2014 DAS honours - Chris and Terry Lawrence

 

DAS honours a great husband & wife for their lifetime contribution.

 

Noma (cancrum oris) is a devastating form of facial gangrene afflicting young children, mainly in sub- Saharan Africa; probably 80% die. Survivors suffer facial mutilation with high grades of trismus. The World Health Organisation estimates that Noma afflicts more than 140,000 people each year. Since less than 10% of cases are reported, this may be a gross underestimate.

 

Facing Africa is a UK-based charity, founded by Chris and Terry Lawrence. The charity provides free reconstructive surgery for Noma survivors in Ethiopia. Despite neither of the Lawrences having medical training, Chris was moved to form the charity with his wife after seeing a German TV documentary on the disease. Through enormous enthusiasm and motivation, Facing Africa recruits teams of nurses, surgeons and anaesthetists, all volunteers, to visit Ethiopia for two missions each year. Each anaesthetic team provides world-class airway management during every visit. Since 2007, Facing Africa has raised over £4 million for this cause and funded over 15 missions to Ethiopia. Nearly all patients need advanced difficult airway management to allow surgery; about 600 patients have been safely treated.

 

Most patients require fibre optics or video laryngoscopy and sometimes, uncommon techniques such as retrograde intubation or cricothyroidotomy for airway control. All anaesthetics have emphasis on contingency planning, both for tracheal intubation and extubation. Standards match or exceed those found anywhere in the world and to date; all have been safe and successful. This is especially commendable given that this has been achieved in the context of anaesthetic provision in the developing world. All drugs, disposables, equipment for surgery and anaesthesia are brought to Ethiopia. Two operating theatres and a ward are rented, travel and accommodation is arranged. Additionally, prospective patients are brought to a Leonard Cheshire Home outside Addis, housed, fed and prepared; all this is freely given. After surgery, patients return to the Home to recover. This is an enormous logistical, political, financial and diplomatic challenge, achieved twice a year since 2007.

 

All anaesthetists are enriched by their experiences, and the skills used are transferable to UK practice. Collaboration with the Royal College of Anaesthetists resulted in the Facing Africa Anaesthetic Fellowship, allowing a senior trainee to join a mission to learn these airway skills. Papers and presentations show the intensity of airway management; for example, the recent case series published by Coupe et al (Anesth Analg 2013; 117: 210-7)Facing Africa anaesthetists also teach Ethiopian trainees safe approaches to all forms of airway management, not just the difficult cases.

 

Through Facing Africa, Chris and Terry Lawrence have given anaesthetists great opportunities for difficult airway management for hundreds of patients. Facing Africa is at the forefront of difficult airway management and is now the only organisation anywhere providing this comprehensive care: “A new face, a new life, a new hope”, to quote Chris.