unable to get proper nutrition due to an inability to suckle. People were curious as to why it appears that Africa has more cleft lip/palates than other parts of the world; Dr. Mengiste explained that Africa has a similar ratio as many as Western countries, but that the problem was the back-log of patients who were not treated at birth. The current back-log is suspected to be about 100,000 patients. Many individuals in Africa do not realize that a cleft lip/palate can easily be corrected through surgery and so if the children survive their first year of life without complications, fixing the cleft palate becomes less of a necessity; however, the change it creates for the patient is enormous. Dr. Mengiste mentioned that since the operation is not a priority for most countries, it is an area where AMREF can make a large impact.
Dr. Mengiste spoke of one patient who was much older than the children they normally focus operating on. The man was in his 50’s and insisted on the surgery. After six months when the doctors returned to this particular hospital for follow up, he actually returned, which is uncommon for most patients. He came with a group of people from his village who also had cleft palates. The surgery had changed his life so significantly that he wanted to ensure others were able to have the same opportunity. Word of mouth is important in the areas where Dr. Mengiste works because they are so rural, it is impossible to reach all the small communities.
Dr. Mengiste also acknowledged the significance of the partnership with Smile Train, an important funder of the AMREF cleft lip and palate program, and personally thanked them for their important contributions to this area. Before working with Smile Train, AMREF was doing about 200 cleft surgeries a year (2005), since we started working together AMREF has been able to do about 1,200 surgeries a year.
Dr. Mengiste concluded by saying that international collaboration is the way to move forward in order to tackle this life altering birth defect. More financial investments are needed in this area from both the U.S. and other countries.