Noma

Noma is a flesh eating disease which has been the reason several of our patients come through our doors. One such young lady was my patient last week. In the west the condition if treated early with antibiotics will not develop into anything serious. Here where medicine is costly and treatment and consultation is also at a price, noma takes it's holds regularly.
Beindhu is a young girl with a 4 month old baby. She arrived to us with a hole in her cheek, through which you could see the inside of her mouth and her tongue. After extensive surgery she has had a muscle flap and skin grafts to reconstruct her face.
As her case was handed over to me I was more than a little apprehensive. She would be a complex case to care for. She had a drain, NG feeds (food through a tube in her nose) and medication to be given via her NG tube, dresssings to be done, intravenous antibiotics to be given, a catheter for her to pee, a nasal 'trumpet' through which to suction her airway, nebulisers to give, regular mouth suctioning and mouth washes needed doing, plus her baby needed looking after! Her baby, Mary, had been a little distressed as her mum was in surgery so would not have milk from a bottle spoon or by any other means, but was crying out in hunger. She in true '2 for the price of 1 patient' style, ended up having an NG tube inserted so we could make sure she got fed! So I had feeds for her to give, as well as 3 other patients to care for. It was however, a challenge I need not have worried about. As Beindhu looked at me through puffed up lips and tight head bandages and drips and drains of all kinds, she was clearly overwhelmed, but quickly we were able to get into a pattern of pointing and prompting so I could suction her when she needed it. As I organised myself I found that I loved every minute of the busyness!
As the shift progressed, so did her condition, she became more alert and ready to hold her baby. I had the task of trying to get Mary to breastfeed without yanking at Mama's various tubes adn drains, and without her getting upset at her Mama's looks. Thankfully it went like clockwork and a look of contentment passed over both Mary and Beindhu's face as she snuggled once again with her Mum. Beindhu was able to have her drip down and her catheter out during my shift, and I was able to take her for her first walk. Now she will continue to be cared for as her wounds heal.
Her first dressing change was done after I left, but was reported to be looking very good. It will be a long recovery, but quite an amazing feat!