Noma

This week I've been learning more about noma, a horrible disease that is almost never seen back home. It's a gangrenous infection that begins with sores in the mouth and proceeds to eat through tissue in the face, reaching the bone and often killing its victims. It usually affects children and is related to lowered immune systems, malnutrition, poor hygiene, unsafe drinking water, and having recently had other illnesses like malaria, scarlet fever, and chicken pox. Some children survive the disease, and without reconstructive surgery, go through life with severely deformed faces, often becoming social outcasts.

Right now we have 2 noma patients on D Ward, a man and a woman both in their 40's I think. When the woman came to us she kept her face hidden behind a veil at all times. Now she's recovering well from her surgery, is regaining feeling and movements in parts of her face that she hasn't been able to use in decades, and she smiles and waves at everyone who comes in the ward. This week I got to care for her when she had her NG tube taken out and started eating soft food, removed all the sutures and staples from her incisions, and began her facial nerve exercises. Her wound care yesterday was a long, tedious task, but definitely worth it when her eyes lit up and she gave me a big thumbs-up afterward. I'm excited she'll get to go home in a few days, but everyone will miss her on the ward.

Today I also was assigned the other noma patient, who had a much more complicated surgery. The disease had destroyed his nose and the roof of his mouth, and what Dr. Gary did to reconstruct his face really amazes me. I had a general idea earlier this week of what the surgery entailed, but when I helped change his dressing today I understood it a lot better. They basically took a flap of tissue from the man's scalp to form a whole new nose, and grafted it in place on his face. Back home they probably would have done a free flap, which is where you completely remove the tissue from the original site. They don't do free flaps here, because the patients' nutritional definciencies and the difficulty in maintaining a sterile environment during recovery here in Africa lower the chances of the graft surviving. Instead, they did a pedicle flap. That's where they cut a flap out of the scalp, but left it attached so that it keeps its original blood source. The end of the flap was used to form the nose, but the rest of the tissue is just rolled up and kept moist in a sterile dressing, connecting the new nose to its original blood source on the top of the head. After 3 weeks, the flap will be cut away from the new nose, unrolled, and placed back down where it originally was on the scalp. The section of the scalp where the tissue for the new nose was taken from won't have its original tissue replaced, so they took a skin graft from the man's thigh to cover that portion. Sounds complicated, right? It gets better. To make a new soft palate, the surgeon stitched the patient's tongue to the roof of his mouth. It'll stay like that for 3 weeks, at which point a new layer of tissue will have grown over the roof of the mouth and the tongue can be released back down. Is that not AMAZING? Who came up with the ideas for these kinds of surgeries? Even more amazing is the patient's reaction to all this. Yes, he's lived with a horrible disfigurement most of his life, but the 3 weeks of recovery he has to go through is awful. His face looks worse at the moment than it did before, there are only a few layers of gauze between his skull and the environment, he can hardly communicate, and he has to eat through a tube for 3 weeks. And yet he's incredibly calm and relaxed about the whole thing, not even complaining of pain! Please keep this man in your prayers over the next few weeks, that he would continue to be at peace, that the nose graft will take and everything will remain free from infection.