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September 14, 2012

Uganda's Poorest Communities Tackling Diseases

by Hilary Heuler

In Uganda, the government has come up with a new plan to tackle a range of tropical diseases that have been neglected for years.  These diseases afflict the poorest and most marginalized communities in the country.

Aggrey Wambi was only nine years old when his legs began to ache and swell.  Now, two decades later, his calves are twice the size they should be.

Wambi, who lives in a village near Iganga, in eastern Uganda, says his stretched skin itches, and the pain is intense.  He has trouble holding down normal jobs, he says, and has to settle for plowing other people's gardens in order to feed his two children.

Wambi is suffering from lymphatic filariasis, also known as elephantiasis.  It is one of the ailments known as neglected tropical diseases (NTDs).

Elizabeth Kurylo, of the International Trachoma Initiative, says that diseases like these can have a profound effect not just on the individual, but on the entire community.

"The whole community is affected because many of these diseases make it difficult for people to do their daily tasks, and this incudes whatever jobs they might have outside the home," said Kurylo.

The Ugandan government is preparing to roll out a new master plan designed to tackle the most common of these NTDs - including elephantiasis, sleeping sickness, bilharzia and plague.  According to Kurylo, Uganda is only the second country in Africa to draft such a plan.

Gabriel Matwale of the Ministry of Health says the focus will be on both prevention and treatment of these diseases.

"We are scaling up by covering endemic communities with mass drug administration, that is, giving them drugs," said Matwale.  "We have a component of improved hygiene and sanitation."

But with most NTDs occurring in hard-to-reach rural communities, Matwale says, it is important to build networks of volunteers who can access even the most isolated villages.

"We need to strengthen what we call village health teams, the lowest level where health care can be got," Matwale added.  "So if we strengthen the village health team level, we would be able to reach the most marginalized communities."

One of the diseases being targeted is trachoma, a crippling eye infection that can eventually lead to blindness.  In some districts in Uganda, over half the population contracts the disease at some point in their lives.

Here in Buniantole, another village in Iganga, a village health team is giving trachoma medication to around 300 children at a local primary school.  The medicine is preventative.  But the disease is highly contagious, and can spread quickly through schools.

Around four percent of Iganga residents suffer from late-stage trachoma, which requires surgery to cure.  The leader of the health team, Mohamad Kibira, explains that in the past, an isolated area like this did not have access to medicine or treatment.

"The problem we have here is that we had no medication around," Kibira explained.  "Like these guys here, they always go far for the medication.  We don't have a clinic nearby.  They don't go for treatment earlier because lack of transport, because they are moving from far areas to the facility."

School headmaster Abdallah Bogere says another problem is poor hygiene. 

"People are not very much enlightened about washing their faces every morning," Bogere explained.  "What we do here, even at school, is learn to wash their faces every now and then.  I have a basin already here, I have soap, so when I see children have come to school with unwashed faces, we try to make them wash."

Kurylo agrees that with many NTDs, hygiene plays a major factor, along with a lack of access to clean water.  This, she says, is one of the reasons why these diseases are such a problem in poorer countries like Uganda, and why marginalized communities suffer the most.

"Trachoma used to be prevalent in the United States, and as sanitation and hygiene improved, it disappeared," said Kurylo.  "When you have a dry, arid, dusty climate where there is limited access to good water, and limited access to safe hygiene, those conditions allow these diseases to thrive."

As diseases of the poor, Kurylo says, NTDs have been neglected by the international community for years.  But, she adds, they are neither difficult nor expensive to treat, and she hopes that the government's new plan will help eradicate them forever.

"We have the tools. We know-how to eliminate these diseases," added Kurylo.  "Most of the medicines for neglected tropical diseases are donated by the pharmaceutical companies.  So really, the costs involve getting the medicine from the central medical stores in each country out to the rural communities that need them.  I think the cost of not treating these diseases is much higher than the cost of taking care of this now."

Uganda's NTD master plan is still in draft form, and the money has yet to be raised.  The total cost of implementation is estimated to be around $60 million.