88 Days

88 Days: that is just about the time remaining on my pulse assignment. How am I changing? What am I changing? what am I impacting? I am asking myself these questions every day I am here. “Success comes from knowing that you did your best to become the best that you are capable of becoming. (John Wooden)” And the quotes of John Wooden resonated within me as I began to write this story. And it is a story about a work in progress. It is something we (I) started, the question is where will it be when my time in Kisumu ends, and will I have been able to lay the groundwork and foundation for a sustainable effort moving forward? I’ve talked about the children, and it is them, their voices and their smiles that are what inspires me. This story is about them, their true innocence and what I hope I can truly do for them.
DSC_0854 Innocence
But this story is also about a jigger infestation: please note that parts of the photographic content are graphic, viewer discretion truly is advised.
So, why is a picture of John Wooden my featured item. John Wooden was an inspirational leader, remembered as the long time head coach to the UCLA men’s basketball team which won 88 games in succession through a 4 year period. He not only built character on the basketball court as well as off, but he built a team, and created leadership through his actions and through his words. How can you read his quotes and not but help to be inspired, and that is what encouraged me to write this particular blog entry: “You can’t live a perfect day without doing something for someone who will never be able to repay you.”
The chigoe flea, or jigger (Tunga penetrans or in Kiswahili, Funza) is a parasitic anthropod found in most tropical and sub-tropical climates. (The Jigger is not to be confused with the larval form of Trombiculidae called chiggers from the berry or red bugs or harvest mites). Native to Central and South America, the chigoe flea was inadvertently introduced into sub-Saharan Africa by humans. Only 1 mm in length, the chigoe flea is considered to be the smallest know flea, but has devastating capabilities. The parasitic flea lives in dry soil and sand, and feeds on warm blooded hosts such as pigs, cattle, dogs, mice and humans. Males drop off the host after a blood meal much like other fleas, but the female chigoe flea burrows into the cutaneous and subcutaneous dermal layers to feed from blood vessels. Each breeding female flea burrows into exposed skin of the feet and hands of mammals, and remains there while developing and incubating up to 500 eggs.JIGGERINFO The swelling causes intense irritation, and the skin lesion may initially look like a small 1 cm blister with a central black dot (which are the flea’s exposed hind legs and respiratory spiracles). If not properly treated or removed, dangerous complications can occur from the new hatchlings, including secondary infections, loss of nails, toe or finger deformation.Foot 1 Hand 1Untreated broken skin is more susceptible to additional infections from fleas as well as soil parasitic worms and bacteria, and non-immunized children are very vulnerable to contracting tetanus, whereby gangrene or other debilitating or disfiguring diseases can also occur. When left untreated, jiggers can lead to other serious medical complications, as it eats away the limbs while inflicting deep rotting wounds incapacitating the victim over time until they die. These wounds are often painful, causing difficulties for victims in daily activities such as walking, playing, and attending school The social stigma and shame associated with jigger victims often causes them to mask the problem rather than seek treatment, which often makes the condition worse. Some of the infected individuals cannot even eat with their hands because their fingers are infested with jiggers. While jigger infestations are not themselves deadly, the secondary infections, however, were responsible for over 265 reported fatalities in Kenya last year.
Poverty and poor hygiene are two of the major causes of jigger. The lack of clean water and the combination of families living and sleeping in homes with dry dusty dirt floors, living in close proximity to infected livestock make them susceptible to jigger infestations. DSC_0832 House Some of the attached figures are a bit graphic, and represent what we saw in the local community of Kiboswa. In short, three weeks ago, Victory, JoJo and I went to attend to 3 orphaned and vulnerable children (OVC’s) with jigger infections in the community day care of Pastor Wilson. We were prepared with peroxide, gloves, bandages and Dettol (an antibacterial soap). The plan was to clean their feet in a basin, and have a first pass treatment with peroxide which would bring the jigger out of the skin. We would treat the open wounds with antibiotic cream and bandages. Well, PULSE Team Plan A evolved into something we were not prepared for as three children turned out to be 20, and we were overwhelmed by the extreme severity of the infections as well as the number of infected children that we clearly were not prepared or properly trained to treat. We preformed only a surface cursory washing of the children’s feet, and we did not feel comfortable applying peroxide to many of these open wounds for fear of not properly covering and preventing secondary infections.
When Plan A fails, it is time to implement Plan B. Conversations, emails, and more conversations led Victoria and me to Ahadi Kenya Trust which aids in the educational programs and initial front line therapy sessions for treating jigger infestations in Kenya. This is the beginning to a long journey that will take weeks and months to demonstrate a truly effective an impactful result for the treatment of the children’s jigger infestation. The Ahadi Kenya Trust is a private organization that wants the government to give priority to those infested with jiggers. A fund has been established to help benefit approximately 500,000 elderly, orphaned and vulnerable children who are infected with this parasite. I have since taken the lead to initiate further conversation with Anne and Joseph at Ahadi Kenya Trust (AKT) and with Pastor Wilson and we began to make arrangements for Joseph to come from Busia (approximately 110 km to the north) to Kiboswa and run a 1st line triage, treatment, and educational session for the local community care workers, and me. Armed with more basins, more Dettol soap, nail cutters, jars of Vaseline, drying towels, and several jars of potassium permanganate, DSC_0845 SuppliesJoseph and I were driven up to Pastor Wilson’s home where 20 OVC’s were awaiting our intervention. Healthcare workers (led by Grace, Pastor Wilson’s wife) were given instructions how to properly cleanse the infected areas (hands and feet) with antibacterial soap, and to allow them to air dry.DSC_0838 OVC Footwashing DSC_0843 Grace with FeetAll fingernails and toenails were clipped to minimize places for jiggers to seek shelter. DSC_0847 Joseph trimming Then all infected hands and feet were dipped for 20 minutes into a dilute solution of borscht, actually it was potassium permanganate (it just looked like borscht, but I was testing if you were truly reading this blog). DSC_0853 Fingers before PPM DSC_0678 Foot 2Potassium permanganate wet soaks treats the blistering wounds such as ulcers and abscesses whereby its astringent action dries out the blistered area, preparing them for further treatment. DSC_0856 Joseph Soaking KidsThe broad antimicrobial properties of this chemical solution kills the skin bacteria and embedded jiggers, significantly reducing risk from the initial and possible secondary wound infections. Treated areas were air dried and then a generous layer of Vaseline was rubbed into each area to moisturize the skin, but also to suffocate any existing jiggers by prevent their spiracles from protruding back through the skin. DSC_0862 Treated Foot For severely infected children, this treatment was to be repeated 2x a week, whereby for less severe cases, every 10-14 days. DSC_0875 the Crowd
Further discussions to hold a follow up evaluation and treatment session, as well as an educational community awareness meeting with village chiefs, community religious and political leaders to further raise the awareness level of the severity of these infestations that the children of impoverished homes are ongoing. Without interventions, without treatments, the long term results and implication could be devastating and disfiguring, perhaps resulting in digit amputation (or worse) if not fatality.
Don’t let what you cannot do interfere with what you can do. (John Wooden)” I have been holding further discussions with AKT to identify potential funding sources that can help with community outreach efforts, including home fumigation to rid households of soil born chigoe fleas. Awareness of the risks for infection will need to result in further separation of livestock from homes, treating floors with farm based remedies as simple as spreading manure across the floor, to more expensive treatments such as coating floors with a layer of cement would reduce first line exposure to the fleas.
“Success comes from knowing that you did your best to become the best that you are capable of becoming. (John Wooden)” How can I assess success in a community where what initially was to be 3 children, morphed into 20, and eventually evolved into 50 or more during our first community treatment session with Joseph. The problem is deeply embedded within the soil and within their community. Identifying and attacking the root causes will take a concerted effort, time, and additional funding that is challenging to come by. As a PULSE volunteer, I have been fortunate enough to help support the initial purchase of supplies, and bring together the parties that need to begin to talk face to face. I have offered to help find additional funding within Kenya for treating jigger infestations, but money is scarce, and contributing and funding organizations are not common. Within the next 88 days, I will continue to do my best to facilitate conversations, help organize community outreach efforts, and help identify sustainable means to ensure these infestations are controlled, become more limiting or perhaps eradicated from Pastor Wilson’s community. But the bottom line is that we have to start sensitizing people about how to guard against jiggers, and it all starts within the home. I can only hope that my interventions awakens the parent’s awareness of the severity of the health implications towards the welfare of their own children, and their ability to take ownership in treating and solving the root cause of the problem enabling them to “Become the Change”.

5 comments

  1. Hi Martin,

    It is Great to be a PULSE Volunteer and help to bring together the parties that need to begin to talk face to face!! makes the difference !!

  2. This problem won’t be solved in a day, but I have no doubt these people greatly appreciated the care you mobilized for them. A journey of a thousand steps starts with one. Keep up the great work!

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