noma

No, not Rob Bell's video productions. Noma is a disease that most of us in the western world have not even imagined, much less seen. Photos, inservices, and teaching times aside...up close and personal, noma is a pretty wacky illness. I had my first noma repair patient for the last few days, a full challenge and a half!

"an acute, necrotizing ulcerative process involving mucous membranes of the mouth. The condition is most commonly seen in severely malnourished, debilitated persons, especially children with poor nutrition and hygiene. There is rapid spreading and painless destruction of bone and soft tissue accompanied by a putrid odor...Treatment involves high-dose penicillin, debridement, and improved nutrition. Healing eventually occurs, but often with disfiguring defects."

That's cut-and-dried for, "sorry kid, you don't have a face any more." At 7 years old, that can be totally devastating.

Aimee arrived on the ward a few days ago. She is one of the survivors, the 10% that make it through acute noma to live an ostracized life, hiding the hole in her face with a rag, struggling to chew soft foods when they fall out as she chews...without even daring to hope for normalcy. Graft after graft have failed, leaving a scarred cheek and a scarred heart. One of the blessed ones - her infection was caught early, before it took an eye or nose. She's chunky now, her exhausted body on my back and soft cheek relaxed, tired from the last love-starved tantrum that we ignore, basking happily in the aftermath of love. We talk in pantomime, waiting for the one staffmember that speaks a little of her tribal language to come down so we can explain surgeries and dressings and drains and tubes. Our plastic surgeon had been held up in Europe, airplane grounded by a volcano a million miles away.

As of yesterday, Aimee has a face again. The physicians assistant that brought her from Cameroon came down to excitedly show photos of surgery - of sutures and skin where there was no skin. My night was filled with IVs and antibiotics, NG tube feeds and codeine and JP drains...and mainly just praying hard that our irrepressible little girl with discipline issues wouldn't pull any tubes out or sensitive plastic surgery dressings off. Her bandages won't come off for a few days yet (we hope!), but we know that underneath there's a new face just waiting to smile!