For the Sunday Series today here is an article from the archives that highlights the story of Dr. Hafiz from India who volunteered for Médecins Sans Frontières(MSF) or Doctors Without Borders. It is an international humanitarian medical NGO of French origin known for its projects in conflict zones and in countries affected by endemic diseases.

For Doctors Day this year, we bring to you Dr. Hafiz's recollection of the time he spent in Nigeria, as a representative of Médecins Sans Frontières. Dr. Hafiz shares his experience of working with patients with Noma, an uncommon but debilitating disease often seen as a result of malnutrition and subsequent immunosuppression.

I had only a faint memory of the name of the disease I had heard during my medical schooling – noma? Cancrum oris? I couldn’t quite remember!

Sometime in 2011, I attended a meeting organized by the Association of Plastic Surgeons near my hometown in India where I heard a motivational presentation of Médecins Sans Frontières (MSF) and its medical humanitarian work in various countries. Immediately after the meeting, I approached the speaker and initiated the process to work with MSF. After several months of waiting and lots of paperwork, I was called for an interview in New Delhi and soon enough I was offered my first assignment. I was thrilled!

My first assignment was to be Gaza in 2017 as a reconstructive burns surgeon. However, it had been abruptly called off because of security concerns restricting access. I had to return home after waiting for two weeks in Jerusalem.

As a plastic reconstructive surgeon, my options in MSF in my field of choice were limited. I preferred not to opt for general surgical missions and war surgery but to remain in my comfort zone which is reconstructive surgery- and so was very excited when the MSF India office called me and shared with me the good news. I was “matched”, for another assignment.

The assignment was as a plastic reconstructive surgeon for the noma reconstruction project in northern Nigeria. I had a lot of reading up to do on noma. It seems Noma is a rather uncommon disease now, but still widely prevalent along an equatorial belt passing through Nigeria, Chad, Cameroon, and the Central African Republic.

The noma assignment in the city of Sokoto, northwest-Nigeria has been running for 4 years now and we are working alongside the Ministry of Health. The awareness of the disease is very limited and so are the treatment options. The disease destroys the bone and tissue affecting the jaw, lips, cheeks, nose or eyes and this rapidly spreading orofacial gangrene is primarily a result of malnutrition and opportunistic oral infections in the already immuno-suppressed child. The mortality rate for the disease is also high and many patients require reconstructive surgery which was where MSF decided to intervene.

The literature regarding this disease is also fairly limited; a small textbook by the Dutch Noma foundation shared with me by an antecedent surgeon became my Bible for understanding the disease. The book contained multiple pictures and accounts of grotesque facial deformities caused by the disease which immensely helped me later, saving me from the shock of the unknown during the assignment.

The international team had extensive experience treating noma which got me nervous at first since this was my first time treating the disease. However, constant encouragement and sound advice from the staff helped me focus on my work. As days passed by, my apprehensions died down as I realized that I could depend on my fundamental skills as a reconstructive surgeon at most times.

I believe my time spent in the assignment was worthwhile. We had treated over 27 patients and the large majority of them showed fair to excellent healing. The camaraderie among the staff also ensured smooth functioning.

Every surgeon knows that post-operative care is vitally important, if not more so than the surgery itself. The ward rounds were therefore very important and something I always looked forward to. This is also when one gets to see the human body perform its job of natural healing after surgery.

More than anything else, what really astounded me was the resilience of these impoverished people. Even with the disease, many would be up and about, smiling in the evening after their surgery, often making us wonder if it was the same patient that we had operated on that morning. Rarely would anyone complain of pain, which was remarkable and in stark contrast to the healthy and fit patients I regularly encounter in my daily practice back home.

The two weeks flew by in the blink of an eye. In a memorable thanksgiving ceremony, the relatives of many of our patients got together in the hospital courtyard on my last day, sharing their gratitude through a traditional dance performance. It was a delightful evening and the energy of the performers compelled even the shy and awful dancer in me to join the fun.

I hope to return soon!