Children without a face (Part 1)
By Dr. Joseph D. Lim (The Dentist Is In)
When he first heard the name, Dr. Bertrand Piccard did not know what it was. Then it was described, and he could not believe it.
“When we see the devastation of the disease with our own eyes, we will never be the same again,” says Dr. Piccard, president of the Winds of Hope Foundation.
“Noma is a disease that not only leaves indelible scars on the faces of its very young victims but also on the soul of those who witness it: the shame of not knowing about it sooner, the horror of its happening in the 21st century, the incomprehension of so little involvement by humanitarian organizations.”
Noma is a deadly opportunistic infection affecting 500,000 people each year, according to the World Health Organization. The United Nations health agency estimates there are 140,000 new cases every year. Nine out of 10 of these cases end up in death.
There is no noma case in the Philippines. We dwell on the disease because of its horrifying consequences and, as Dr. Piccard puts it, “the incomprehension” that nobody seems to be doing enough to prevent the disease from scarring children.
And while there is no noma case in our country, it can strike any country any time.
The sad fact is that noma affects children under the age of 12 in the poorest countries. It is especially sad because it is an ancient disease traced to the age of Hippocrates and Galen; and yet, amid modern medical science, children between the ages of two and six are affected by the deadly scourge.
It shouldn’t be the case. Since the 20th century (except during World War II when it spread in German concentration camps), noma has been virtually eradicated in Europe and the United States simply by improving nutrition, hygiene and treating noma patients with antibiotics.
Noma seems to have no links to any specific bacterium or virus. What is evident is that malnutrition, especially inadequate A- and B-vitamins; dehydration; unsafe drinking water and poor poor hygiene; nearness to livestock farms; recent illness; diseases (including AIDS) that compromise the immune system; and ignorance – one or all of the above may cause noma.
It begins with gingivitis, a gum infection. The disease worsens fast, causing the mucous membranes of the mouth to develop ulcers in the cheek. In just a few days, tissue degeneration quickly follows and affects the bones in the face. (A variation, noma pulendi, causes tissue damage to the genitals.)
The condition then becomes irreversible due to a weakened immune system that defends the body from infections. It need not happen. In the short span of a few days, common antibiotics would have halted the progression of the disease.
“But no one knew,” Dr. Piccard says. “The child is now condemned to see a gangrenous infection ravage his face, destroying soft and hard tissue, and present to the so-called civilized world, the true face of misery: hideous, revolting, unacceptable.
“20 percent of the victims survive, but with terrible suffering: gaping holes in the face, scars that restrict jaw movement and prevent normal feeding, breathing problems, social rejection due to repulsive disfigurement.”
Noma causes physical damage in facial functions such as eating, speaking and smiling; in some cases, the damage may be permanent that it requires plastic surgery; even then, reconstruction is a complicated procedure even for experienced dental surgeons.
Reconstruction takes a long time, conducted about a year from initial treatment and when the patient is fully recovered.
“Children without a face. Did you know they existed?” asks Dr. Piccard./PN