Seven years ago, Dr Hafiz Muhammed went from Kozhikode, his hometown, to Coimbatore to attend the annual conference of plastic surgeons in India. There he heard a speech by a member from Doctors Without Borders (or Médecins Sans Frontières because of its French origin), an international humanitarian NGO.
As soon as the speech got over, Dr Hafiz signed up to be a member, following it up by submitting his credentials and attending interviews. In 2019, he got his first assignment to go oversees – all the way to Nigeria – and be part of a team of doctors treating a disease called Noma.
“It is a disease that was once prevalent in other parts of the world including India, but now it is mostly concentrated in one part of Africa. We went to the state of Sokoto, in north western Nigeria,” says Dr Hafiz, the only doctor from Kerala to join what came to be called Project Noma of the MSF. He has returned after a three-week trip, treating, along with other doctors, 27 Noma patients.
“The disease comes out of malnourishment, mostly affecting kids between the ages of one and five. They contract a bacterial infection which means their immune system becomes less active. It starts as a small ulcer in the mouth but rapidly invades the soft tissue (like the cheeks) and the bones. And then destroys them. Ninety per cent of the victims die. The rest who survive have big gaps in their cheeks and lips, and parts of their nose would be lost. Many can’t open their mouth, which means they can’t even eat or speak. It is a grim sight,” Dr Hafiz explains.
Team of doctors from Doctors Without Borders at Sokoto, Nigeria
The team of doctors included surgeons and psychologists. Dr Hafiz was among the reconstructive surgeons who fixed the patients’ cheeks and lips and disfigured faces. “They’d be very pleased because many of them had not opened their mouths for years. They were also very tolerant of pain – even the children never complained,” he says.
Poverty is, of course, at the root of the problem. There is little chance of it recurring in India, because there is access to healthcare in every part of the country, unlike in Nigeria. It can, Dr Hafiz says, be treated easily if the victim is taken to a hospital soon enough. But the doctor performed surgeries on survivors who were affected even 10 to 15 years ago. “Surgery can be done, yes, on children and grown-ups, years after the onset of the disease,” he explains.
Dr Hafiz says he is humbled by the experience. “I had my apprehensions at first. I have never been exposed to the disease before. But we were given books to read and the team leader helps in planning. In the three weeks we were there, one whole week was spent in travel to reach Sokoto. And then we screened the patients to choose those we could perform the surgeries on. Some had malaria and could not be operated on,” Dr Hafiz says.
Noma was present in Europe in the beginning of the 20th century and surged in the Nazi concentration camps during World War II. It’s currently most prevalent in poor environments, mostly along the African ‘Noma belt’, which stretches across the Sahara from Senegal to Ethiopia. The World Health Organisation estimates that around 140,000 children contract Noma every year.