Surgeons’ mission faces a hard graft

A life-saving charity has been officially launched with the mission to twin every British plastic surgery unit with one in a developing country. Tingy Simoes reports

Dr Barbara JemecSet up by consultant plastic surgeon Miss Barbara Jemec (right), BFIRST – the British Foundation for Inter­national Reconstructive Surgery and Training – has already sent UK surgeons to Cambodia.

It is planning to work with other countries such as Myanmar and Bangladesh to deliver training and surgical skills to local medics, ensuring that everyone has access to expert surgical care.

With deformities and traumatic injuries often resulting in social exclusion, poverty and destitution, BFIRST not only trains surgeons on location, but also ensures that the training has practical longevity and is tailored according to the resources available. This means that each country will have a unique package that best fits their needs and available resources.

The charity, launched at the British Association of Plastic, Reconstruc­tive and Aesthetic Surgeons’ (BAPRAS) Winter Scien­tific Meeting at the Royal College of Surgeons of England, recognises that the benefits of such a drive are mutual, with UK-based surgeons also learning valuable skills while at the location.

London-based plastic and recon­structive surgeon Mr Greg O’Toole was supported by BFIRST on a recent trip to Cambodia.

He says: ‘BFIRST supported my trip to the Children’s Surgical Centre in Phnom Penh, which offers free care to Cambodians. We treated many patients with injury to the brachial plexus – the spaghetti junction of nerves in the neck that supply the arm and hand.

‘These injuries are often the result of a moped accident, as the rider lands awkwardly and stretches the nerves beyond breaking point. Operations included nerve grafts and tendon transfer procedures.’

Severe burns

Mr O’Toole added: ‘We also saw several children with severe burns. Much of life in rural communities has not changed in centuries, with reliance on fire for food and warmth.’

‘Toddlers are drawn to the flames with inevitable consequences; their hands grasp red hot embers, which melt fingers together and all are then lost in a ball of scar.

‘To be able to use their hands again gives these vulnerable children the chance to return to their lives and their schools and one day to plough the fields, harvest the rice and support families of their own.’

The training means that local clinicians become equipped to treat a wide range of conditions, such as cleft lip and palate, life-altering burns, congenital def­orm­ities and injuries, which may otherwise result in abandonment in the case of babies and children, or marginalisation and loss of work in the case of adults.

Ranging from simple surgical techniques to more complex procedures, training will give surgeons the skills that are taken for granted in First World countries.

The educational programme is hands-on, face-to-face tutoring in the local environment, treating reconstructive problems using local resources.

BFIRST’s training packages also incorporate training for surgeons’ staff, such as nurses and therapists, enabling the medical and surgical team to provide holistic care for all patients. The charity is currently training a number of surgeons abroad, including three in Cambodia.

Chairman of BFIRST Miss Jemec says: ‘BFIRST equips surgeons with an array of key skills, allowing them to offer life-saving – and livelihood-saving – care. The vision for BFIRST is to provide surgeons in developing countries the skill set they require to continue using the techniques they have learned via our tailored training packages.

‘Our long-term vision is to have most of the UK plastic surgery units twinned with a unit abroad, forging long-term friendships, collaboration and support. BFIRST’s mission is to release some of the world’s most vulnerable adults and children from the poverty, destitution and marginalisation caused by deformity, disability and disfigurement.

‘We are incredibly proud to being on the road to achieving this with the official launch of our charity.’

In three trips to Cambodia alone, BFIRST surgeons working alongside local teams treated over 45 hand surgery cases including burns and trauma, congenital deformities, tumours and snake bites.

Greg O’Toole adds: ‘Dur­ing my time in Cambodia with BFirst, I was also able to treat children with birth defects such as microtia – being born without one or both ears.

Amazing initiative

BFirst box‘The expertise for this type of surgery was unavailable in Phnom Penh and so my visit was also a good opportunity to teach the principles of the techniques involved to local surgeons.

‘I feel privileged to have been able to offer help and training. BFIRST is an amazing initiative which has, and will continue to, save the lives of many.’

BFIRST has also funded fellowships, which involve surgeons from resource-poor countries visiting UK plastic surgery centres, where they are taught relevant surgical skills.

One such surgeon is Dr Rashedul Islam, who came to the UK in 2013 through BFIRST. Dr Islam, a plastic surgeon from Bangladesh, stayed for six weeks to train.

The skills he learned while on location were not limited to surgical techniques. He also took away with him knowledge of the day-to-day running of a UK-based surgical unit.

Dr Islam says: ‘I am very thankful for the opportunity BFIRST has given me, which allowed me to visit a plastic surgery unit in the UK and have a closer view as to how the system works.

‘I was very impressed with the unit, the consultant and staff. Thanks to the amazing training I received, since returning to Bangladesh I have been able to carry out more operations and procedures than before, which have benefited many patients. I would like to thank all those involved in the process right from the beginning. I am so grateful for having been given this unique, and very positive, experience.’

Unable to walk

British surgeons have already operated on many injured or disfigured people around the world in similar missions to BFIRST’s, such as treating a two-year-old in rural Ghana who had suffered burns to his leg, resulting in scar tissue so severe that he became progressively unable to walk.

Visiting UK plastic surgeons were able to release the scar tissue, giving him the ability to walk again, also training the local team in this technique.

In Uganda, the whole of a teen’s scalp had been burnt off, meaning his skull was visible and exposed.

Using an operating microscope, muscle from his back was detached and placed on his skull. He was the first patient in the unit – and probably the entire country – to undergo microsurgery.

BFIRST relies on donations to continue with its mission. Suggested amounts range from just £40, which can pay for gloves, antiseptic cleaning solution and dressings for 15 patients, to £850, which can pay for a week’s plastic surgery training for a local doctor.

Hand pointing red Donations can be made on the BFIRST website at