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Facing Africa Noma
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Noma (cancrum oris) is an acute and ravaging gangrenous infection affecting the face. The victims of Noma are mainly children under the age of 6, caught in a vicious circle of extreme poverty and chronic malnutrition who suffer unimaginable pain, discomfort and social exclusion from their communities.

Noma is an opportunistic infection that begins with ulcers in the mouth that is promoted by extreme poverty. If the condition is detected in the early stage, progression can be prevented with the use of mild antibiotics and immediate nutritional rehabilitation. If left untreated, as happens in most cases, the ulcers progress to Noma at an alarming pace. The next stage is extremely painful when the cheeks or lips begin to swell and the victim’s general condition deteriorates. Within a few days, the swelling increases and a blackish furrow appears and the gangrenous process sets in and, after the scab falls away and a gaping hole is left in the face. It is estimated that the mortality rate reaches up to an alarming 90%.

The World Health Organisation (WHO) estimates 140,000 new cases of noma every year, mostly in sub-Sahar Africa.

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Access to health care is often very poor in rural Ethiopia, partly due to physical isolation, but also related to the weak position of the issue within national priority setting. It is very likely, that Nyaluk, pictured below, has never been to hospital or undergone any medical treatment. None of her 4 children were born in the hospital. We will never be able to fully comprehend the feelings of our rural patients, feelings of people who have always lived with long established traditional laws, languages, dress, religion, sacred ceremonies, rituals, healers, and remedies. When they arrive to our care in Addis Ababa sometimes after days of journeying through the countryside, they are faced with the complete unknown: white people inspecting their faces, asking them questions they have never been asked before, trying to get them into routine of sleeping, showering and eating. People like Nyaluk are rarely given the opportunity to represent their own perspectives and understanding of their health and their views on the actions to be taken to improve it. We always ask our patients what they want, what they expect and how they FEEL about surgery. It is heart-breaking to see some of them walk away from a possibly life changing operation because they are so overwhelmed by it all. After spending most of her childhood and adult life with face affected by NOMA, getting married and having children, Nyaluk chose to have her surgery in May 2017 and October 2017. She is going to come back for revision in May 2018. Pictured below: Nyaluk before and after her surgery. ... See MoreSee Less

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