Her name is Baby, yes that is her real name. She is a shy, small, 15-year-old young lady. She came into our hospital early this week for surgery on her jaw. Most of the left side of her face has disappeared over the last 2 years due to a disease called Noma. 

'Noma is a type of gangrene that destroys mucous membranes of the mouth and other tissues. It occurs in malnourished children in areas of poor cleanliness. The exact cause is unknown but may be due to bacteria called fusospirochetal organisms. This disorder most often occurs in young, severely malnourished children between the ages of 2 and 5. Often they have had an illness such as measles, scarlet fever, tuberculosis, cancer, or immunodeficiency. Risk factors include Kwashiorkorand other forms of severe protein malnutrition, poor sanitation and poor cleanliness, disorders such as measles or leukemia, and living in an underdeveloped country. Noma causes sudden, rapidly worsening tissue destruction. The gums and lining of the cheeks become inflamed and develop ulcers. The ulcers develop foul-smelling drainage, causing breath odor and an odor to the skin.'

When Baby entered into D ward she held her head down, her shoulders were slumped, and did not make eye contact. My first interaction did not make us fast friends. I had to start an IV and she later told me we were not friends because friends don't stab each other. SO I spent the rest of the evening trying to win her friendship. I brought her crayons and we colored together, but she lost interest. So I brought her a slinky and she played with it for about 5 minutes then she again lost interest. So as my last-ditch effort I brought her an etch a sketch. As I showed her how it works she smiled and said "Thanks my friend".

Baby went to surgery and they made her a new left side of her face. It is quite remarkable actually. She came in with no confidence and left with her shoulders straight, her head held high, and a beautiful symmetrical face, and I... gained a friend.