Noma: Our experiences living without a face

Cancrum Oris popularly called Noma (often an infection of the mouth or genitals) has remained a public health concern in many communities. The disease affects the oral cavity, and spreads and eats away the cheek, nose, and bones; in other words  parts or most of the face. According  to the World Health Organization (WHO) “Noma […]

Cancrum Oris popularly called Noma (often an infection of the mouth or genitals) has remained a public health concern in many communities. The disease affects the oral cavity, and spreads and eats away the cheek, nose, and bones; in other words  parts or most of the face.
According  to the World Health Organization (WHO) “Noma is a gangrenous lesion that affects young children living in extreme poverty primarily in Africa and Asia. Lesions are severe gingival disease followed by necrosis (premature death of cell in living tissue) of lips and chin.”
WHO said without any treatment, about 90 per cent of children affected by the disease die. The annual incidence figure of the disease is 20 cases per 100,000 population and it occurs in 39 of the 46 countries of the African region.
 Recently, a team of  surgeons from Germany, Netherlands, United States and Kenya were at the Noma Hospital, Sokoto to conduct surgery for some noma and cleft lips patients who came from across Nigeria and beyond.
The Noma Hospital in Sokoto was established 15 years ago, and is the only hospital in Nigeria designated to treat Noma cases. Many children and adults with Noma and cleft lips were operated upon while some are still awaiting surgery at the hospital.
Among those operated upon was five-year-old Zuwaira Abubakar from Argungu Local Government Area of Kebbi State who had part of her cheek consumed by Noma.
“It started like a small boil before it swelled and burst leaving a horrific gap on her cheek,” Zuwaira’s mother explained.
Zuwaira has passed the first and second stages of the operation and is now waiting for the third and final stage, to be performed after six weeks.
The first stage of surgery had been carried out on 35-year-old Hadiza Umar from Kano State and she is now waiting for the commencement of the second stage. One could hardly understand her when she is speaking due to the effect of Noma.
Gambo Mohammed, 17, from Bauchi State was born with part of his nose missing leaving a wide gap.  Part of the damaged nose has been put into shape by the surgeons and he is also waiting for the next stage of operation to be done.
25-year-old Sanusi Altine told Daily Trust that his journey with  Noma  disease started  when he was  10 years old. Altine from Dabagin Bum village of Wurno Local Government, Sokoto State, said as a child living in a remote area, he started treatment at a clinic in Marnoma village but that as the case got worse, his upper lips chopped off.
“I heard about Noma Hospital, Sokoto and came here. I have received the first stage of operation. I am receiving care, waiting to heal before the second stage is commenced,” he said.
Another patient, Awwalu Bala, 25, from Gwadabawa Local Government Area of Sokoto State revealed that he had been nursing Noma disease since he was a kid until he heard about Noma Hospital on a radio programme,and travelled to Sokoto.
He has also undergone the first stage of operation on his cheek which had been chopped off by the disease and is now receiving care before undergoing the second stage of operation.
Among those awaiting surgery is five-year-old Hafsat Adamu from Katagum Local Government Area of Bauchi State. Her case was also said to have started like a boil which later started swelling on her cheek until the larger part of the area was eaten away leaving a gaping hole near her mouth.
The parents initially tried local medication but it got worse. They later took her to Noma Hospital and are now waiting for surgery to be performed on her.
Also, two-year-old Faruku Adamu from Bayawa village in Tambuwal Local Government Area of Sokoto State had similar symptoms and was also given local medication.
He spent two months on local medication and his health kept deteriorating, till he was eventually brought to Noma Hospital where he is among the patients awaiting surgery.
 “There are three things which if you don’t have them, you won’t have Noma disease. When you have those things, you have Noma disease. When you avoid malnutrition, poor personal hygiene and playing with animals, you wouldn’t have Noma disease. The main thing is malnutrition. Noma disease is not a new disease. The first case of the disease was diagnosed during the Second World War; there was famine then,” said  Dr. Bello Ahmed, Chief Medical Director of Noma Hospital.
He said from January to date, the hospital has invited two teams of surgeons and 70 patients have been operated on so far, adding that the latest group of surgeons was the 54th team that have come to perform surgery at the hospital since inception.
“When the hospital was established, we signed a  memorandum of understanding with some foreign partners to help us with the plastic surgery because till date our state and the country at large don’t have many plastic surgeons that can take care of these kinds of cases,” he said.
Dr.Ahmed added that come October, this year, the same surgeons would be at the hospital for the next intervention which targets about 40 patients.
He said the state government provided treatment free of charge for the patients from the time of admission to discharge. These include:  accommodation, feeding, and transportation.
“In fact some of them after discharge, don’t have transport money. We give them money to their respective destinations,” he said.
 He said because of the stigma attached to the condition, sometimes the outreach department of the hospital went to various places to encourage those with the condition to come to the hospital.
As the only hospital in the country designated for Noma, Dr.Ahmed said arrangements are in top gear for the federal government to take over the hospital.