As part of our Complex Surgical Mission we treat patients who have very severe cases of facial disfigurement – some of these include Noma, large facial tumours known as AmeloblastomasTrismus (Lockjaw) and abnormal bone tissue growths such as Cherubism. This article discusses Noma, and the role Project Harar plays in treating victims of this destructive disease. 

What is noma?

Noma is a rapidly progressive, gangrenous infection which mainly eats away at the oral and facial tissue and bones in the face. Noma primarily affects malnourished children under the age of five who live in areas of poverty. People living with noma will often suffer from a high mortality rate; it is estimated that approximately 90% of people with noma will die if left untreated, and those who survive will suffer from disfigurement and disability.

Who is affected by noma?

According to the World Health Organisation, approximately 500,000 people are currently affected by Noma, with a yearly incidence of 140,000. Most of these are in Africa. It is difficult to accurately estimate the global prevalence and incidence of noma as a large proportion of people do not seek treatment - this is often because they live in remote areas, isolating themselves and are lost to follow-up. 

What causes noma?

The destruction of facial tissues can be attributed to a person’s immune response to noma, rather than only bacterial causes. Therefore if someone is malnourished, they will be more likely to be severely affected by noma compared to someone who wasn’t malnourished. Additionally, as noma is a disease of poverty, other factors linked to noma are believed to be:

  • Poor oral hygiene - specifically ulcers which facilitate the entry of bacteria
  • Unsafe drinking water
  • Poor sanitation
  • Limited access to healthcare
  • Recent infections such as measles
  • Low childhood vaccination

Noma and discrimination

Of the 10% who survive noma, many are left severely scarred, with deep facial wounds exposing their bones and teeth. This means they have difficulty eating, speaking and even smiling, leading to discrimination and stigma from their communities. This means they can be very isolated, dropping out of school and work.

Complex surgery from highly specialised maxillofacial surgeons is required to correct the consequences of noma. In rural Ethiopia there is limited access to these services - there are an estimated 127 surgeons for a population of over 85 million people so those affected by noma do not receive the treatment they need. They are left feeling very alone and hidden away from society, finding it difficult to make friends.  

Our role 

As part of our Complex Surgical Mission, we provide people who have been affected with Noma reconstructive surgery. For many, this is the first time they start to feel part of a community again. After surgery, they return to their communities feeling happier and more confident to re-join school and mix with their peers. Their lives are transformed both physically and emotionally – just like Zeynab (below), who we treated in our complex mission in 2018. 

When Zeynab came to us, she was shy and withdrawn. She had a whole in her cheek because of noma. After her reconstructive surgery, Zeynab became more interactive and even learned how to write her own name, with the help of one of our volunteer nurses Grace.