Fieldset
"Our shared humanity": Overcoming noma in Nigeria

British nurse Scarlett writes from Sokoto in northwest Nigeria, where a specialist team is helping children in the community fight a devastating and disfiguring disease through surgery, mental health support, and importantly, prevention

This is the second part of Scarlett's story from Sokoto. Read the first part, "Rage serves no place": Finding hope in a Noma hospital, here

Life-changing complex surgery

The surgery itself is carried out four times a year during two to three week periods. This is when MSF provides an international surgical team to undertake this highly complex surgery

The patients can range from children who require soft tissue plastic surgery to adults who require multiple operations to manipulate tissue grafts from around the body to cover their huge facial wounds. 

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Doctors Steve and Tamara performing a procedure in Sokoto
Doctors Steve and Tamara performing a procedure in Sokoto

The team lead in this intervention, David, is a specialist plastic surgeon who remakes noses by using ribs to create the structure that was consumed by the disease many years ago. 

Our consultant maxillofacial surgeons, Julia and Hakki, help release the trismus patients often using flaps from the head rotated internally to keep the new jaws separated and stop them from re-fusing again. 

[It is] challenging for surgeons who have to work around microscopic maps they have learnt across decades of training

The trismus release surgery is followed up by the excellent physiotherapy team. Their job is to work with patients daily to encourage this new mouth opening and teach them physio which they must undertake for years to come.  

The wider context

The MSF team works in collaboration with the Nigerian Ministry of Health (MoH) to run the hospital. However, insecurity in this region of the country has exasperated the displacement of people nationally and effects the provisions of healthcare services at local levels. 

In northern Nigeria, the excellent and expert national staff are few and stretched between many hospitals. This makes it important for MSF to support the hospital until greater stability and more resources allow for the handover such a complex surgical project.

This was evident during one particularly difficult case where the surgery took an adverse turn…

Working together to save a life

The nature of our patients’ disability means their anatomy is abnormal and difficult to predict.  This is challenging for surgeons who have to work around microscopic maps they have learnt across decades of training. 

During one surgery, a teenage patient suffered an unpreventable bleed. The team acted fast to stop her losing more blood, however, it had been a challenge.

After the patient was stabilised, the decision was then taken to create our own intensive care unit and sleepover at the hospital, so we could care for her together. Our fantastic anaesthetists, Steve and Tamara, along with our compassionate local staff formed an intensive care night shift team.

To our joy, the next day the patient woke up. She made an excellent recovery.

The right decision

The lead recovery nurse helped translate between us. It was a pleasure to communicate with this humble teenager who had already brought her own children into the world and worked enormously hard to provide for them.  The operation will hopefully increase the self-esteem of this already strong young mother. 

It was the right clinical decision to engage all of our resources in this emergency situation.

Surgery fascinates people, and amazes those who can see the transformation of these brave patients who have regained part of their identity.  Nevertheless, prevention is always better than treatment. 

The key ingredients in this success story were the experts formed in the multidisciplinary team that MSF had created, and the resources which they had provided. 

However, if MSF were to ever stop supporting the hospital, such outcomes are questionable.  Despite the best local medical staff who are passionate about caring for their community, the realities in this resource restrained environment may prohibit them from safely doing so.

Prevention is better than cure

Surgery fascinates people, and amazes those who can see the transformation of these brave patients who have regained part of their identity.  Nevertheless, prevention is always better than treatment. 

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MSF team members Moses and Kelly helping community ambassadors learn about oral hygiene
MSF team members Moses and Kelly helping community ambassadors learn about oral hygiene

Noma is a dangerous and deadly infection which is totally preventable and must be eradicated.

Unfortunately, noma is not yet officially regarded as a “neglected tropical disease” by the World Health Organisation. This means the struggle to prevent it, and create international awareness and engagement, is left to national and local organisations.

So, the MSF health promotion team strive to educate the community and to empower them to avoid their children suffering from this debilitating disease.

There is a tangible feeling of shared humanity

One method they use is to invite local community elders and family members to become “ambassadors” who can take back the messages and share them within their communities.  This type of engagement is vital to the noma project and the future of affected patients.

The noma outreach team accesses remote villages in boarding states to spread awareness and educate communities on how to identify symptoms. This service has faced increased restrictions recently due to insecurity however our team is continuing to try and reach those cut off from public health services.

Shared humanity

MSFs’ impact is felt throughout the hospital. There is a tangible feeling of shared humanity in the relationships between patients, families, local and international colleagues whilst you work there. 

The heartbreaking repetition of young children brought through the door with their faces mutilated by Noma needs to be addressed at an international level. 

Until such violations of their rights are addressed, it is essential that MSF supports the families in the holistic rehabilitation that they will require for years to come.

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Read More: Stories about treating Noma

Noma in Nigeria: "The resilience of our patients is astounding"

"Rage serves no place: Finding hope in a noma hospital"