Noma is said to be one of the neglected tropical diseases.

Ms. Casti, you are a nurse and work for Doctors Without Borders. You worked for nine months in a clinic in Nigeria that treats noma patients. What is this disease?

Eva sleeper

Editor in the “Life” department of the Frankfurter Allgemeine Sunday newspaper.

Noma is a serious bacterial infection that develops on the lining of the mouth and from there eats away at other soft and bony parts of the face. It occurs in rural areas of South America, Asia and Africa on, among other things in the north-west of Nigeria. The problem is: Noma starts off very non-specifically. The children may have bleeding gums, the palate is red. It’s not urgent at the moment. But it becomes acute very quickly. By the time people around you react, it’s usually too late.

Only children get sick?

Yes, between the ages of two and seven. Around 140,000 children are affected worldwide every year. This is an estimate of WHO from 1994, which has not been updated since. The number of unreported cases is probably high, since 90 percent of the children die – and that within a few weeks if the disease is not treated in the first few days after the onset. The risk factors are malnutrition, lack of vaccinations and diseases that weaken the immune system, such as measles, tuberculosis or HIV. The ten percent who survive are often hidden by their families or sometimes do not return to their villages of origin. Or only after they have received reconstructive surgery treatment in the hospital.

How do you have to imagine the suffering of these children?

On the one hand, this depends on how quickly noma is recognized and treated. On the other hand, it depends on which parts of the face are affected: jaw, lips, cheek or nose. Distortions usually occur, making it difficult to eat, speak, see, and breathe. If the cheek is affected, it can happen that the wound extends from the eye, which is sometimes also affected, to the jawbone, and actually only half of the face is there. The survivors suffer a lot, physically, but of course also mentally. The disfigurement stigmatizes them greatly, they are excluded from society and they feel very alone.

Mulikat is 33 years old today.  She suffered severely from noma as a child.  After several operations, she can enjoy her life again.

Mulikat is 33 years old today. She suffered severely from noma as a child. After several operations, she can enjoy her life again.

Image: MSF

How are patients treated in the acute phase?

In the hospital, her wounds are cleaned and treated and bandaged every day. The children are given antibiotics and therapeutic feeding as most are malnourished. They receive physiotherapy and psychosocial support, both the children and the person they came with; usually this is the mother. On average, it takes six weeks before most patients can eat and speak independently again. During this time they are usually also immunized. That means you get it vaccinationsthat are intended for childhood.

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