Noma

What's noma you ask? I'm guessing most of you have never heard of it - I'd never heard of it until I got to Liberia so this will be an educational post. Noma is a disease that exists in the poorest countries of Africa, a disease that has been eradicated from developed nations for over 100 years (except it was very common in the Nazi concentration camps). It is a disease of malnutrition and poverty and usually affects children. It is a disease we face here on the ship.

Noma comes from the Greek word that means 'to devour.' This disease affects the face of a child and basically eats away at the tissue. A simple round of antibiotics could stop it but you have to have access to healthcare in order to know this. The usual course of getting noma is like this: a child is who already malnourished and immuno-compromised gets a systemic illness (usually measles - of course, we don't see measles much in the U.S. since we are all immunized against it). If they survive this illness (most don't), they are susceptible to infections in the mouth. This infection turns into noma which eats away at the face (mouth, nose, cheeks). The mortality rate from noma is about 90% - if the child survives, they are left with a very disfigured face.

There are an estimated 400,000 children affected by noma in Africa. However, there is only one hospital in all of Africa (in Nigeria) that can perform surgery to restore their faces. And there is Mercy Ships.

We currently have at least one child on our ward who survived noma. Her name is Mathlyn and she has been with us for quite awhile as the reconstruction of her face will take place over many operations. Here is a photo of my roommate Amber and Mathlyn after her first surgery. Mathlyn had noma when she was 2 years old - she is now 11 years old and weighs only 61 pounds. When you are missing your lips, palate and part of your nose, it is difficult to get an adequate amount of nutrition. Currently her mouth is sutured shut so she is being fed through a tube in her nose and she has a trach so she can breathe.

Dr. Gary Parker, our long-time maxillo-facial surgeon, gave a presentation to the medical staff about noma and how they reconstruct the face in surgery. It was absolutely amazing. If you are the queasy type, you may want to skip over this part! I'm not sure I can explain this very well but I'm going to try to give a very oversimplified explanation.

The surgeon basically has to use other parts of the face to replace the parts that are missing. For example, if you are missing your upper lip, they use part of the bottom lip. They can't just cut out part of the bottom lip and reattach it to the upper lip because the tissue would die if you cutoff the blood supply. So they cut part of the bottom lip but leave part attached and flip it upside down to attach it to the upper lip. So at this point, it is attached to both the bottom lip and the upper lip. This remains this way for 21 days. This is the stage Mathlyn is in which is why her lips look so odd. After 21 days, another surgery is performed where the tissue is cut from the bottom lip. This tissue now becomes the upper lip (the bottom lip is now smaller).

If more of the face is missing (like the nose), then the surgeon uses a flap of skin and muscle from the temple region (it's called a scalping flap - I think the name says it all as to how they remove the skin) and reattaches it to the the area that is missing in the same way as the lip (they don't actually completely detach it from it's original place for 21 days).

Sorry if that makes you queasy but I personally am amazed by the techniques used in reconstructive surgery! The goal for these surgeries is to help that person become part of society again. Their faces will never look exactly 'right' but hopefully they are repaired enough so that the person can eat, drink and talk normally and can go out in public again.

So there's your African disease lesson for the day. Another reason to be thankful for living in the richest countries of the world.

Peace,
Michele