The parents of a three-year-old boy are rejoicing after volunteers on board a charity hospital ship removed a large, painful growth from the side of his head – a condition that had been developing since before he was born.
Emmanuel’s mother, Manteneh, and father, Yirah, had sought help for most of his life, but doctors at local hospitals in northern Sierra Leone were unable to treat him beyond prescribing pain medication for his rare condition.
Manteneh explained that shortly after her son was born, she noticed a white-coloured swelling around his ear. Unsure of what to do, she compressed the area with warm water, but things began to worsen. “The area later turned into a sore, so I stopped washing it,” Manteneh said. “We went to so many local hospitals and clinics, but they sent us home.”
Emmanuel was later diagnosed with lymphangioma, an abnormality of the lymphatic system that occurs during pregnancy, often not apparent until after the child is born. While rare, these cases account for four per cent of all vascular tumours in children, most of them becoming evident by two years of age.
Royal London Hospital’s Maxillofacial Head and Neck Surgeon, Leo Cheng, has contributed to around 600 surgeries on 23 visits to Mercy Ships over the last 20 years. Although he didn’t perform Emmanuel’s surgery, he speaks about the condition: “If Emmanuel had been born in the UK he would have had immediate access to specialist treatment through the NHS. This is why I continue to volunteer with Mercy Ships as there are so many women, men and children like Emmanuel, who need access to life-changing surgery.”
In Emmanuel’s case, the lesion developed on the side of his face, near his ear, and continued to expand until it was a large lump, causing him pain. Emmanuel’s lymphangioma, though uncommon and noncancerous, had the potential to cause facial nerve damage and distort the shape of his face. Although Emmanuel was too young to fully understand people’s reactions to his condition, his parents struggled with the social stigma and frequent questions.
“Sometimes I get ashamed when people see him and start asking me, ‘Is that a boil? What's the problem? Why is his jaw like this?’” Manteneh said, saddened. “I do get embarrassed.”
Like many others, the family heard a public service announcement that one of the charity’s hospital ships – the Global Mercy – was coming to Sierra Leone to offer free surgical care. Manteneh explained: “I didn’t know if it would work, but this was our last chance.”
Emmanuel’s condition forced his father, a student at the University of Makeni, and his mother, a tailor, to stop working to care for him, putting a strain on their finances. Sierra Leone’s economy faces challenges like high unemployment rates and staggering inflation, with the average base wage around £27 per month. In these conditions, families often cannot afford basic medical care, much less treatment for rare conditions like Emmanuel’s.
Since his family lived in northern Sierra Leone, they relocated to Freetown and the coast in July 2023, living with friends and relatives temporarily so they could be closer to the Global Mercy for their son’s appointments.
Mollie Felder, a volunteer maxillofacial nurse on the Global Mercy, explained: “There are significant barriers for patients with these kinds of conditions. On top of the financial costs of travel and paying for surgical and post-op care, the lack of availability of medication, and access to surgical specialists makes it nearly impossible for patients like Emmanuel to find care. There are no maxillofacial surgeons in Sierra Leone, and only one paediatric surgeon.”
“If the mass continued to grow, it could press on more of the surrounding areas, potentially causing problems such as facial nerve compression, which would affect the way he is able to move his face, and even cause facial disfigurement,” added Mollie.
Emmanuel’s doctors on the Global Mercy planned to remove the growth with maxillofacial surgery, requiring at least two preliminary visits for injections to harden the tissue, making it safer to remove. After several visits, Emmanuel was ready for surgery.
“I was so worried for him. After they took my son away for surgery, I couldn’t eat any food,” his father, Yirah, said.
Hours later, Emmanuel returned from the successful surgery and was able to hug his father. Volunteer nurse, Mollie, said the impact of not having surgery would have had far-reaching effects that went beyond the physical.
“[Finding access to adequate healthcare] caused emotional strain on his mother, as well as the child, in part due to stigma and discrimination surrounding such visible differences and lack of knowledge as to the cause of these anomalies,” said Mollie. “If he would continue to experience social isolation due to his condition, it could affect his development given his young age.”
Over a period of days, Emmanuel’s post-operation swelling reduced, and he was ready to go home. While Emmanuel kicked a football around with his new friends, his father was incredibly grateful for his son’s recovery. “When he came home from surgery, it was like we had just given birth to Emmanuel,” Yirah said, smiling. “The entire community was very happy for my son’s surgery. People around us were saying that Emmanuel is a newborn baby!”
At home, Emmanuel played with the neighbourhood children as if nothing had ever changed, but his parents were in tears, overjoyed watching their son begin a normal life. “I’m addicted to the indescribable joy and smiles of patients and parents after their transformative surgery on board,” says volunteer surgeon, Leo Cheng. “And I will keep volunteering for as long as I am able.”
