NGO focus AWD Kinderhilfe in Nigeria

In the first issue of Noma Contact we asked readers to write and tell us what they - and the organizations they work for- are doing in the fight aga inst noma. One of those who responded was the Foundation for the Support of Children in Germany. The foundation's report is highlighted on this page. Remember, if you are active against noma, please let us know what you are doing. Your experience can make people more aware of the problem and can help guide others who want to fight noma too. Send your contributions to: Mrs Marie-Helene Leclercq, Noma Project, Division of Noncommunicable Diseases, World Health Organization, 1211 Geneva 27, Switzerland. • NGO focus AWD Kinderhilfe in Nigeria Patients wait to reg iste r at the hospital in Sokoto. The AWD-Foundation for the Support of Children (AWD Kinderhilfe), in Hanover, Germany, has been supplying speedy help for children in misery since 1991. The founda- tion, which works internationally, is commit- ted to saving lives, curing disease and improv- ing the living conditions of children. In August 1994 we learned about the prob- lem of noma from a television report on the activities of the Swiss charity Sentinelles in Niger. Since then we have tried to develop a concrete strategy for intervention. In Octo- ber 1996 A WD Kinderhilfe sent its first team of surgeons to Sokoto in northern Nigeria in collaboration with the Interplast Germany or- ganization. The members of the team were all skilled in plastic and maxillo-facial sur- gery and their task was to carry out reconstructive surgery on the disfigured faces of noma survivors. They operated success- fully on 40 patients. Surgical instruments, equipment for anaesthesia, medicines, dress- ings and other requisites were financed by A WD Kinderhilfe. In our contacts with local health profession- als and government officials we found that the extent of the problem of noma was little known, especially in Sokoto. Only occasion- ally did persons with the facial gangrene come to hospital. Many simply stayed away as there was little expertise available to help them. The 2 successful work of our team in the local general hospital aroused the interest of the health ministry and the Sokoto state gov- ernment. They very soon recognized that noma is an important public health con- cern. In fact, an experienced German surgeon, Dr. Johannes Meixner, has been working at the hospital in Sokoto for the past eight years. A WD Kinderhilfe engaged him as leader of the noma project as he was fa- miliar with the treatment of noma suffer- ers and with local health workers. He takes care of pre-operative screening, post- operative treatment and local arrange- ments. He is also A WD Kinderhilfe's con- tact person with the Ministry of Health and the state government. In 1997 we sent two further teams of sur- geons to Sokoto. All in all nearly 150 per- sons with noma have had reconstructive operations thanks to A WD Kinderhilfe. Although we shall continue to send teams of surgeons to Sokoto periodically we are also looking for a more permanent solu- tion by setting up a noma treatment cen- tre in Sokoto. This would not only pro- vide surgery but would also offer facili- ties for research and for the training of local doctors. There is consensus that the problem of noma can be solved only by a multisectoral and multidisciplinary approach. Apart from the medical causes of this terrible disease - severe malnutrition, coexistent infection, lack of hygiene - there are contributing factors such as poverty and the lack of health infra- structure. These socioeconomic factors also explain the geographical distribution of noma. Most cases are reported in sub-Saha- ran African countries where people live in conditions of deprivation. Apart from further epidemiological and etiological research, the first steps have to be prevention and raising awareness of the problem. The biggest difficulties are the lack of clini- cal skills and poor socioeconomicconditions. There is urgent need to document the noma situation worldwide so that priorities can be established. We have discussed all these issues with the local authorities in Sokoto and they have re- acted very quickly. In October 1997 the foun- dation was laid in Sokoto of the first noma children's hospital in west Africa. Once es- tablished, this hospital will be financed, staffed and equipped by the Sokoto state gov- ernment. Prevention and treatment of noma are now integrated into primary health care programmes. Of course, assistance from nongovemmental organizations will still be needed in the fu- ture. Our noma project is to be integrated into Nigeria's federal Family Support Pro- gramme, which is active in all States of the country. This gives us a link to the local gov- ernments of the other States. We hope that the hospital in Sokoto may become a noma treatment centre for the whole of west Af- rica. (For further details, contact AWD-Stiftung Kinderhilfe, Rendsburger Strasse 34, D- 30659 Hanover, Germany. Tel: 49 511 9020268. Fax: 49 511 9020250.) Latest news AWD-Kinderhilfe's latest visiting medical team (the fifth) was in Sokoto during Sep- tember 1998. The nine-person team carried out 51 operations on 39 patients in almost three weeks. Most of the patients were noma sufferers but a few had cleft lip or other in- juries to the mouth or jaw. During their stay, the AWD-Kinderhilfe team was invited to give a presentation at the Sokoto school of nursing. Around 120 A medical team carries out reconstructive surgery on a noma patient in Sokoto. students attended, about half of whom had seen patients with noma. Team members not only demonstrated the principles of surgi- cal reconstruction but also stressed the im- portance of preventing noma and of treat- ing it adequately in its early stages. The German-language RTL television has sent a team to report on the work of A WD- Kinderhilfe in Sokoto. The aim is to follow this up with a special phone-in fund-raising programme that will be broadcast in Ger- many in the near future. • Niger workshop calls for media coverage to raise awareness of noma Journalists in Niger have been called on to alert people to the danger of noma. A media workshop in the town of Dosso in July urged journalists and others working in the media to give more cov- erage to noma. Public awareness of noma is seen as key both for stimulat- ing efforts by the health authorities to eradicate the disease and for encourag- ing community members to take steps to avoid it. The media workshop, which was organ- ized by the Ministry of Public Health with the support of the German nongovernmental organization Hilfsaktion noma, brought together some 40 health communication person- nel and journalists. The Director of Communication at Niger's Ministry of Communication and Culture called for "complete and regular information" on noma so that people better understand the disease, its causes and its conse- quences. People must be aware of what to do to prevent noma, he said, and must realize that if it occurs they must lose no time in seeking medical treatment. One result of the workshop, which took place from 21 to 23 July, was a full page devoted to noma in Niger's national newspaper Le Sahel. On 6 August 1998 the newspaper not only reported about the workshop but also published an ac- count of the causes, symptoms and treat- ment of noma, how to prevent it and what to do if you identify it in your child. For further details about the work of Hilfsaktion noma, contact: Ms Ute Winkler-Stumpf, Hilfsaktion noma, Eichendorfstrasse 39, 93051 Regensburg, Germany. Tel: 49 41 93684. In Niger: Or Sibomana, Hilfsaktion noma, 3