Podoconiosis: The risk of walking barefeet

She sits forlornly at the verandah of her daughter’s house in Sahara village in Kimihurura, as she stares at the rising and falling sky. This is always her routine every day. She silently curses at the disease that afflicted her nine years ago. This disease has rendered her immobile. Podioconsis is a disease that affects those who work bare feet in volcanic areas. And Rose Hirwa, 67, is one of its victims. “I just felt one day an itch on my right leg and I scratched it, thinking that it would go away. But it did not. Instead, both my legs continued swelling and I thought that I had been cursed,” she says. Thinking that she had actually been cursed, she refused to hear all pleas, even from her husband, that she visits hospital. She was waiting to die from the “curse” that she says she thought was visited on her by a neighbour she had had long standing feud with. Cause, treatment According to Dr Rachna Pande, a specialist in internal medicine at Ruhengeri Hospital, podoconiosis is a condition where chronic lymphedema occurs in legs. This is said to occur due to chronic exposure to silica present in volcanic soil and occurs in people walking bare footed. “Filaria is another mosquito borne illness which can cause such swelling, but I was told that some cases tested in Kigali were negative.” However, Dr. Pande clarifies there’s no treatment available for the condition. She says: “Anti inflammatory drugs like diclofenac or ibuprofen may help marginally. What is needed is-soaking in tolerably hot water for 14-20 minutes every day to soften the hard skin, scrubbing gently with a soft brush to remove dead and thickened skin. This done for few days to weeks regularly helps much. In case of blisters formed, they have to be punctured and dressed. Antibiotics would help if there is a superadded infection in form of wound or abscess.Prevention lies in educating young children not to walk bare footed, since chronic exposure to sillica can cause podoconiosis.” Enter Imidido But now, people like Hirwa are among tens of others who get some sorts of help at Musanze to help manage their sore legs, thanks to Imidido project based in Musanze. The project is an initiative by an American philanthropist; Tonya Houston who came to Rwanda from USA said she saw the plight of those who’re suffering from the debilitating condition. She advises that the disease can only be prevented through wearing shoes but it cannot be cured. “I came, I saw and I said that I wanted to conquer the disease by changing the mindset of the patients who think that this disease is as a result of curse. Now several of them are coming to the centre and we are helping them to change their mindsets and manage the disease. “It can’t be cured but it can be contained. And this is what we are doing here,” she adds. In order to achieve that feat; Houston has employed several people. Every other Monday and Thursday, those who suffer from it come to the centre where their legs are washed with drugs that help to contain the progress of the disease. Then the other employees go around the villages and schools to educate people to stop working in their farms bare feet. Potential victims are educated also that they shouldn’t take the disease as a curse but just a normal one which comes as a result of their normal work in their farms.” I visited the centre on a Thursday when I came to see the work done by Imidido project. This was not my first visit though, but it even became more eye opening. People had their legs cleaned by bandages that contained the drug. “I feel better after having my legs cleaned. The festering wounds and scales that had hitherto become the hallmarks of both my legs are no longer there, thanks to the work done by Imidido,” says Celestine Hakizimana from Musanze district. Apart from that, Houston has also managed to buy them a posho mill that they use to sustain themselves. “The posho mill has become a godsend to our community of people suffering from podioconsis because we’re now able to sustain ourselves. We lack the capacity to do any other kind of work because of this condition,” says Hakizimana. For the young Maria Uwineza, the condition has regretfully interfered with her schooling but she hopes that one day, she will return to school. She says the stigma associated with it has alienated her from her peers and she’s not able to play with them anymore. “I just hope that one day, my legs will be normal again and I will live my normal life. It’s hard living with this kind of condition. But I’ve managed to learn its source and I’ve been recruited by this project as one of the educators to help fight the stigma,” she tells me. What Hirwa is praying for is a wheelchair to make her get out of her daughter’s house. “I really want to see the outside world again, to see with my own eyes the kind of developments that I hear is happening in Kigali and other parts of the country. I’ve prayed for a wheelchair to transport me around this city but my only daughter is also struggling daily to feed the family. For now, she cannot afford the object of my desire,” she tells me with some regret in her voice.

Health

Podoconiosis: The risk of walking barefeet