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Oasis in a dry land

When she was about three months old, Teresa Olaniyan fell down. That singular accident led to a condition which she has been living with over the past years-Noma. Noma or Cancrum Oris, has been described as “a gangrenous disease leading to tissue destruction of the face, especially the mouth and neck region.”

Twenty-six-year-old Teresa Olaniyan is one of the over 100 patients to be operated upon at the Noma Children Hospital by a team of surgeons from Spain, France, Germany, and the Netherlands, who are already in Sokoto for the exercise.

Teresa, a Noma patient ,who hails from Ife –North Local government of Osun state, had come all the way from the southern part of Nigeria to the north-western state of Sokoto to receive treatment at the WHO referral centre for the treatment of  reconstructive and plastics surgery.

Teresa was at the hospital five years ago and had come again for further operations.

An ambitious young lady ,Teresa would not allow herself  to be deterred by her condition. She is a student at  the Osun state college, and  also works at the  rehabilitation  centre  in Osun.In addition, she  makes candle.

But Teresa observes “many people think when we who are physically challenged, we have no future and they neglect us, they look down on us but it depends on our focus and our prayerful life that tells us what we want God to let us be and to do for us.”

Hapily,the Noma  Children hospital which is dedicated to the treatment of Noma has  in the  last 10 years  has been giving hope to a number of NOMA patients and others with spectrum of  conditions  such cleft lips, cleft palate, tumours(cancer of the jaw) burn contractures etc.

Every quarter, a   team of surgeons  from outside the country visits the  Noma Hospital,Sokoto  to perform Surgery on about 100 - 150 patients within the two and half weeks that they are around.

Simon Matthew, 12, with a condition known as neurofibromatosis is another patient to be operated upon in present exercise. He became afflicted with this condition shortly  after birth. His mother, Mrs. Mary Onoja Matthew who is with him at the hospital explains,“it started as sickness and I took him to Usmanu DanFodiyo University Teaching Hospital where I delivered him”.

Mrs Matthew said as Simon grew up, there were some extraneous growths around his neck region. The experience, she declared had been stressful.

  “I used to cry and pray to God that He should give the doctors wisdom to treat him.”

This is the third time Simon would be operated upon at Noma and the doctors said the operation was meant to reduce the unwanted skin around the neck..

The Chief Medical Director of the Hospital, Bashir Abdullahi Jabo, a paediatric surgeon revealed that the current team was the 45th his hospital received since the inception of the intervention  programme 10 years ago.

He noted that patients came from all over the country and beyond, like Niger Republic, Ghana and Togo to receive medical attention.

The medical director disclosed that the hospital faced the  challenge of resources to cater for the patients in the hospital as it provide 100 percent free services including feeding and drugs.

“Some of them even get transport fare from the hospital when they are discharged .That is quite stressful .100 percent healthcare is not obtainable anywhere in the world”, he added.

Jabo, however, acknowledged that most of the patients were poor.

“I think it is right to say most of the patients that are affected by this condition are poor. Usually, Noma afflicts children if they are malnourished. The bacteria would expand to parts of the body.”

May be that is why it is called ‘Noma.’ This disease afflict people in rural, farming communities, where children do not have access to balanced diet.They would become malnourished. The disease seems to be prevalent in northern part of the country.

 But how is the hospital funded? The medical chief said it is funded mostly by the state government and partly from Federal government, while operational /surgical materials come from foreign partners, including AWD of Germany, Dutch Noma Foundation and Facing Africa. He adds that the foreign partners take care of foreign experts that come for the surgery and that they send the surgical consumables on a quarterly basis.

Every time the medical team arrived, the state government would give between N3 million and N4 million every quarter, Jabo revealed.

He explained that the fund is used to purchase drugs, take care of the feeding and everything that they need.

“It may not be sufficient but at least, they would carry us a long way.” he remarked.

On its part, federal government gives a grant to the tune of N2.5million monthly to run the hospital, and on quarterly basis it gives the hospital funds for some capital projects, such as the procurement of some equipment.

Kebbi state government is also said to give N50,000 on monthly basis. The Noma project in Sokoto started as pilot scheme at the Specialist Hospital before a hospital was build for it in 1999. Record shows that as of September 2009, about 700 patients, children and adults had been attended to under the scheme.

The medical director stated that though the number of new NOMA cases  had reduced, “in true sense we cannot say it has reduced. Some patients may be dying somewhere because they have no access to hospital. In Nigeria,  there is no proper record of births and deaths, so one can’t say what caused deaths.”

The medical director pointed out that “If the child is in a very bad condition, that is, the acute stage and there is opportunity to manage the ailment, he would die because  he would need blood, antibiotics. Maybe many of them are dying, we don’t know, but from what we have been seeing in the hospital, it has declined.”

On new cases of Noma, Jabo said, “so far, we have five cases now which are quite high from what we used to know. So people are still poor or what, we cannot say if the incident is on the decline. We need more time to go round the communities to find out what is happening before we can make an objective statement.”

Usually, he said, most of the patients they see were the ones who have already survived the condition and deformities.

To curb the disease, Jabo said they had been carrying out awareness campaign at the rural areas. “We always advice them on the nutrition of their children and oral hygiene. The people have to ensure that they immunize their children.

This disease is common from the age of three to six and these are the ages that are covered by childhood  immunization.”

He noted that NOMA is caused by a combination of factors,”Some other sickness can affect the sickness can lower children’s  immunity and Noma would set in. Malnutrition is there, infectious diseases - malaria, measles - would depress the immunity. These are things that would trigger it. So you cannot say it is one thing that leads to Noma.”

The  medical chief asserted that the hospital’s campaign focused on the preventive aspect of the disease.

“We try to educate them on these factors. It is better prevented and it can be prevented if patients are aware of how this thing results”.

In the last 10 years, the hospital has been manned by the Germans. Dr.Jabo is the first indigenous medical director of the hospital.

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