MSF psycho-social workers hold a dance party with Noma patients and their caregivers to boost their spirits before the patients undergo surgery. In August 2015, MSF held a surgical intervention for 19 Noma patients at the Children’s Hospital in Sokoto, northwestern Nigeria. Noma begins as an ulcer inside the mouth extending from within outwards, rapidly destroying the soft tissues and the bone. The disease is caused by poor oral hygiene which is exacerbated by severe malnutrition commonly associated with extreme poverty.