"Can we not just give them shoes?"

I laugh when I think back on my last blog post and my genuine intention to publish a new post each week. 8 months later and here we are. I can only apologise to the thousands of fans I have let down and attribute it to the infamously busy student life of the last year (sometimes I had more than two lectures a week!).

So far we’ve modestly looked at what jiggers actually are and the impact that they have on individuals infected (see blog posts 1 and 2). My original plan was to now look at the prevention of jigger infection and its importance. However, I thought it more potent to answer a question that I get a lot when I attempt to explain how jiggers can be combatted in the community. The question being “Can we not just give them shoes?” Now, I am not going to address the harmful “us” and “them” attitude that this promotes (maybe at a later date), nor will I dismiss this question as dull, in fact I would be worried if someone didn’t consider shoes as a viable option for combatting jiggers. Unfortunately however, as I’m sure you can imagine, it is just not that simple.  In fact I think the questioner knows this and is rather hinting at a broader question being “what needs to be done to combat jiggers?” This then is the question I will answer.

This question was roughly the principal focus of my dissertation (final paper) for university and has taken up a lot of my precious time (almost 8 months). Let me answer the question with another question or questions (I love questions!); firstly, what is our goal in combatting jiggers? Is it just to treat jiggers once and then leave the patients to it, or should it be a long-term commitment that ensures the patient will not be infected again after treatment? Secondly, do we concern our “combatting jiggers” with the personal wellbeing of the infected individual and lifting them out of poverty, which we learnt was a serious problem in my last blog post? And also, do we aim to change the misconception of jiggers in the community that is so damaging in the first place? I would argue that if you want to truly combat jiggers you cannot leave out one of these aspects.

We are therefore looking at a programme that focuses not just on jigger treatment but also on prevention, community awareness and ideally poverty alleviation. It is useless treating an individual if they are then going to go home and become infected again just as it is useless focusing on prevention if you’re not going to treat those who are already infected. They go hand in hand. We are now all of a sudden looking at a pretty big programme; at least it goes well beyond giving out shoes!

So we’ve established that combatting jiggers requires a more comprehensive approach:

-       Treatment

-       Prevention

-       Community Awareness

I will look at each of these tasks individually and attempt to explain what they entail related to jiggers. To kick us off in my next blog post, we’ll be looking at the complications of how to treat jigger infection. 

You can expect this within the next 8 months.

Cheers

Jigger IMPACT

Before I hit you with some of the many impacts that jigger infection causes, I’m gonna throw you a right hook with a quite horrible picture of jiggers at work. 

Now I know this photo doesn't make too pleasant viewing, but I’m banking on it wetting your appetite to find out more about jiggers and how they can actually affect an individual besides the obvious.

One thing that I find striking having been involved with jiggers for a while now, is how many issues are directly involved in or in some way implicated in the infection of jiggers. 

First of all we’ll take it look at the obvious and then get on to the more complex.

Physical Impacts

As you can see from the photo, jiggers seriously impact an individual physically. This photo is of a man who could barely walk due to the infection. As you can imagine this prevents him from working for a living. His case may have been more extreme than most, but often one finds that your average infected individual’s mobility is hindered, whether it be walking to school or just doing the daily chores. The nature of rural livelihoods in Kenya renders mobility a vital ability, more so than we  may think coming from a more urbanised lifestyle.

Secondary Infections

Another impact of jiggers are the diseases that can come with infection. The jiggers themselves are not actually carriers of any disease, yet they still find a way to make one very susceptible to a life threatening disease. Here we are talking about secondary infections such as Tetanus, Gangrene, HIV/AIDS, etc. By feasting on the blood of the host, jiggers reduce the effectiveness of the immune system. It also opens up the flesh of the skin to provide access to these other diseases. This especially occurs when the traditional method of treating jiggers is employed. This method is still regularly used today; it involves piercing the skin with a blade and pulling the jigger out with a needle resulting in some very big and, more importantly, exposed  wounds. Some treatments have been known to share needles between patients facilitating the transfer of HIV from one patient to another. It has to be said though that this is now a rare occurrence due to the vast amount of education and health awareness that has gone into preventing HIV/AIDS in recent years.

Psychological Impacts

Jiggers is an infection loaded with harmful stigmas and myths. I myself have heard it explained away as "witchcraft". Other quite bizarre conclusions have been drawn, such as the view that jiggers is something in the blood, past down the generations. People believe these myths because often jiggers seems to stay in the family due to the conditions that they have lived in. Essentially this all stems from a lack of education and awareness on the issue (something we will get into at a later date). Although these claims may be baseless, they can affect an individual psychologically. This is particularly evident in school life, as children infected suffer from bullying and are often left out of activities due to their condition. This results in low self-esteem and poor school performance. Many kids don't even make it to school due to their condition. These stigmatisations can cause an individual or family to feel worthless in their community. They may begin to believe the false stigmas created about them, making them less likely to try and beat the infection.

So you can see what a menace jiggers really are. What I think is imperative to note is how all these impacts are entangled in poverty. Poverty leads to jiggers, and jiggers make it harder to escape poverty. It is a vicious cycle that I will explore more in my next post on the "prevention of jigger infection".

What an earth is Jigger infection?

Having recently returned from my third visit to Western Kenya, I felt compelled to write something on the crazy scenes unfolding surrounding a little known menace called jiggers. Also known as Tunga Penetrans, Chigoe fleas or – perhaps less sophisticated – Dodos. We’ll stick with “Jiggers” as it is the most commonly used label in Kenya and also offers me quite a jazzy hook line for my blog. Once one gets past the childish humour that comes with such a name as Jiggers, we arrive at a serious neglected primary health issue that has sneakily chipped away at many unsuspecting individuals, not only in Kenya but also large parts of Sub-Saharan Africa, South America, the Caribbean and pockets of Asia

Jigger Campaign in Kibingei, Western Kenya.

So now I have your attention, let’s get in to the nitty-gritty of the problem. 

What are Jiggers?

Without being to scientific, Jiggers are basically sand fleas. They are very small parasitic insects that live in dirty, dusty and dry terrain. They are often found in the soils and dusty homes of rural areas. To survive, a Jigger will latch on to either animals or humans, where it feasts on the blood. Jiggers are not high jumpers so they are most common in areas that are in contact with the floor e.g. toenails and fingernails. However there have been cases where they have infested all over the feet, legs, hands, elbows, buttocks and even private parts. The female jigger with the aid of the host’s blood can lay up to 100 eggs in two weeks, which drop off from the skin back on to the ground hatching within three to four days. The first signs of infestation are itching and irritation as well as a small black dot in the skin. If found and treated early one can avoid a lot of problems. Unfortunately, there are too many cases where the infestation is not identified early and the jiggers develop into a huge problem which needs special treatment. Infestation can lead to serious health and social problems of which we will explore at a later date.

AHADI KENYA – the main organisation that works on Jiggers in Kenya – has registered around 2.6 million infested people in Kenya alone. However the true number may well be more as it is very difficult to identify infested people as they are often in very rural areas where data is limited. Adding to this, jigger infection is something that quite frankly has received minimal attention across the board in the Global Development Health sector. Diseases such as malaria, HIV/AIDS and Tetanus have understandably taken the limelight when it comes to donor funding and support. For these reasons the World Health Organisation (WHO) recognises it as a neglected skin disease. Awareness needs to be raised on this subject if progress is to made. So for the next few weeks I will continue to post on this issue, addressing areas such as:

• The impact of jiggers and its implication
• How to prevent and treat jiggers
• What is being done to combat jiggers
• What needs to be done to combat jiggers

You may be surprised to learn just how problematic these jiggers can be. So please bear with me as I attempt to explain this as best I can in an interesting manner. I can’t promise that I won’t gross you out with some horrific pictures, but I hope that you take something from it and help raise awareness for those who are suffering daily from jiggers. Expect another post next week.