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The afternoon was hot and annoying; Aisha had to keep wiping the sweat off her forehead as she thwarted the flies off her face while standing under the mango tree. She was impatiently waiting in front of the medical tent at the south end of the Bakassi IDP camp (internally displaced people’s camp) in Borno: her new home. Her right jaw had been hurting for a week, maybe 2 weeks now…she often lost track of time here and in fact, she couldn’t even remember how many months it had been since they moved here. They now slept in this white “leather” house that leaked when it rained. Mama said they had to manage the little they had here and she hoped things would get better.

An Internally displaced persons (IDP) camp in Northern Nigeria.
Photo credit: https://blogs.unicef.org/blog/childrens-stories-of-horror-and-hope-in-northeast-nigeria/ UNICEF/NYHQ2015-2030/Esiebo 

Her earlier trip to the medical tent was unproductive as she was not given any treatment, the nurse said the “tooth doctor” was not available at this camp. This camp hospital had a general doctor and few nurses attending to so many people. The nurses often complained about how they rationed medication and medical supplies. They prioritized catering for the very young children over the older children in the camp. The attending nurse today, like many of her colleagues, promised to help Aisha find out where she could get dental treatment in another health care facility. This series of unfulfilled promises by the workers in the “camp hospital” was becoming a norm to Aisha. The nights were particularly difficult as the pain in her jaw worsened. This pain was coupled with the fact that she could barely move while she slept – her 7 siblings and mother had tightly arranged themselves on the floor in their tiny tent. She did not have the luxury to be restless at night, neither could she sleep. On this particular night, the pain was excruciating and it hit her brain harder than the day Baban Saleh had come to break the news that her father was a casualty in one of the incessant bomb explosions in Borno.

The sound of morning prayers and the early morning cock crow ignited a sigh of relief because she could finally get the medical attention she desperately needed. Aisha could not be bothered to brush her teeth; though she had stopped brushing 3 weeks prior because of the pain. She succeeded in pulling Maman Aminu, her mother, along with her to the medical tent. Filled with hope, the nurses would take her condition more seriously when they saw her with her mother. As they stood in line under the mango tree, Mama confessed that Aisha’s mouth smelt terrible. After being scorched under the sun for 4 hours, there seemed to be light at the end of this very long and dark tunnel. Uncle Dikko, the bald chief nurse, attended to them and said that they would have to travel to the Mamarun Nufawa in Sokoto to get adequate treatment. He stretched out his arm, handing over some pain medication to her. Going to Sokoto, which was several states away, was almost impossible as her family barely had enough money for two meals. The next morning, Aisha noticed a sore on her gum and an awful smell oozing from her mouth. Her symptom progressively worsened with time. She noticed her right cheek began to swell and darken. Maman Aminu brought some brownish-purple concoction from the herbalist “Mallam Iliya” who lived down the street. She was instructed to drink the disgusting looking liquid which tasted awful. With time, her cheek became greyish black as the stench from her mouth worsened and hung heavily in their tiny tent. Sleep now becoming impossible for her, she watched as her siblings tossed and turned in a bid to fall asleep amidst this putrid odor.

After four days, she noticed she had developed a small hole on the right side of her face. By the third week, the flesh over the right cheek had fallen off, gradually exposing her teeth. Some time passed before she realized her facial skin had stopped falling off. The other children would not play games in the center of the camp if they sighted her on the playground. The medical staff in the camp were helpful…or she thought. They helped her clean her cheek wound and gave her some more pain medications but they left the facial wound exposed even though she begged them to put a plaster over it. She grew tired of the other children at the camp laughing at her. It hurt so much when she looked at her face in the community mirror the women at the camp shared. She wondered what she had done wrong to be disfigured at age 8. The children believed she was cursed and so they would not play with her. She couldn’t blame them. Her mother was told the same by Mallam Iliya…

9 years later. . .

“Aisha, Aisha” her older brother, Aminu, said as he tapped her shoulder, “the visitors from Nganzai have left. Mama said I should tell you that you can stop hiding.”  Before Aminu came to disrupt her thoughts, she imagined a time when she would not be an unsightly outcast…even to her own family. It had been 9 years since she became a monster to them. This particular set of visitors had come to seek for her kid sister’s hand in marriage and Aisha was to be away till the marriage proceedings were over. Maman Aminu did not want her to scare away this suitor like the previous ones. This was life as she now knew it. . .

WARNING!!! Graphic content below

Cancrum Oris (NOMA) is a devastating rapidly progressing flesh-eating facial infection affecting 6.4-7 in 1000 children in North-western Nigeria. Noma typifies the complex interaction between poor oral hygiene, malnutrition, dirty environment, unclean drinking water, immunosuppression (HIV), poor access to routine childhood vaccinations, and health care.

This is a fictitious representation of real-life situations in northern Nigeria among many other regions of the world whose communities have been affected by NOMA.

Visit http://noma.msf.org/ for more information.

References:

  • Farley E, Oyemakinde MJ, Schuurmans J et al. The prevalence of noma in northwest Nigeria. BMJ Global Health 2020;5. https://gh.bmj.com/content/bmjgh/5/4/e002141.full.pdf
  • K.W. Marck. Cancrum oris and noma: some etymology and historical remarks. British Journal of Plastic Surgery 2003;56(6):524-527. https://www.jprasurg.com/article/S0007-1226%2803%2900224-8/fulltex

1 Comment

  1. Pleasant novel/poetic presentation of a clinical case, readable by all.
    Unpleasant side of human deprivation, poverty, terrorism, war, internal displacement, lack of medicare esp dental in Nigeria rural areas etc
    Kudos to the author

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