In sokoto state in northern Nigeria, MSF medical teams are providing the life-saving care they need on a daily basis to patients affected by defective chancre, a severe gangrene disease that begins in the mouth and primarily affects children. But the treatment was only part of the fight, with nurse Veronica Emeh recounting what she saw and heard.
Zygoid is an infection that affects the face and can erode the body's soft tissues, usually completely destroying bones and sometimes destroying a person's nose and even eyes. It mainly affects children under 7 years of age.
There are many factors that contribute to the matriarch, including malnutrition, lack of vaccination, poor oral hygiene – and ultimately, poverty.
First, the patient will have bleeding gums and become inflamed, then soft tissues and the mouth will be affected, and decay will begin to appear inside the cheeks. All of these problems arise very quickly. The children's cheeks became swollen and painful. Before you realize it's a bomb, the problem erupts.
When I talk to the parents of the children, they are constantly trying to figure out what is going on. For most children, the disease has damaged tissues in the mouth before the outer surface is affected.
In the first stage of the progression of the chancre, when a patient is infected with acute necrotizing gingivitis, doctors can easily treat it with antibiotics and therapeutic foods. After a week in the hospital, your child should be well. However, when the japonics progresses to stage 2 (edema appears) or stage 3 (gangrene appears), the child's condition can deteriorate rapidly.
Many parents don't know what a chancre is. When they start to see symptoms, they don't know what to do.
Many of the patients come from poor communities, as well as the poorest families in those communities. When symptoms start, they don't always have the money to see a doctor.
Sometimes, they believe that the disease is caused by mental strength and therefore do not seek medical care or go to a traditional healer. So when they brought the child to our medical program, the damage caused by the jaundice was already severe.
We cut off the damaged tissue and bandage the wound, repeating this several times until the damaged area heals. The child then has to wait a few months to a few years until they are in a position to undergo a surgical plastic surgery.
In some cases, due to severe damage, children develop closed teeth, also known as "lock-in jaw disease." Oral tissue becomes hard and sometimes affects the bones. Children with closed teeth may feel bad. They have difficulty eating due to limited opening, which can lead to malnutrition.
Children often have a hard time understanding that they need to go through painful physical therapy to open their mouths. It's always sad to see children with this disease. Even before I became a mother, I found it difficult to face. But I try not to show these feelings in the face of patients, because these performances will make them lose hope.
The hardest part of the operation is when the operation fails, because the children have gone through many stages before: going to the operating room; going through painful surgery; and then having to keep their heads motionless for several weeks. These things, which are already painful for adults, are even more difficult for children.
Although horse chancre is an evil disease, we will also have success stories. Sometimes, children with cheek defects due to horse chancre begin to recover after surgery, and some patients recover so well that you can't even see what caused the scar.
Others suffer from occlusion and have not been able to open their mouths for years, but after targeted palacing treatments, they can easily speak, eat and move their mouths.
One of the most memorable patients for me was a child who had completely lost his nose. That was the first time I saw a medical procedure for nasal reconstruction. After that, we went to the children's village for follow-up. When we got there, everyone gathered around us as if they were seeing God, because they knew who had done the treatment for the boy.
Previously, the boy was discriminated against in the community, he dropped out of school, and people bullied him because of his appearance. When he returned from the hospital, most people didn't recognize him. He had good news for the community – if children like this could come to the hospital to do such a beautiful reconstruction, why wouldn't anyone else?
Seeing a patient with a facial deformity come to our hospital, receive anesthesia, and recover function is like seeing a magic spell, and there is nothing more gratifying to me than this!
Before I joined MSF, I knew there was a disease called horse chancre, but I had never seen it with my own eyes. It's a neglected disease. In Sokoto, we are doing our best to reach out to people with the disease, provide them with care and help them reintegrate into the community. But there are still thousands of patients who have not yet reached our hospital.
We've seen patients come to us from Delta States, 1,000 kilometres away, which shows that the country is in great need of treatment for jaundice. Currently, MSF is trying to get into prevention mode. It's challenging – how do we prevent marmoving? One of the factors that contributes to illness is poverty. How are you going to alleviate poverty? In the face of the horse chancre, MSF can not fight alone, the world needs to pay attention to, more struggle to fight against the "evil disease" of the horse chancre.
© Claire Jeantet - Fabrice Caterini/INEDIZ
Sokoto Zoma Chan Chancosa Hospital is the only medical facility in Nigeria dedicated to the treatment of this neglected disease, operated by the Ministry of Health, with the support of MSF, providing free medical care to patients, including plastic surgery.
Amina, 18, first came to Sokoto's Zhoma Chancosa Hospital in November 2016, where she returned to the hospital for surgery in 2017 after a series of tests. She contracted zygoids as a child and, like many other survivors, is accustomed to using a headscarf to cover her face.
Umar (left), 8, and Adamu, 15, stand in the hospital's post-operative ward. They are shortly after the operation and need to stay in the ward for four to six weeks to avoid infection, but they are looking forward to getting out of the room soon.
Sufyanu, 3, returned home with her parents and relatives after being treated in the hospital. When he first went to the hospital, he was in an acute onset, facial injuries had begun, and he was also suffering from malnutrition, and he received nutritional treatment, antibiotic treatment, and debridement and dressing for his wounds in the hospital. He had to grow a little older to undergo plastic surgery.
©Claire Jeantet - Fabrice Caterini/INEDIZ
At MSF's Zumbai Hospital in Sokoto, mental health support staff come to the postoperative recovery ward every day for rounds to support patients and their caregivers through the difficult recovery journey.