Aira Hospital

Elephantiasis is a disease which can be treated conservatively with good result (see page “ELEPHANTIASIS”)

We know all too well that the result of surgical treatment is not promising in the long run – something which I am being reminded repeatedly by people engaged in the podoconiosis programs around.

But what do you do when a young man turns up at the OPD with a huge deformed leg asking for an amputation? Just chop it off?

I personally cannot resist helping and trying to save his leg. The surgical treatment is rather simple but time consuming.

The principle behind the surgery is very simple:  if there is no subcutaneous tissue there will be no subcutaneous edema. So cut away all subcutaneous tissue! The method was described by Dr Thompson and the procedure carries his name.

Start to harvest skin from the leg with a handheld dermatome.

Excise all the affected subcutaneous tissue from the leg down to the fascia.

Then transplant the skin back on the bare fascia and elevate the leg in traction with a pin through the calcaneus

The result might not be cosmetically the best, but the patient is happy and relieved.

The special form of elephantiasis called podoconiosis which represents almost all of the cases seen here in Ethiopia is caused by small mineral particles from the red soil which penetrates the skin and blocks the lymphatic system in people walking barefooted. It could be easily and simply be prevented by protecting the feet with shoes. Poverty prevents that.

The problem caused by podoconiosis is enormous. There are a lot of patients suffering from the disease, but except the beggars in the street you do not see them easily. They usually hide as it is considered a shameful condition - a curse. 

One researcher has calculated that the overall financial lost in Ethiopia from this disease widely overshadows that caused by HIV/AIDS!

Elephantiasis is a disease of the subcutaneous tissue caused by blockage of the lymphatic drainage. Since the lymphatic fluid cannot drain properly it collects in the subcutaneous tissue causing chronic edema – that is elephantiasis.

Podoconiosis is a special form of elephantiasis which affects only the feet and is believed to be caused by minerals in the red soil entering and blocking the lymphatic vessels in the lower extremities in the poor bare foot walkers. Secondary infections of the skin and subcutaneous tissue aggravate the disease, and the swelling of the subcutaneous tissue can take enormous and very disturbing proportions.

Around one million people are believed to be affected by the disease. They constitute a highly neglected group which is often socially isolated. When visiting Ethiopia you will notice that many beggars in the street are affected by this disease.

Our Public Health sector has introduced a program of treatment (curative health care) of patients affected as well as a public information campaign (preventive health care) about the disease.

The treatment is very simple and cheap. It consists of daily footbath with a special soap

Followed by softening the skin with oil.

The locally produced soap is made with the leaves of a tree which is said to have germicide properties. After only a few treatment sessions there is great improvement – objectively verified by measuring the ankle circumference. The patients are extremely enthusiastic – not the least because for the first time in their life somebody has shown some interest and something is being offered for  them. The hopelessness has been challenged! 

The patients a fit with shoes made in the regional capital Nekamte, at a cost of 80 birr. However the patients who are generally poor are only charged 10 birr.

The total estimated cost per patient per year for this treatment is 250 birr     (16 €).

Below are some pictures from a Podoconiosis workshop at a small clinic around Tchallia (three hours walk from Aira)

First all the students from the neighboring school had lectures about elephantiasis and goiter – the two most common endemic diseases in the area. Everyone listened with eyes and ears opened. After the lecture the students joined the workshop where they were exposed to patients with both diseases – very instructive.

Around 150 patients came to the clinic for the workshop

Every patient has to bring a jar with 5 liters of clean water and a plastic container for the footbath.

Information is extremely important since most people believe that the disease is caused by a curse from a Kalitdja (a witch doctor), or contagious by eating from the same dish or drinking from the same cup.

Three such groups with around 150 patients in each are currently in action – a total of nearly 500 patients. The idea is that the patients themselves continue the treatment at home or in smaller groups, and that the knowledge will spread, and initiative will be taken by health centers, clinics and other organizations to start similar workshops.

This particular workshop was attended by some “big shots” from the local district administration who wanted to express their gratitude and appreciation for bringing help to these neglected patients. After the speeches a poem was read by two young girls.

This is how we work in Aira – we do not separate curative from preventive health care because we know that these two entities has to work hand in hand! Donor agencies listen and learn!