Saline Atieno developed a dangerous and disfiguring bacterial necrosis called Noma as a young child in Kenya. Though the disease has a 90 percent mortality rate, Saline somehow survived, only to face an extremely difficult future in her village on the outskirts of Nairobi. Now, after a fascinating eight-year journey that brought her to Stony Brook, Saline has not only survived, but returned home a transformed 19-year-old woman with a new face — and a bright new future.
Saline’s story began in 2010 when Leon Klempner, DDS, an orthodontist and Stony Brook Dental Medicine associate professor, learned of her plight after returning from an educational mission in Nairobi.
“We brought a team from Stony Brook Medicine to Gertrude’s Children’s Hospital in Nairobi where we spent a week there teaching,” said Klempner, who received an email from a physician affiliated with one of the international cleft charities that included a photo of Saline. “He told me that nobody in Nairobi was able to help her and asked if there was anything that I could do.”
Klempner reflected on the children that had been turned away in all of the years he had spent on missions to developing countries, and was inspired to help Saline and others in similar situations. In 2011, the non-profit organization Smile Rescue Fund for Kids became a reality, enabling Saline to come to the U.S. for help.
Noma is known as “the Face of Poverty” because the factors associated with poverty — chronic malnutrition, poor oral hygiene and sanitation, exposure to viral and bacterial infections — may lead to disease progression. It had left Saline with a face so severely deformed that even eating and breathing were difficult.
Once she arrived at Stony Brook in 2013, Klempner and Alexander Dagum, MD, chief of Plastic and Reconstructive Surgery, Renaissance School of Medicine at Stony Brook University, and their colleagues created a plan to reconstruct her face and mouth to improve her physiological functions and appearance.
“She was infected when she was about five, and she had already been born with a cleft lip and palate,” said Klempner, adding that Saline was homebound, having been ridiculed by other schoolchildren. “We decided that if we could bring her to Stony Brook, she’d be a good teaching case for the residents and at the same time we could help her.”
Ten surgeries and more than a year later, Saline’s life had improved considerably, and she returned to Kenya in 2014.
“Dr. Dagum did some miraculous work restructuring her face,” said Klempner, noting that Noma had eaten through the skin, muscle and bone in Saline’s face, which left her with a gaping hole that went all the way into her nasal cavity. “As a result, she was prone to infections and had difficulty breathing, speaking and eating, not to mention the psychosocial aspects of it. By the time we sent her back home, she’d had her face reconstructed and was able to begin speaking and eating normally.”
But Saline’s journey did not end there. As with many plastic surgical procedures, healing time was required.
“You can’t do everything all at once, particularly on a growing child,” said Klempner. “It was a good time to send her back and reevaluate how and if we’d be able to treat her in the future.”
Over the next few years, Saline had a series of recurring infections in her cheek that couldn’t be diagnosed or treated in Nairobi. In 2019, Klempner decided to bring her back to Stony Brook for additional treatment, where Dagum found the source of the infection and successfully treated it. During the course of this treatment, the COVID crisis hit. International travel restrictions prevented Saline from returning home, but Klempner and Dagum found a silver lining.
“Since we had her here, we decided to take the opportunity to make some additional refinements that were necessary,” said Klempner.
Klempner was able to coordinate presurgical orthodontic care to enable Dagum to reconstruct her jaw. Stony Brook Dental Medicine’s Christine Valestrand, clinical assistant professor in the Department of Prosthodontics and Digital Technology, provided prosthodontic care and created a maxillary overlay partial denture for Saline to restore aesthetics and function to her teeth and mouth. Saline will be able to maintain this dental prosthesis in Kenya despite the limited dental care available there.
Between February 2019 and late January 2020, Dagum performed five additional reconstructive procedures to reduce the risk of future infections and scarring around her lips, face and forehead, and removed a developing cyst from her cheek.
The extended stay transformed Saline’s life in other ways; she improved her English skills, received important follow-up care and guidance from her Stony Brook clinical care team, and is now described by her caregivers as a smart and funny young woman.
After more than a year living with a host family on Long Island, Saline returned to Kenya on May 2 to a future that includes coverage of her medical expenses as well as tuition and room and board to a vocational school, all provided by local donations to the Smile Rescue Fund for Kids.
“She wants to be a hairstylist and there’s a one-year program offered in Nairobi,” said Klempner. “We feel we can provide her with a vocational skill that will hopefully enable her to be self-sufficient and support herself. Even though we’re sending her back, we’re still here to support her.”
Since Noma only survives in pockets of the world that are impoverished, Klempner wanted to do something to help her village as well.
“We didn’t feel good about sending her right back to that environment,” he said.
During the past several years, Klempner and the Smile Rescue Fund for Kids has helped the village purchase water tanks to collect rainwater, as well as solar lanterns.
“We found out that the villagers would spend 50 percent of their meager income on kerosene to enable them to provide some light for their children to do homework after dark,” he said. Through the Smile Rescue Fund, Klempner was able to provide more than 200 solar lights for Saline’s village, an investment he said has helped double the income of the village while creating safer study conditions for the children. The group was also able to provide customized wheelchairs for children that needed them.
“These simple things made a life-changing difference in Saline’s village,” he said. “We feel that these types of things are part of our responsibility.”
Dagum echoed that sentiment.
“It’s our job to transform lives, and it’s a great feeling when you help people to be themselves and feel that they can do everything that anyone else can do,” said Dagum. “Sometimes we take things for granted.”
Dagum admits that it can be hard emotionally when he treats patients — sometimes prenatally — until they are in their 20s and even later.
“I’ve gotten to know many of my patients very well,” he said. “Some days I feel like a father of 1,000 great children and other days it’s 1,000 children who are misbehaving. But at the end of the day they’re my children, and I try to take care of them all.”
Though both doctors acknowledge the bittersweet nature of their profession, they also note the great reward that comes with doing such work.
“The extra time that Saline spent in the U.S. during the pandemic gave us an opportunity to help her heal, adjust, and see her future,” said Klempner. “Now it’s time for her to go home.”
— Robert Emproto