Why try to treat Jiggers?

****Note: Some pictures may be graphic and unpleasant, they have been placed at the end of the post***

       As many of you know, I live in Western Kenya, in a rural village called Chebukaka. When I first arrived here, one of our tasks as a Peace Corps Volunteer in the Health Education sector was to complete a Community Needs Assessment (CNA). This activity allowed me to get acquainted with what was going to me new home for these two years. A major piece of this assignment was prioritizing the health needs of the community. Through meeting with community health workers, medical staff at my dispensary, and doing extensive field visits and interviews throughout my sublocation, the disease that always came out on the top of the list was jiggers. Well, like most people, I first had to figure out what exactly were jiggers, and how they came about and how could we try to help with this problem. Luckily, my fellow volunteer Joy Storm, who lived within the same location as myself was already working on this problem with her community, and I was able to receive a great deal of assistance and information from her. I discovered that jiggers are a small flea that burrows into the skin, and proceeds to lay its eggs and feed off of a person’s blood. They can cause severe itching and pain, and need to be removed or treated in order for them to go away. Physical removal, if there is several on a person’s body (which is usually the case), can create several open wounds that often lead to other infections. However, the proper treatment, using potassium permanganate to soak the infected areas is extremely expensive for a Kenyan living in my rural village area. The disease is known to be one evolves from being unhygienic, but this lack of hygiene is caused by extreme poverty. In the process of completely my CNA I discovered that the average household income for a family, which often times included up to 12 people, was about 300 Kenyan shillings per month. That roughly equivocates to be around 4 USD. A bar of soap found at any small shop in the village will sell on average for about 60 Kenyan shillings. Doing that math, means that about one fifth of that families monthly income is going towards the purchase of one bar of soap. Unfortunately, this product we usually call a necessity becomes a luxury, and its purchase takes a back burner to things such as food, shelter and clothing for the family.

            Once a family and their household is infected with jiggers, it becomes a cycle, because even if the jiggers are removed from the person’s body, they will most likely be re-infected from the fleas that have taken up residence in their homes. The flea thrives in dry, dusty areas, which is the exact make up of many villages dwellings which are made of a dirt and mud mixture, not the concrete structure I am blessed to be living in. This is why a complete treatment, not only of the person but also of their homes is important to eradicate jiggers. It is necessary to educate the people on what a jigger is, how they can prevent them and how to properly treat them. This is what I hope to do with the outreach I am planning. I want to educate those who are infected, as well as community health workers and medical personnel on the proper way to treat and prevent, and then go about doing so with 200 participants. We will treat their homesteads so that they may not be re-infected from their own homes and as a final prevention step after the full two-week treatment is completed provide the participants with shoes. Through research done by my colleague and friend, Joy, wearing close-toed shoes has a great effect on the prevention of contracting jiggers. The disease can cause extreme pain and discomfort, deter children from reaching their full potential in school, and prevent adults from being able to work and provide for their families.

Below I have put the link to the grant I am trying to get funded for this project and have placed the small summary here as well.  Please consider donating to the community if you can, any little bit helps! 

https://donate.peacecorps.gov/index.cfm?shell=donate.contribute.projDetail&projdesc=13-615-114

“Tungiasis is a neglected tropical disease that is commonly referred to as "jiggers." It is a disease that is endemic in Latin America, the Caribbean, and Sub Saharan Africa. Jiggers is caused by the female sand flea (Tunga Penetrans) which penetrates the skin causing severe inflammation and other morbidities such as necrosis, auto amputation, difficulty walking, tetanus and can even result in death. In Kenya, it is estimated that 2.6 million people are infected with jiggers. Unfortunately, even though it has such a high prevalence in the country it has not been a priority in the public health sector. With this project I am hoping to bring awareness of the disease as well as motivate the community in the fight against the disease. In my area, jiggers not only causes severe health complications but also impacts work and school attendance because of the inability to walk or concentrate. There is also a large stigma associated with the disease that creates further isolation for those infected. The project will take a systematic approach to the prevention and treatment of jiggers. We will treat 200 people in the community for jiggers. Before, as well as during and after the treatment, participants and facilitators will receive education on prevention of the disease. Also the home compounds of those treated will be fumigated to rid the homes of the pest. The recommended way to treat jigges is to soak the area affected three times a day for a two week period in a solution, or to extract the fleas using a sterile procedure. The latter is not the preferred method in those severely affected with the disease because it can often lead to secondary infections. Unlike many other neglected tropical diseases, treatment of jiggers can be costly. The soaking solution, potassium permaganate, costs about $30 per person, and with all the other required materials for treatment, the cost rises to be about $50 per person to treat. Although the amount seems small, here in Kenya this could be over a half of years salary for someone in the village. We are asking for partners to provide funds to help cover the costs of the fumigation and oil needed for the treatment, as well as some of the secondary materials for treatment of each individual. The community will be providing for the rest of the campaign. The community health workers have partnered both with the district medical offices and Kenya's national anti-jigger campaign to make the project a success. "

 

 This is what jigger infested feet and hands look like, the infected areas are painful and can itch, and the tissue can become necrotic. Without proper treatment and continued infections, the areas, often times toes can auto amputate. 

 

 This is an example of the medication used to treat the jiggers. You add the medication to water to allow the infected areas to soak for 15 minutes, which you do three times a day for two weeks. This noninvasive way of treating the jiggers is not painful.

 Above shows a community health worker putting oil (Vaseline) on the affected areas after treatment, which is done because the medication dries out the skin.

 Demonstration of the proper way to treat the ailment, first you must wash affected areas.

 Showing how you use Sevin Dust to treat the homes, which kills the fleas and any eggs they have laid.

All of the above photos are courtesy of Joy Storm, who has done a similar project in her community and found a great deal of success in this course of treatment!

So if you have gotten this far, I just want to say thank you for checking out the project, and seeing what kind of illnesses affect those who live with so little. While HIV/AIDS, malaria and TB receive a great deal of attention, there are other diseases such as jiggers having just as great of an impact on many communities in the area. 

I hope you are all staying well!

With love and sunshine,

Lindsey Rae