No one talks. No one says anything. Jeremy Mwathe’s scrubbing punctuates the drone of the bee hive in the tree above the crowd. It’s too hot to leave the shade of the tree but I’ve never been this close to a beehive. The air feels as thick as hot honey but smells like dead flesh and potassium permanganate. I haven’t eaten since I woke up. I’m hungry but Jeremy is scrubbing the dead flesh off the skinniest leg I’ve ever seen. If I think about eating gagging will certainly follow so I lift my camera and keep shooting. I feel better with the trauma coming in mediated by my lens.
I photograph the leg that Jeremy is washing in chemicals. It belongs to an elderly man who seems to be teetering between life and death. His hands and feet are infested with parasitic sand fleas that burrow into the skin and leave openings behind for bacteria. His infections are so bad he can’t really walk. Or eat. Or anything.
I’m in awe of Jeremy’s altruism.
Ballast is material, like sand, rocks, or water, used to stabilize ships. A ship named the Thomas Mitchell packed its bowels with ballast sand in 1873 and set out from Brazil for Angola. On their journey across the Atlantic the crew began to complain of sores and infections in their hands and feet. They could see no culprit but painful and itching bumps developed along the edges of their fingernails and in between their toes.
The crew of the Thomas Mitchell was learning about something that pre-Incan cultures had carved into small clay statues a thousand years earlier. Archeologist have found ancient figurines from multiple cultures across South America depicting people examining numerous pot-marks their own feet.
The ballast sand was infested with Tunga penatrans, a parasitic sand flea, and along the way the crew contracted the disease it causes; Tungiasis. The crew had managed to contract one of the few parasites to originate in the Americas. Twenty-five years after they landed in Angola an Austrian explorer reported from the East African Island of Zanzibar that Tunga penatrans had crossed the continent. Today, this South American flea has become a global infestation that ranges from Hispaniola to New Guinea and some experts fear that it could spread to Mediterranean Europe or Australia, given their temperate climates.
I’m watching another pair of horrifically skinny legs being scrubbed of dead flesh. These belong to a man with my name. Daniel was born in 1923 and had a career as a tax collector and a tribal leader for the government. He has the worst tungiasis case I’ve ever seen. He’s frail and unable to walk or feed himself. He is lucky to be alive. Rarely do people die from Tungiasis itself but the open wounds these parasites leave behind are ripe for Tetanus and other infections that kill all too often. Health workers set about trimming his crumbling nails and washing his flaky dissolving skin. I’m again in awe of their charity and care but I’m less confident that anything we’re doing will solve this problem.
Tunga penatrans are born of eggs and spend the first half of their lives in dry and sandy soils. They go through a few stages of molting where they actually decrease in size so that they’re not really visible to the naked eye. At this point they seek out a host, human or any other mammal will do, and burrow into the skin to feed on blood while leaving their abdomen exposed to excrete waste and eggs. The later must be fertilized by male fleas that also feed on blood but once they’ve done their fertilizing business they crawl away and die. Meanwhile the female remains neck deep in your skin pumping out stringy red waste and little white oval eggs for about five weeks when she too dies and after a short time her body collapses and the carcass dislodges from the skin.
I fear that so long as Daniel’s home is infested with sand fleas treating his hands and feet will be unsustainable. Even if our treatment completely cures him today (though I’m skeptical of that) he will be infected again tomorrow.
Daniel’s life owes no thanks to the community health center that I can almost see from his little mud house. He tells me that he sought treatment there multiple times but they never had the supplies to treat him. Finishing our work we walk back to the health center and I stop in to ask them if they have any antiseptics on hand. No? Do you have any disinfectants? No. What can you possibly treat without at least those?
Everywhere I travel in western Kenya I am disappointed by the inability to treat Tungiasis effectively. Either out of ignorance or lack of resources this disease was winning the war. I interview dozens of people who knew almost nothing about Tungiasis and I visit dozens of health facilities with almost no basic medical equipment at all. I follow up with a few Tungiasis patients to see how they have responded to treatment. I am disappointed and sadly not surprised. They are all still infected with sand fleas.
I do not want this story to end on a sad note. Soon, I will travel to coastal Kenya where I will work with Dr. Lynne Elson to document her organization, Dabaso Community Unit. This organization is using the local Neem Tree to create a highly effective insect repellent that can be mixed into bars of soap and sprays. This unique and sustainable prevention method has never been photographed and could eventually become the ideal model for dealing with Tungiasis across Africa.