Facing Africa Anaesthetic Fellowship: anaesthetic briefing notes and application information
The Facing Africa Anaesthetic Fellowship is funded by the Royal College of Anaesthetists for the
October mission. The successful Fellow will be a senior UK trainee (ST5 or senior) with a proven
interest in difficult airway management. The Fellow will be a member of a Facing Africa team visit. The
Fellow will be involved in shared management of about elective 40 cases, most of which are noma
survivors and very commonly have difficult airways. Full supervision and training is provided. Please
see the website for general information: www.facingafrica.org
Noma (Cancrum Oris, Gangrenous Stomatitis) is a devastating disease of malnutrition, mostly
afflicting young children. There is rapid necrosis of mouth and midface with 80% mortality. Survivors
suffer extensive facial destruction, distortion and disfigurement. The World Health Organisation
estimates that there are 140 000 cases each year, mostly in sub-Saharan Africa.
“Facing Africa” supports teams of Consultant Surgeons, Anaesthetists, Ward and Theatre Nurses to
provide surgery for facial reconstruction with rotation and free flaps. A team (about 15 members) visits
Addis Ababa for two weeks, twice a year. Two theatres at the MCM Hospital are used. All drugs and
equipment are brought from the UK or stored securely in Ethiopia. Theatres are equipped with
ventilators supplied with piped oxygen and air. Isoflurane, sevoflurane and halothane are used in
circle systems and monitoring to Association standards is routine. Patients recover on a ward staffed
by Facing Africa nurses.
DIFFICULT AIRWAY MANAGEMENT
Nearly all patients have recognised difficult airways. In particular, there are high grades of trismus and
restricted tissue mobility in the mouth, mandible and midface. Tracheal intubation using fibreoptics or
videolaryngoscopy are the usual methods selected for airway control. Advanced airway equipment
available includes fibreoptic bronchoscopes (with the Stortz Telepack system), videolaryngoscopes
(Glidescope, Mcgrath Mac), optical stylet (Bonfils), “front of neck” equipment (retrograde, narrow- and
wide-bore cricothyroidotomy devices) and Ventrain.
Currently three anaesthetists and a trained anaesthetic nurse, all with experience in difficult airways
(at least one experienced in Noma cases) provide anaesthesia for two adjacent theatres.
All cases are fully assessed with planning at two combined surgical/ anaesthetic meetings. Robust
airway management strategies for intubation and extubation are formulated. These conform to current
DAS and NAP4 guidance. Tracheal intubation is usually done under general anaesthesia, but awake
techniques are an option.
Patients selected for reconstructive surgery are either children or young adults. They are admitted to
the Menagesha Centre (a Leonard Cheshire Home) two weeks before surgery to improve their
nutrition and dental health. All are screened for Hepatitis B and HIV. After surgery, patients recover
first at the MCM hospital and return to Menagesha for rehabilitation for up to a month.
There is great potential for original research and audit. Written permission for publication and
presentation of data is obtained from patients or their guardian.
Teaching for hospital anaesthetic trainees is also offered. The appointed fellow should provide a
written report within four weeks of the visit for the College and Facing Africa.
SUMMARY
This is a great opportunity for the appointed fellow to learn advanced airway techniques in fibreoptics
and videolaryngoscopy over two weeks. The skills learned are transferable to UK difficult airway
practice. There is ample scope for lectures and presentation, raising the profile of the travelling
fellowship.
How to apply for the Anaesthetic Fellowship:
1Please check the RcoA website. The Fellowship is approved each year. If the Fellowship is
funded, it is announced in early March or April for the October mission for that year. The closing date
will be early summer, this is announced eac year.
2 If you wish to apply: You CV on one side of A4, Arial 9pt with: Biographical details, Airway
Experience, Prizes, Publications and statements about what a Facing Africa Trip can do for you and
what you can do for Facing Africa. The name of a suitable referee (no actual reference needed for
your initial application). No other CV needed. Each application is rated by a number of FA
anaesthetists, the highest scoring applicants will be offered a telephone interview. The successful
applicant only will need to provide a reference from a senior colleague e.g. college Tutor.
Send to: David Ball dball@nhs.net
Dr David Ball, Dr Bill Hamlin, Dr Grant Rodney (Facing Africa Anaesthetists)
General reference: Enwonwu C, Falker Jr WA, Phillips RS. Noma (cancrum oris) Lancet 368: 14756.
Anaesthesia reference: Coupe MH, Johnson D, Seigne P, Hamlin B. Airway management in
reconstructive surgery for Noma (Cancrum Oris). Anesthesia and Analgesia 2013; 117: 210–17.