Many Ugandans have no idea what it is like to suffer from elephantiasis or even if it really exists in the country. The disease, which is characterized by swelling of the limbs, scrotum and other body parts up to almost ten times the normal size, has created fear and pain among the people of Kamwenge district, Western Uganda leaving them perplexed.
Men, women and children as young as eight in Busiriba sub county have experienced the disease for over 20 years and know what it is to live with this debilitating and disfiguring disease.
Gloria Atuhaire, 14, from Kyairumba village has been sick for eight years. She has extremely swollen feet and lives a miserable life. She can hardly walk; worse still she is an orphan who has received no care from the government.
“I get severe fever and pain all the time. I cannot walk with ease, my classmates laugh at me at school but I have to push on. I have never got any treatment. Every time we go to the health unit they tell us we go to Fort Portal [but] my uncle has not managed to take me.
“I feel very isolated when I see my agemates playing and sometimes not wanting to play with me. This is the most terrible disease that I have seen in my community. I wish I could get some help and get healed.”
Byamukama Didus, Atuhaire’s uncle, says the girl started showing signs of the disease at the age of six and has been living in a miserable condition for eight years.
“She lost all her parents and now stays with her grandmother. I offer her material help for school and cater for her hospital bills. I tried the health units around but they offered no help,” Byamukama Didus said.
Peter Byamukamain, in his early 30s, says he has experienced the disease for 28 years and has lost hope for being cured.
“I was 12 years when I got the disease. I first got swellings on my left leg, then my right leg, and after my private parts. I had been operated twice on my private parts where they pull out water, but the swelling keep coming back. I will be going back for operation you can see how I am swelling. I experience a lot of pain and since the day I got the disease I feel not wanting to live,” he says.
He adds: “Sometimes I wish I had got the swellings in my legs only. I can bear with the pain but with the private parts the pain is much. I don’t know how the disease came but I hear that it is spread by a mosquito,” Byamukama says.
“I cannot do any job. My mum is taking care, father neglected me after I fell sick and does not offer any help to us,” he added.
Despite the disease presenting itself in the area for over 20 years medical officers and the district has not done much to help the residents with clear information in regard to the causes and prevention of the disease, which has left some to seek traditional ways of getting rid of it.
Michael Kisembo, the district coordinator of Integrated Women Development Program (IWDP), a local NGO that carried out a survey to identify the affected people in Busiriba, says some residents think they were bewitched while others think they contracted the disease because they stay near the national park.
“One of the residents told me that he has been bewitched and that he knows the person bewitching him. Others believe they contracted the disease from animal wastes. This shows that the district has not labored much to provide these people with the information,” Kisembo said.
He adds: “We have identified 58 affected people but majority are still there since they could not reach everyone; 21 are men and 37 women.”
Gerivaziyo Byomugabi, one of the sick residents, believes he was bewitched by his neighbor after his cows grazed in his garden and they quarrelled.
“My cows went and grazed in his gardens and we picked a quarrel; two years later I developed the swellings. Others could have had the disease, but me - I was bewitched by him - but I will keep on praying.”
Dr Vincent Olowo, the environmental officer in Kamwenge, who represents the district health officer explained that the disease might be a type of elephantiasis known as podoniosisor nonfilarial elephantiasis, since most people who are affected have swellings in the lower parts of the body.
Olowaalso revealed that in 2004 the Ministry of Health carried out research in Kamwenge district but did not find the parasite that caused lymphatic swellings and so concluded that the swellings are caused by the soil.
“We don’t have cases of swellings of the hands, breasts and other upper body parts. Since we don’t have them we are most likely to say that these people have podoniosis, which is caused by the soil.”
“When a person keeps on stepping on the volcanic soils there are some minerals or soil particles which keep entering the body through the pores in the feet. As the soil accumulates it blocks the pores and goes into the lymphatic system and once it is blocked body wastes will not come out and in the end the body swells due to the pressure exerted,” Olowo explained.
He said the whole district is affected but Busiriba sub county is the worst hit area.
“The disease is in both Kibale county and Kitagwenda, but the most alarming place is Busiriba sub county. But the whole district is not safe,” Dr Olowo said.
IDWP mobilized all the affected people, who petitioned the district for neglecting them, and tasked the district to provide them with information about the disease and also consider the sick as vulnerable peoples in the government programs.
Kisembo says IWDP organized the people and is advocating for better service delivery for those affected.
“We want the government to offer these people quality delivery. You can see majority of them cannot walk with ease and in the near future they will completely stop walking. So let the government provide them with health services, counseling and treatment and also consider them special in government programs like NAADS,” Kisembo said.
EriyaMujungu, the deputy resident commissioner in Kamwenge, challenged the residents to embrace shoes and keep good hygiene as one of the preventive measures for the disease.
Dr Lowo tasked the residents who are already experiencing swelling to keep their affected parts clean, and use Vaseline to soften the skin to avoid other infections which can cause death.
“You have to keep your feet clean, there’s no medicine. Wear shoes, its is the only measure which will help you guard against other infections,” Olowo said.
Utilities
According to the World Health Organization, elephantiasis is characterized by skin thickenings and gross swelling of underlying tissues, particularly in the legs, scrotum, vulva, male genitals, arms and breasts, and cause underlying, accompanying internal damage to the kidneys and lymphatic system as well.
More than 44 districts are affected. In Uganda, 14 million people are at risk and 4.8 million infected.
Causes
The rapid and unplanned growth of cities, and the mosquito breeding grounds they can develop, may be a primary cause of the parasitical form of elephantiasis, which stems from filarial worms called wuchereria bancrofti and brugia malayi.
Treatment options for patients with elephantiasis may include Albendazole, Diethylcarbamazine, Ivermectin, and Doxycycline for worm infestations, rigorous hygiene of the affected areas, lymph fluid flow promotions that help reduce the frequency of acute inflammations, and surgical treatments for scrotal elephantiasis.
Podoconiosis
Most rampant among poor farmers in the central and eastern portions of the African continent and in Central America, podoconiosis or nonfilarial elephantiasis generally affects the lower legs and feet with extremely painful swelling and cracks in the skin. These may be prevented simply by wearing shoes in high altitude areas around volcanoes, where red clay and high alkaline content can enter and clog the lymphatic system producing symptoms that may not appear for as many as thirty years.
Endemic areas
Countries where elephantiasis rates are most endemic include Ethiopia, Uganda, Tanzania, Egypt, Sudan, Kenya, Rwanda, and Burundi.
- A 30 year old Peter Byamukama shows his affected leg, he has spent 18 years with the disease
- A woman shows her affected legs.
