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The Yorkshire theatre nurse helping Pakistan’s children with facial deformities

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Annette Middleton is travelling to Pakistan this month to help children with terrible facial deformities, as part of volunteer efforts to provide plastic surgery to those in need.

Ms Middleton, 58, will join two plastic surgeons and an anaesthetist at a hospital dedicated to repairing cleft lips and palates in Gujrat in the Punjab province.

“I’d only ever seen two patients with cleft lips before I went to Pakistan”

Annette Middleton

In Pakistan, up to 10,000 babies are born each year with cleft conditions but many have no hope of paying for operations.

Ms Middleton went on her first trip with the East Yorkshire charity Overseas Plastic Surgery Appeal (OPSA) in 1999 and has been going back to Pakistan annually since. OPSA carries out procedures and trains staff during two trips each year, thanks to UK donations.

Describing her early experiences, Ms Middleton said: “It was a wake-up call when I got there. The lack of resources, the lack of training, but, in contrast, the willingness of staff to learn was incredible.

“When I first went, it was so basic,” she said. “When I used to walk in the hospital door over there, I could smell the gas coming from upstairs. They didn’t have ‘sharps’ bins and glass vials of drugs would crunch underfoot.

“We convinced staff to put sharps in boxes at least, but I remember at the end of my first trip when we were driving away, looking back to see them tipping the box out of the first floor window into an alley,” she said. “There was no real concept of danger and safe systems of work.”

“There was no real concept of danger and safe systems of work”

Annette Middleton

She quickly realised none of the theatre staff had been vaccinated against hepatitis B and now ensures all local nurses and theatre staff are protected. While her primary role is helping the surgeons during dawn-to-dusk shifts, she also trains the Gujrat-based nurses.

“Over time, we have managed to instil some standards and structure in terms of operating lists, operating on the youngest patients, many of whom are massively undernourished, first,” she said. “There was no cross-matching of blood at the start… but we have that now.

“Staff weren’t trained in life support but they are now,” she added, noting that she and a colleague had “made it our mission this year to source defibrillators for the hospital”.

“When we visit this month we hope to take at least two with us as there currently aren’t any – not unusual in many Pakistani hospitals. We’ll be training staff how to use them during this trip,” she told the Hull Daily Mail.

Overseas Plastic Surgery Appeal

The theatre nurse helping Pakistan’s children with facial deformities

Annette Middleton

Ms Middleton, who now works in the private sector and volunteers, like the rest of the OPSA team, for free, said: “We do as much as we can, to get the best out of the time we have got.

“Each time we go, we try to improve something and that’s the reward for me. Each time I go, I’m able to see the changes and the difference we are making. Sometimes, it seems like one step forward and two steps backwards but, overall, progress is made.

“It is hugely rewarding,” she said. “We take so much for granted here in the West, with our amazing NHS. It makes me appreciate all the more what we all have.”

She added: “I’d only ever seen two patients with cleft lips before I went to Pakistan as all the children born here with such problems were treated at Hull Royal Infirmary. Ask anyone here when they last saw a child with a cleft lip and most people would ask, ‘what’s a cleft lip?’.”

Ms Middleton, who works for Hull Plastic Surgeons, trained at Hull District School of Nursing. After being inspired in the surgery she saw while working in recovery at Kingston General Hospital, she moved to theatres.

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