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Battlingelephantiasis

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PeterOyukihaslivedwithelephantiasisfor31years.PhotobyPaulMenya

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ByBAMUTURAKIMUSINGUZI
PostedMonday,March242014at02:00
INSUMMARY

Theminsitryofhealthsaysmorethan11millionUgandansaresufferingfromNeglectedTropicalDiseases(NTD).Starting
today,HealthyLivingwillrunaseriesofstoriesonNTDs.Webeginwithelephantiasis,adiseasethatleadstomassive
swellingofbodyparts.

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Anguish,pain,immobilityandstigma,iswhat
PeterOyukiandPatrickBalikobahave.Thetwo
havebeenabandonedbytheirwivesbecauseof
theirlargedeformedlegsandfeet,thatarea
resultofelephantiasis.
Oyuki,whohaslivedwithelephantiasisfor31
years,sayshelosthiswife,themotheroftheir

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threechildren,tohisneighbourinLukinduB
Village,BukatubeSubCountyinMayuge
DistrictineasternUganda.
Mywifeleftmethreeyearsago.Myhandsome
neighbourtookherawayafterconvincingher
thatsheshouldnotlivewithasick,disabledand
uglymanlikeme,Oyuki,51,saysinsadlow
tone.

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UnlikeOyuki,Balikoba,a47yearoldresident
ofBuseeraBVillageinBusakiraSubCounty,
MayugeDistrict,isstillwonderingwhatforced
hisspousewithwhomhehadfivechildrento
moveoutoftheirmaritalhome.Mywifelefta
monthagoandshedidnotgiveareasonfor
leaving.Idontknowifitwasduetomy
illness,Balikobawonders.

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Oyukirecallsthatthediseasestartedin1983.It
beganwithitchingthenIstartedfeelingcoldand
difficultyinwalking.Mylegsbecamepainful
andheavytocarry.Ihavetriedtogetthisillness
treatedandfailed.Idonotknowwhatcauses
thisdisease,heshares.

Insearchforaremedy,OyukiwenttoBuluba
LeprosyHospitalinMayugeDistrictwherethe
doctorsrecommendedamputation.WhenIwent
Checknow!
toBulubaHospital,IthoughtIhadleprosybut
whenthedoctorssuggestedamputatingme,Ileft
becauseIfearedlosingmylegs.ThenItriedtraditionalmedicinewhichfailed.Meanwhile,the
symptomshaveincreasedandIhavelivedlikethissince,hesays.

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Balikobastartedsufferingfromelephantiasisayearago.Itbeganwithitchingandswellingofmylegs.
Thepaincomeswithheatandsweatingallovermybody,mainlyduringtherainyseason.Theitching
happensonlyinthedryseason,Balikobasays.
Idontknowwhatcausedthisdisease.IhavenotyetgotanyformofmedicationbecauseIwasntaware
thatIcouldgettreatmentinhospital,Balikobaadds.
OyukislegdevelopswoundsonwhichheappliesProcaineBenzylPenicillin(PPF)oramoxylcapsule
powder.HecontinuestotaketheIvermectintablets,whicharegivenfreeofchargebytheministryof
healthonceeveryyear.ExtremeheatandcoldnesscauseOyukialotofdiscomfort.Iusuallyexperience
alotofpainwhenitisveryhotorcold.IgetsouncomfortablethatIcantevenmovearound,hesays.
AccordingtotheMayugeDistrictVectorControlOfficer,JumaNabonge,Oyukisconditionisinthe
irreversiblestageofelephantiasisandhewillhavetoliveinthissadstate.
WeshallmakesureBalikobastartsgettingdrugsfromtheVillageHealthTeam,Nabongepromised,
adding,Thedrugwillkillthewormbutunfortunatelythesizeofhislegswillremainthesame.
IdonotknowifIwilleverheal.Myhopesareinthedoctors.Otherwise,Ihavenooptionbuttolook
aftermychildrenuntilthetimeIleavethisworld.Myextendedfamilywilltakecareofmychildren
whenIdie,Oyukisays.
Victimsplea
MywishisgovernmentshouldtreatmesothatIcanhealandothersufferers,Balikobasays,adding
ratheroptimistically:IfIheal,Iwillmarryagain.
TheplightofOyukiandBalikobaisanexampleofthesocialstigmaanddiscriminationthatvictimsof
NeglectedTropicalDiseases(NTDs)faceinUganda.Itisnotonlythemalevictimswhosuffer,butthe
womentoo,arechasedfromtheirmatrimonialhomesbytheirhusbands.
Whatcauseselephantiasis?
Elephantiasis,anNTD,scientificallyknownaslymphaticfilariasis(LF),iscausedbytinythreadlike
parasiticfilarialnematodewormscalledwuchereriabancroftitransmittedbymosquitoestohumans.

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Infectionisacquiredearlyinlifebutgraduallybeginstocauseinternaldamage.
Adultwormsarefoundinthelymphaticvessels(usedforcarryingwastebodyfluids),wheretheycause
damage,leadingtoelephantiasis(swellingofthelegsandfeet),hydroceles(swellingofthescrotum),the
vulvainwomenandotherpartsofthebody.However,themajorityofinfectedindividualsshowno
physicalsigns.
Accordingtotheelephantiasis/podoconiosisProgrammeManagerintheministryofhealth,Gabriel
Matwale,thesymptomsfilarialfevers,whichareoftenmistakenformalaria.Onewillhavegeneralbody
weaknessandbodypains.
Also,thevictimsskinstretchessomuchthatithardens,thusturningintoahabitatfororganismslike
bacteria,fungiandvirusesresultinginfullblownelephantiasis.
Thediseasederivesitsnameelephantiasisfromthefactthatthelegsandfeetswellalot.
Prevalencerate
AccordingtotheDrugsforNeglectedDiseasesInitiative(DNDI),elephantiasisaffectsanestimated120
millionpeoplelivingintropicalareas.Theministryreportsthatelephantiasismostlyaffectsthepoorest
Ugandans.Itisamajorpublichealthandsocioeconomicproblemwith4.7millionpeoplein54districts
outofthe112sufferingfromthedisease.Another14.5millionareatariskofbeinginfected.
InsomecommunitiesineasternandnorthernUganda,upto25percentofadultsshowchronicsignsof
LFmainlyhydroceles.
Treatmentcoverage
TheNTDControlProgrammeprovidesannualdrugtreatmentstonearly13millionpeopleinaffected
areasunderitsMassDrugAdministration(MDA)activity.
MDAsoccurannuallyindistrictsendemicwithNTDsthatcanbecontrolledwithmedicine.Thefirst
MDAwithivermectinandalbendazoleagainstelephantiasiswascarriedoutin2002intwodistricts
(KatakwiandLira),reachingcoverageratesofabout75percent.
TheMDAhasbeenscaleduptocoverallthe54affecteddistricts.Healthworkersalsoconducthydrocele
surgeries.Thereareplanstoscaleupthenumberofsurgeriesconductedbyimplementingsurgical
camps.
Thosewithelephantiasisgethealtheducationtocontrolsecondaryinfectionsandalleviatepain.Health
officialsrefuteclaimsthatelephantiasisiscausedbywitchcraftandhydrocelesarehereditary.Matwale
saystreatingelephantiasisinUgandaisnotclearcutliketreatingmalaria.
Thisischronicinfectionwhereobvioussigns(elephantiasisandhydrocele)appearlaterinlife.Our
strategyistointerrupttransmissionwherebypeoplearegivenmedicines(MectizanandAlbendazole)
despitetheirinfectionstatus.Bydoingthat,thosewhohaveitwillhavereducedthewormload,which
cantbepickedbythemosquito.
Themajorchallengeistoconvincethosewithoutthesignstotakethemedicine.Also,thereislittle
focusorhelpforthosealreadyinfectedbecausethemedicinehaslittleeffect.Lastly,welacktransport
andoperationfundstointensifysupervisionofvillagehealthteammemberswhoareourfrontlineservice
providers,Matwaleadds.
Accordingtotheministrymorethan11millionUgandansaresufferingfromNTDs.Ugandahas12
NTDs.WorldHealthOrganisationsaysNTDssuchasleprosy,elephantiasisandleishmaniasis(kala
azar)arefearedandthesourceofstrongsocialstigmaandprejudice.Asaresult,thesediseasesareoften
hiddenoutofsight,poorlydocumentedandsilent.
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