SHE can’t remember why she wanted to become a nurse. She just knows she never wanted to be anything else.

Now, with her career spanning 40 years, Annette Middleton is travelling to Pakistan this month to help children with facial deformities.

Annette, 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.

“Ask anyone here when they last saw a child with a cleft lip and most people would ask ‘What’s a cleft lip?’” she says. “It’s not like that in Pakistan. Babies don’t get operations or treatment after they’re born because there is no NHS.”

Growing up in Cottingham, Annette attended Newland High School for Girls and set her sights on nursing.

At 18, she joined Hull District School of Nursing and combined studies with practical training at Hull Royal Infirmary, Kingston General and Princess Royal Hospitals.

She worked on the Medical Chest Unit at Castle Hill before joining the recovery team at Kingston General Hospital, helping patients after operations. It was there she got the bug for surgery.

“With surgery, my initial perception was that there is a beginning, a middle and an end,” she says. “You could always see an end for a patient.”

Enthralled by the intricate techniques deployed by the surgeons and the benefits to patients, she worked with consultant Bob Heycock, who set up the first plastic surgery unit in Hull.

She also supported the theatre team during surgery as a “circulating nurse”. And she loved it. So, when a position came up in theatre she took it

Annette moved up the ranks, eventually becoming a junior sister, sister and then theatre manager. Plastic surgeon Nick Hart came to work at the unit and she learned about his work in Pakistan, travelling to Gujrat to repair cleft lips and palates for people with no money to fund their care.

“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,” she says.

“Mr Hart went on his first trip without a theatre nurse in 1998 but, when he came back, he said he would ‘benefit’ from the presence of a scrub nurse and that was it.”

Around one in every 600 babies in the UK is born with a cleft lip and palate but most undergo corrective surgery soon after birth and always within a year. In Pakistan, up to 10,000 babies are born each year with cleft conditions but, with no NHS, poorer families have no hope of paying for operations. 

Annette, who has two daughters and two step-daughters and lives in Cottingham with husband Phil, went on her first trip with East Yorkshire charity Overseas Plastic Surgery Appeal (OPSA) in 1999 and has been going back to Pakistan every year since. She’s only missed two trips in 18 years – once through ill health and immediately after 9/11, when it was considered unsafe to travel.

 “I was fascinated to learn about their approach to healthcare but it was a wake-up call when I got there,” she says. “The lack of resources, the lack of training, but, in contrast, the willingness of staff to learn was incredible.

“I was also shocked by the poverty. The wealthy people are so very rich but the poor have absolutely nothing and they are there in their millions.”

At first, operations offered for free, were carried out in a former warehouse and furniture showroom in Gujrat, managed by Dr Ijaz Bashir, whose philanthropist father, now in his 90s, founded the Decent Welfare Society to help the poorest in society in Gujrat. He ‘donated’ the building for provision of healthcare services to the impoverished people in the region and it still serves as a maternity unit.

Dr Bashirfounded the Pakistan Cleft Lip and Palate Association and OPSA carries out operations and trains staff, thanks to donations from businesses and people in East Yorkshire and across the country to pay for the much-needed medical supplies.

Now, Annette and the other members of the OPSA team work from the world’s first hospital to specialise in cleft lip and palates, opened in Gujrat last year.

While Mr Hart, now retired from surgery, continues to head the charity, consultant plastic surgeon Muhammed Riaz leads the team of clinicians and OPSA travels to Gujrat twice a year, helping scores of babies, children and young adults during each trip.

“When I first went, it was so basic,” Annette says. “Here, we have very strict standards.

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

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 role during dawn-to-dusk shifts alongside the surgeons is crucial, Annette 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. There was no cross-matching of blood at the start, something which is a given here in the UK but we have that now.

“Staff weren’t trained in life support but they are now. Consultant anaesthetist Zahid Rafique and I have made it our mission this year to source defibrillators for the hospital.

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

OPSA is helping Gujrat staff understand the importance of multi-disciplinary working and now have speech therapists and orthodontists working alongside them to give patients the best possible recovery.

For Annette, who now works in the private sector and donates her time, like the rest of the OPSA team, for free, she knows their work is critical to give people without hope a chance.

“We do as much as we can, to get the best out of the time we have got,” she says. “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 and probably one of the most worthwhile things I do.  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.”

To help Annette and the surgical team from East Yorkshire continue their amazing work.