I noticed her move with quiet grace around
The Plaster House, shielding a secret behind her mask. Two days later, lying on the operating room table, Rose*, a 25-year-old Tanzanian woman, was being prepped for a procedure that would change her life. It was then that I discovered Rose had been viciously attacked last year by a wild hyena. The ruthless animal mercilessly took her right forearm, four fingers on her left hand, and severely disfigured her face, leaving her without a nose and upper lip. It’s nothing short of a miracle that she survived these devastating injuries.
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Plastic surgery is a relatively new specialty in the country with only six surgeons who completed a full residency program in recent years. The injuries Rose incurred required advanced surgical techniques that have not yet been mastered by the newly trained physicians. Enter Dr. William Brown, founder of
One World Medical Relief, a U.S. based non-profit organization, comprised of passionate plastic and reconstructive surgeons that have been traveling to Tanzania twice a year for close to 30 years to perform highly specialized operative procedures that are beyond the current capabilities of local medical professionals. Dr. Bill had met Rose during his visit last March and had been planning his surgical approach for months, which he admitted kept him awake most nights. My husband, David, Dr. Bill’s partner for 16 years, recently traveled with him on several medical missions to Tanzania. Last month, together with the surgical team at the Foundation for African Medicine and Education (FAME) hospital in Karatu, they performed two complex procedures involving a pedicle flap transferred from Rose’s forehead to reconstruct her nose and an Abbe pedicle flap retrieved from her lower lip to reconstruct the upper lip. A nasal trumpet was repurposed into two stents to keep her nasal passages open as she heals. I accompanied David and Dr. Bill on this recent trip and assisted as one of the circulating nurses during the case. The procedures went well but her first few days post-op were rough. Rose could not speak as her lips were sutured together in one area to allow the flap to take hold. Her lips will then need to be surgically divided in 3-4 weeks by the local general surgeon. Despite her discomfort, we could see the courage and resilience in her eyes. We’ve received updates that her recovery continues free of complications.
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Our two sons, Ethan and Ryan also joined us on the transatlantic journey to East Africa and had an opportunity to volunteer at The Plaster House.
The Plaster House is a non-profit organization that provides care to 700 children and select adult patients each year. Founded by visionary Sarah Rejman in 2006, The Plaster House mission is “to offer high love, low-cost surgical rehabilitation for children with a disability in Tanzania.” The team of dedicated occupational therapists, nurses, medical attendants, housemothers, and support staff work in unison to ensure each child receives proper nutrition and medical attention to promote healing in a safe and nurturing environment. Children and their families travel from all regions of Tanzania to be treated for a variety of disorders including clubfoot, skeletal fluorosis, cleft lip and palate, congenital disorders such as hydrocephalus, as well as treatment for severe burn injuries. Sarah, along with Keira DiSpirito (in charge of Clinical Services at The Plaster House), work with surgical teams both domestically and abroad to identify patients and coordinate all logistics required to perform the procedures. Post-operatively, the children return to The Plaster House for recovery and physical rehab. Ethan and Ryan spent the week engaging in play and providing much needed attention and distraction for the youngsters. They enjoyed their interactions, handing out yo-yos, puzzles, stickers, and candy, and were thrilled to help bring some laughter and joy, especially to those with minimal mobility confined to their bed.
Clubfoot
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We take it for granted that each of the disorders mentioned above are expeditiously diagnosed and treated in the United States. But that isn’t the case in Tanzania. For example, in the U.S., clubfoot can be identified in utero with prenatal ultrasounds which are then treated soon after birth with excellent outcomes. In Tanzania, most of the children cannot obtain treatment until much later in life, if at all. According to the World Health Organization (2023), approximately 100,000 babies worldwide are born with a clubfoot each year. It is a birth defect in which an infant’s foot or feet turn inward caused by shorter and tighter tendons in the leg, inhibiting a child’s ability to stand and walk. Treatment should begin as soon as possible and commonly involves the Ponseti method. Keira, an occupational therapist by trade, describes the nonsurgical approach as “stretching and positioning the child’s foot toward the correct position and then casting the leg from the toes to their upper thigh.” The process is repeated every four to seven days with repositioning and a new cast. The length of treatment is typically two to three months followed by intense rehab. The Plaster House, so aptly named for the serial casting treatments they provide, fills the healthcare gap for children that would otherwise not have access to this life-changing therapy.
Skeletal Fluorosis
Ground water contains fluoride in varying amounts. While controversial, some public water supplies in the U.S. are fluoridated to reduce dental cavities. However too much fluoride can have toxic effects. Fluorosis, or chronic fluoride toxicity, is caused by high fluoride concentrations in drinking water, commonly found in regions of Africa and Asia, affecting millions. Habitual ingestion of high doses may lead to dental fluorosis, a mottling of the teeth. In severe cases, it can result in skeletal fluorosis causing weaker and brittle bones, muscle wasting, and calcification of ligaments and tendons leading to reduced joint mobility, pain, deformities, and fractures (Pazirandeh, Burns and Griffin, 2022). High levels of fluoride in areas of Tanzania are a major public health concern. There is no cure, but in some cases, it can be reversed. The Plaster House works with children impacted by this disorder, casting their joints as the bones continue to develop to prevent long-term crippling.
Cleft Lip and Palate
Cleft lip and palate are other congenital defects that are treated promptly in the U.S. They occur when the tissues of the upper lip and roof of the mouth don’t join completely during fetal development. A combination of genetic and environmental factors contributes to the defect, including vitamin deficiency (folic acid), smoking during pregnancy, substance abuse, genetic disorders (DiGeorge syndrome or Pierre Robin sequence) or medications (antiseizure drugs, acne treatments, or methotrexate) (Cleveland Clinic, 2022). Clefts negatively impact eating, breastfeeding, hearing, and speaking, and can cause dental issues such as cavities and missing, malformed, or displaced teeth. In addition, the physical deformity often results in poor self-esteem, emotional, social, and behavioral problems in young children. More importantly, in many countries, the defect leads to isolation and often neglect of the child. The surgical repair is typically divided into two stages: the cleft lip is first repaired between 3 and 6 months of age followed by closure of the cleft palate between 12 and 18 months. During our time in Karatu, Dr. David and Dr. Bill performed 18 cleft lip and palate repairs while training one of the local plastic surgeons, Dr. Edwin, on the Furlow double-opposing z-plasty technique. David had an opportunity to see several of his patients whom he operated on last March doing well and return for the second stage palate closure.
Burn Contractures
Lastly, in addition to Rose’s heartbreaking story, we encountered several children who suffered from severe burn injuries. Many families in Tanzania do not have electricity or running water, forcing them to rely on wood fires within their homes for cooking and warmth. Parents must go to work each day, leaving their children unattended, and unfortunately accidents happen. Yvonne* is a 7-year-old girl who suffered from significant full thickness burns of her chest, abdomen, hips, and legs when her clothes caught on fire. Her parents had left for work that morning and she had to endure her injuries alone until they returned that evening. They did not seek medical treatment right away, instead allowing the burns to heal at home resulting in bilateral hip contractures that prevented Yvonne from walking upright. Dr. Bill, Dr. David and Dr. Edwin released the contractures and performed bilateral gracilis muscle flaps to the groin areas. The gracilis is a long, thin muscle of the inner thigh, and in Yvonne’s case, her burns were so significant the contractures obscured her anatomy making the muscle harvest extremely problematic. Working together, the surgeons successfully completed the procedure and improved Yvonne’s overall mobility. In total, the surgical team released eight burn contractures that week.
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Operative Setting
The operating theatres were a pleasant surprise — clean and well organized. We experienced momentary blackouts in the middle of a few of the procedures as the electrical generator intermittently shut down, yet everyone proceeded undeterred until the lights resumed normal function. The FAME staff was remarkable, moving swiftly and fluidly, adhering to strict sterile technique and standard operating room procedures. Everyone spoke English which was essential since our Swahili was limited. Dr. David and Dr. Bill are accustomed to having specific equipment and instruments on hand but when not available, the nurses were able to think on their feet and implement an innovative solution. They were unfamiliar with some of the instruments used, but they were extremely flexible, stepped up to every challenge, and learned on the fly. The days were long and exhausting, yet all were focused on the end-goal. It was an honor to work alongside this talented and motivated group of healthcare professionals at FAME Hospital.
Thank You!
Special thanks to Dr. William Brown, Sarah Rejman and Keira DiSpirito for taking care of us on this journey. The trip exceeded all our expectations, and we were received with tremendous warmth and hospitality. We met Tanzanians from different tribes including the Maasai, Chagga, Iraqw, Datoga, and the last hunter-gatherers, the Hadzabe. It was a diverse population, yet they all shared the same foundational qualities of kindness and generosity.
While we believe in giving back locally, we also feel it is important to step out of our comfort zone and into the unfamiliar, to help people with no sense of entitlement, filled only with gratitude. With hearts forever changed, we look forward to returning again and again. Thank you, Tanzania!
To learn more about these organizations and to donate, please visit:
www.oneworldmedicalrelief.org
www.theplasterhouse.org
*Note: Patient names have been changed to protect their privacy.
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