Microsoft Word - Volunteer Handbook Final 2019 .docx

Volunteer Handbook
Complex Surgical Mission 2019

February 15th – April 13th







Welcome to Project Harar!


Thank you for volunteering your time with Project Harar!

Project Harar provides treatment for patients with facial disfigurements from some of the most remote
areas of rural Ethiopia. Facial disfigurements disproportionately affect the poorest people due to the lack
of availability of treatment in rural areas, the cost of accessing treatment and lack of knowledge of what
treatment is available. This is exacerbated by malnutrition, poor oral hygiene practices, and overall poor
health.

Those with facial disfigurements find it difficult to perform the functions that most of us take for granted –
eating, breathing or talking – and they also face great stigma and discrimination. Without the support of
Project Harar, their future will be bleak. They will live isolated lives, often hidden from sight and neglected,
unable to attend school, earn a living or get married. Most will become malnourished and many will die
prematurely.

The majority of our work focuses on treating patients with cleft lip and palate by providing outreach
services, surgery, nutritional support and speech and language therapy. Throughout the year, our outreach
team proactively engages with local communities to find some of the most isolated individuals with severe
facial disfigurements who are then treated during our complex surgical mission.

More information about our work can be found at www.projectharar.org

Please read this handbook carefully, as it details some of your key duties during your trip with Project
Harar. If you have any questions please email [email protected]

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What is the Complex Surgical Mission?


Once a year, Project Harar recruits and coordinates an international team of volunteer medical
professionals (surgeons, anaesthetists, doctors, nurses and dietitians) who travel to Addis Ababa to
operate on around 50 individuals from remote areas of Ethiopia, with severe facial disfigurements. These
include conditions such as noma – a flesh eating facial gangrene – life-threatening giant facial tumours,
wounds and scarring from animal attacks, lockjaw and complications as a result of harmful traditional
healing practices. Please see the list of the range of medical conditions you may encounter while
volunteering with us on pages 4-5.

If it were not for the complex mission, it would not currently be feasible in Ethiopia, to provide these
patients with the treatment that they need.

What to expect:

• Uplifting team atmosphere – everyone working towards a common goal
• To fall in love with the Ethiopian people and Ethiopia in general
• Hard and rewarding work
• Interaction with experienced Ethiopian medical teams
• Exposure to fascinating and advanced pathology
• Fantastic coffee!


What is the set-up for the complex mission?


Pre-Operative: 15th February-1st March: Our Complex Surgical Mission begins with two weeks of
comprehensive pre-operative care in a patient facility in Addis Ababa (details on centre TBC).

Operative: 2nd March-16th March: The two week operative stage will take place at Yekatit-12 government
hospital in Addis. It is home to the Ethiopian Plastic Surgery and Cleft Centre. All of the operations will be
carried out in this hospital along with the immediate post-operative care in the plastic surgery wards.

Post-Operative: 16th March-13th April: Patients are discharged from Yekatit-12 to the Cheshire
Rehabilitation Centre where the bulk of their post-op care will take place. Cheshire is located to the west of
Addis Ababa and is a place of peace and beauty.


















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Ethiopian Culture and Food


Ethiopia has a diverse mix of ethnic and linguistic backgrounds, with more than 80 different ethnic groups,
each with their own language, culture, custom and tradition. The most common languages in the Capital,
Addis Ababa, are Oromo and Amharic. Sometimes, to communicate with patients, you are required to
translate using a number of different people with different dialects.

The two main religions are Christianity (approximately 60% of the population) and Islam (approximately
30% of the population).

The Ethiopian calendar is the principal calendar used. It is a solar calendar, where each year contains 13
months. Therefore, they are 7 years behind the Gregorian calendar and it is currently 2011.

The most common form of greeting is a handshake with direct eye contact. The handshake is generally
much lighter than in Western cultures. Gifts may be given to celebrate events of significance or religious
occasions. Since Ethiopia is an extremely poor country, expensive gifts are not the norm. In fact, giving a
gift that is too expensive may be viewed negatively. It may embarrass the recipient if they are unable to
match it in kind. Ethiopians generally speak in soft tones. Loud voices are seen as too aggressive.

The Ethiopian National dish is called wat. However Ethiopian food is probably best known for the spongy
sourdough flatbread called Injera, made up of teff flour and water, which serves as the “spoon” for lentils,
beans, meat, and vegetable sauces piled on top. This is eaten with the right hand. There are also some
Italian influences on food with the popularity of pasta and pizza. The favourite drink of many Ethiopians is
bunna (coffee), pronounced boo-na. Other locally produced beverages are tella (traditional beer) and tej (a
mead or honey brewed wine).

Please let the UK office know if you have any dietary requirements as they will be booking your flights and
preparing your lunches during the pre-operative and operative weeks.





(Left: a typical Ethiopian meal with Injera; Right: a traditional Ethiopian coffee ceremony)



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What do you need to bring?


Clothing
It is advised you bring clothes that cover you up well - low cut tops, string vests and tight clothing can be
seen as disrespectful. Ethiopia is a modest country and we must be respectful of their culture. February is

at the end of the dry season and is considered one of the best times of the year to visit Ethiopia. During the
day it will be warm but because Addis is at an altitude, it can get chilly at night – the best thing is to bring
layers. Hospital dress code is similar to the UK. There will be the occasion to dress-up in the evening so it is
worth packing something for that, including jeans to dresses. You might want to also pack a swimming
costume for your time off. If you would like a recommended kit list, please email [email protected]

Baggage
The airline will allow 2 bags of 23kg, however for volunteers coming out during the pre-op and surgical
weeks, 1 of these bags will be packed by Project Harar staff and will include equipment and drugs for the
mission.

Electrical Items
Ethiopia uses the 2 prong European plugs. If you have any extension cords with these plugs please also
bring them along as often sockets are limited. You can bring electrical equipment out with you such as
laptops/iPads/phones, but volunteers must be responsible for all their own valuables. All hotels have Wi-Fi
although the speed is slow and power cuts are regular!

Medical equipment
Project Harar will provide the medical equipment needed but please bring a pack of gloves and aprons
with you. It is also definitely worth bringing a headlight and a decent camera if you have one (although not
a requirement!) Please get in touch with the Project Harar office if you would like to donate any nursing
equipment.


What conditions will you see?


The array of pathology you will see during the complex mission is quite incredible, fascinating and at times
quite daunting. Most of the pathology can actually be categorised into several groups.

The main categories of pathology that we have seen on previous missions include:

1.1 Tumours
1.1.1 Bony (CT scans are required for all bony tumours)

• Ameloblastoma

• Fibrous dysplasia of the facial skeleton

• Maxillary cyst

• Osteoma

• Malignant tumours

• Encephalocele (and other neurosurgery cases)

1.1.2 Soft tissue (Scans usually not required)

• Vascular malformations

• Lipoma

• Neurofibroma 4

• Parotid masses
• Lymphangioma
• Keloid scar
• Malignant (SCC)


1.2 Trauma
1.2.1 Interpersonal (mainly machete attacks)
1.2.2 Animal attacks (mainly Hyena attacks)
1.2.3 Iatrogenic or self-inflicted



1.3 Soft tissue defects
1.3.1 Peri-oral defects (usually the effects of Noma)
1.3.2 Nasal defects (May have resulted from pathologies including Noma, leishmaniasis, skin cancer or
syphilis)
1.3.3 Facial clefts
1.3.4 Burns


1.4 Trismus (OPG X-ray required)


2.0 What other conditions will you have to deal with?


2.1 Chronic co-morbidities
2.1.1 TB
2.1.2 HIV
2.1.3 Diabetes


2.2 Post-operative complications

2.2.1 Wound dehiscence
2.2.2 Wound infections
2.2.3 Chest infections
2.2.4 Bleeding
2.2.5 Pain
2.2.6 Trismus
2.2.7 Flap necrosis


Who to call if you need help


It is of utmost importance that our patients are safe and receive the best care that we can provide during
the duration of the mission and onwards into follow-up. From a medical perspective there are several key
people to contact during a medical emergency:


• Dr Mekonen Eshete – Head of Plastic Surgery at Yekatit-12 hospital ([email protected])
• Prof Mark McGurk – Medical Director for Project Harar ([email protected])
• Nominated Ethiopian Trainee at Yekatit-12 – more details to follow

There is a crisis management plan and patient safeguarding policy that will be circulated to all team
members. This provides details of how to escalate care in an emergency scenario (medical and non-
medical) with the necessary named contacts and their telephone numbers.

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• Help whilst in Yekatit-12 during the operative phase - During the operative phase there will be
plenty of people around to help, both from the Project Harar and Ethiopian teams. There will also be
a number of phones and walkie-talkies available (numbers will be circulated when you arrive in
Addis). The lead nurse and junior doctor will be easily contactable via mobile phone.


• Help whilst in Cheshire during the post-operative phase - If help is required whilst patients are in
Cheshire, the first port of call is to the Ethiopian Plastic surgery unit at Yekatit-12 Hospital. The
patient can be transferred to this unit if needed for intervention. The Project Harar medical team
will be contactable in the UK for advice.














We hope you have a fantastic and memorable mission!



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