JOS, NIGERIA — The tropical disease known as lymphatic filariasis, or elephantiasis, affects 120 million people worldwide.
The devastating parasitic illness causes lymphedema, in which legs, arms and genitals swell to enormous size. Now, a new public health strategy, tested in Nigeria, is raising hopes that this crippling disease can soon be eradicated.
In the quiet of a courtyard in the northern Nigerian city of Jos, a dozen people sit in a circle on white plastic chairs, talking about their affliction: lymphatic filariasis, an infectious disease also known as elephantiasis. John Umaru, the group leader, made the introductions.
"This is the Jos lymphedema support group, also known as Hope Group," Umaru said. "It is an association of people who are already suffering from lymphedema or elephantiasis, which is a chronic stage of the lymphedema. They meet here regularly so they will share experiences and share some ideas on how people have survived with this condition."
Lymphatic filariasis (LF) isn’t fatal, but the grotesque and often painful swelling never goes away, and those who develop elephantiasis face the lifelong stigma of disfigurement.
Hamisu Isa, a member of the Hope Group, is a big man, dressed in a brilliant blue robe and brown turban. Isa has had LF for about 25 years. His left leg is enlarged.
He comes to the Hope Group to learn how to take care of his leg and to cope with his deformity. Umaru translated as Isa describes his rigorous daily care routine.
"He soaks his leg inside a bucket full of water and then now wash with soap, and then use this towel to dry the skin after that he now applies some Vaseline ointment, and then he now goes to his working place," Umaru said. "At the working place, he is very careful so that he doesn’t get injured. After work he comes home, he washes again, and then apply the same ointment, and then he will sit and raise his legs."
Fortunately, Isa may be among the last people here to suffer from lymphatic filariasis. The Nigeria Ministry of Health and the Carter Center, a philanthropic research institute established by former US. president Jimmy Carter, announced recently that they have successfully stopped the transmission of LF in this part of the country.
Nigeria has the world’s third highest number of lymphatic filariasis cases, after India and Indonesia. LF is spread from person to person by a mosquito bite, which transmits tiny parasitic worms called microfilaria into the victim’s bloodstream.
Dr. Adel Egege, who directs the Carter Center’s LF prevention program in Jos, explained how the disease progresses.
“These adult worms block the lymph system. It results in an accumulation of fluid," Egege said. "This accumulation…could be in the arm, in the leg, in the scrotum. And we call it elephantiasis because the…area is roughened and thickens out like the skin of the elephant. It looks rough and tough.”
Egege said the Carter Center, working with the local health department, has been running what’s called a mass drug administration, giving two anti-parasitic drugs to everyone in the region, and distributing mosquito-proof bed nets to most families to prevent the nighttime insect bites.
That combination of the drugs and bed nets blocked the spread of the LF parasites, effectively eradicating the disease in the test area.
"With the mass drug administration, we had substantially removed all the infection, but with nets added for two years, we have not seen any worms in the mosquitoes," Egege said.
The results of the pilot program have been so promising, said Egege, that the Nigerian government is planning to expand the program throughout the entire country.
Carter Center and Nigerian health officials are hopeful that, with a nationwide campaign, LF could be gone from Nigeria within six to 10 years, sparing future generations its terrible consequences.
When that day comes, though, there will be no relief for those already stricken with lymphatic filariasis, people like Hamisu Isa and members of the Hope Group. But their permanent disfigurements will be dramatic reminders of this bygone tropical scourge.