Arusha — Augustino is curled up in a chair fast asleep with his eyes wide open. He's in the waiting room of Selian Hospital, Arusha hoping to see Dr Bill Brown who will perform his magic on him. Augustino hasn't been able to close his eyes since falling head first into a fire at the age of 3. Now, five years later, he is getting new eyelids which means he will also be able to go to school for the first time.

This young boy is one of 65 children from Arusha and Manyara regions waiting to see the medical team, headed by plastic surgeon Dr Brown with one other plastic surgeon, 2 anaesthetists, 2 physician's assistants and an emergency physician who have come over from America for one week to operate on cleft lips, cleft palettes, bone deformations and post-burn scar deformations.

This extraordinary project was the idea of a quietly spoken, modest physician from Minnesota, Professor Mark Jacobsen: "I suppose it began with our orthopaedic work. There are so many children in this part of Tanzania that are effected by excess fluoride giving rise to the bent legs and crippling changes in their bone structure. We started operating on them and invited in surgeons that we knew from the United States to give us a hand

and train our staff in caring for those children. Whilst we

were out in the villages, we began to find children with cleft lips, palettes and burns who needed care as well and so our programme expanded in to inviting Dr Brown over to do some plastic surgery on that side of it together with our orthopaedic side."

Dr Brown is in the OR finishing off a cleft lip and palette operation on a one year old girl, he's stitching up the inside of her mouth whilst explaining the problems this could have caused her if she hadn't had this chance to correct it before she was 2.

"Babies born with cleft lips have a higher risk of infection, malnutrition and then death. What happens with a cleft lip and especially when you have a cleft palette too is that breast feeding is not as efficient, it's like trying to suck through a straw that has a hole in it", said Professor Jacobsen.

The mothers of these children suffer from humiliation and depression, some believe that witchcraft is the cause and they won't carry their baby on their backs or let them go outside. This made life quite difficult for the outreach volunteers to find their patients for the clinic.

The operation Dr Brown performs on cleft lips takes just 25 minutes; he closes the lips so that the baby can feed from their mother and on his next visit, six months later, he closes the inside so that the child will have very little evidence of any deformity as they grow up. "But then you'll see the mama after the baby is fixed and the whole relationship between the mother and her child changes. The depression lifts from the mother", said Paula Gremley, Occupational Therapist.

Burns are a common problem within our region. "It happens in much of the community because cooking is done over an open fire, it's on the floor so toddlers are likely to tumble in or tip scolding water or hot oil on themselves causing burns of varying degrees of severity. In children and in all of us to some extent, as a burn heals, the scar tissue that forms around the burn actually shrinks over time. So, if you have a burn across your elbow or your hand the healing process will actually contract those joints in to a non-functional position," said Jacobsen.

Dr Brown and his team have performed around 1,000 operations since their first visit to Arusha ten years ago. The average cost of an operation comes to approximately US$400 or Tsh500,000 covering the outreach programmes, the actual operation and the after care at the Plaster House where children can stay for several weeks before returning to their villages. These costs are subsidised through various donors including the Rotary Club, Church communities, local and international communities. "We usually ask the family to contribute Tsh100,000 but if they are unable to we still operate on them. We go out and find it ourselves," said Jacobsen.

Thanks to this project, most of these infants will never know what life could have been like for them suffering from a cleft lip with the possibility of being ostracised from society; suffering such pain in their bones from fluorosis that they couldn't bear to walk to school; suffering from severe burn scar deformations losing all mobility in their arm and not being able to pick up a pen.

Tanzania doesn't yet have the facilities to be able to match Dr Brown's skills but Professor Jacobsen is hopeful that one day, there will be a Tanzanian version of this talented team.

The atmosphere amongst these visiting doctors, their assistants and the staff at Selian

Hospital is humorous, generous and easy going; they are constantly teasing each other

and making their patients smile. I was really quite jealous and desperately wanted to be part of this dedicated team which is why I was reluctant to hand back my scrubs.

Augustino successfully received his new top and bottom eyelids and is now recuperating at The Plaster House rehabilitation centre in Arusha. He is hoping to start school next term.