The Big Stories || Elephantiasis: 2,373 confirmed cases recorded in the Upper East Region
The Big Stories || Elephantiasis: 2,373 confirmed cases recorded in the Upper East Region - JoyNews
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Transcript
00:00 Welcome back from the break. Let's talk about the elephantiasis issue in the
00:05 Upper West Region. Bright Alomatu is the death officer for lymphatic
00:10 filariasis, the NTD program. He is joining us for a conversation on this one.
00:15 Solomon Atimbire is program manager, American Leprosy Mission. He's also
00:21 joining us as well. Solo and Bright, good morning to you gentlemen and welcome.
00:30 Good morning. Great. Let me start with you, Bright. Have we been able to
00:38 understand why this is happening?
00:42 Well, yes, we very much understand the situation in the country. We have mapped
00:51 the disease across all regions in the country and out of the 16 regions, we
01:01 have 12 of them being endemic and we have 116 districts that transmission of
01:11 the disease was found to be ongoing. We did that exercise in 1999 and we
01:22 started an intervention to interrupt the transmission of the disease. So we've
01:31 been doing this since 2001. We've been administering medications to prevent the
01:38 spread of the disease. And Upper East is one of the many regions that are
01:44 endemic. And every year we send ivermectin and alabendazole for
01:51 volunteers to move from house to house, register whole populations and then
01:56 treat them. And as we speak, we've been able to interrupt the transmission of
02:01 the disease in 109 out of the 116 endemic districts. So for now, we have
02:10 seven districts that are yet to see interruption of the transmission of the
02:16 disease. And Upper East region, for instance, even though we are talking of
02:21 high numbers of people living with the manifestations of the disease, we've been
02:29 able to also interrupt the transmission of the disease in Upper East region. So if I may...
02:37 But if you say you have interrupted...
02:42 A bit more on the situation of Upper East...
02:44 If you say you have interrupted, it means that there shouldn't be a spread.
02:49 Which year were you able to achieve this and why are we still having
02:53 these numbers? Yes, so the disease is such that one gets infected when an
03:03 infected mosquito bites you. The mosquito bites somebody that has the parasites in
03:09 the blood and then takes some of the parasites and when it comes to bite you,
03:13 it gives them to you. But it takes many years for the disease to develop.
03:21 The infection leads to damage to the lymphatic vessels which leads to
03:25 accumulation of the fluid in the vessels and also in some tissues. And that is
03:31 what we see as the swelling. And we have the elephantiasis, which is the swelling
03:36 of the limbs. We have that of the legs, that of the hands, elephantiasis of the
03:41 breasts, even elephantiasis of the penis.
03:46 And we also have hydrosal, which is the swelling of the scrotum. So
03:53 these are all signs of the disease. But it takes many years for the signs to
03:58 start showing. And if you pick any endemic population, you may find many
04:04 people having the infection and yet just a few of them might have gone ahead to
04:10 develop the condition. And therefore, normally if we want to know where the
04:18 disease is, we don't go looking for the big legs, the big scrotum and the like.
04:21 But we rather test people to see the level of infection in the people. And we
04:28 do the mass treatment, we target everybody and that is aimed at stopping the
04:34 spread of the disease. And many people, as I said earlier, may have the infection
04:40 but may not have the swelling. And again, many of those that even have the
04:48 swellings, you test them now, they no longer have the parasites. The parasites
04:52 kill, the damage occurs and the parasites are dead and gone. Now they are living
04:55 with the effect of the damage to the vessels. And this condition was,
05:03 especially for the swelling of the limbs, we don't talk about a cure for them
05:09 because it's difficult. So we manage them. But the swelling of the scrotum, the
05:17 hydrosel and that of the breast, there are operations that are able to cure. But
05:22 for the swelling of the limbs, we don't have a cure. So we manage them. And that
05:28 is why, even though we've been able to interrupt transmission of the disease in
05:32 the region, we still have people living with the swellings. And the numbers that
05:38 we talked about as a result of an active search that we went to undertake and
05:44 that came out with these numbers that we are talking about. Okay. All right. If I
05:49 may add, Upper East, as I said, it's not the only endemic region and probably the
05:56 high numbers may be as a result of the many dams and then the irrigation
06:02 projects we have within the region. As I said earlier, it is the very anopheles
06:09 mosquito that also transmits this one. So where you have situations where
06:14 certain factors lead to huge numbers of mosquitoes within the environment, the
06:21 likelihood of increased transmission is very high. And probably that is the
06:27 cause of the high numbers that we see. But this is not a new thing. It is a
06:32 chronic condition. So these are people that have been living with the swelling
06:36 over the years. So this started so many years ago. And because this disease also
06:43 comes with a lot of stigmatization, social exclusion and rejection, people
06:47 tend to hide their conditions. Okay. And again, until recently when we started
06:54 building capacity of health workers to provide care for these patients, they go
07:00 to health facilities and will not get the needed care. And therefore, most of
07:04 these patients have been hiding in their corners trying to do one thing or the
07:09 other. But now that we have the capacities out there, when we went out
07:13 looking for them, they came up because they know there is care for them now.
07:17 Okay. That is why they came out and we saw these huge numbers. What is the
07:24 favorable condition for the agent mosquito to thrive? The availability of
07:31 fresh water. Okay. So as we have the dams, we have the many ponds. Also we have
07:40 irrigation projects. Upper East has two big irrigation projects. The Tono
07:44 irrigation that is found in Navongo serves the Kasana Nankana and then the
07:51 Busa areas. We also have the Via irrigation project that also serves the
07:56 Bongo and the Boga areas. And there are also many dams around. So even if you
08:02 relate to malaria, these areas again have very high incidence of malaria
08:07 across the country. So they are most the regions with the highest numbers
08:13 when it comes to malaria incidence. And the relationship with a mosquito also
08:19 leads to these high numbers we are seeing with regards to lymphatic filariasis.
08:24 So it's not to do with the people, it's not to do with the tribe, it's not
08:29 to do with the food that they eat, or it's not to do with anything. It's just
08:33 that the factors are favorable for transmission. And that is why we see such
08:40 high numbers. And it is quite focal. So once you have an individual living with
08:46 the parasites in him or her, and then you have the mosquitoes available to pick
08:51 and then spread, and the likelihood of fast spreading is very high. Let me bring in
08:59 Solomon Atimbere here. He is Program Manager, American Leprosy Mission.
09:03 So I'm sure you've listened to Bright and you know his explanation on why we
09:09 do have the elephantiasis cases in in Upper West. I'm sure what he says means
09:18 that it is not a cause or a source of worry, isn't it?
09:25 Well, good morning to your listeners. I would say it's not a source of worry.
09:33 What is not a source of worry is the fact that the Ghana Health Service has worked
09:38 over the years to interrupt transmission. So in terms of new people getting the
09:46 infection, that may not be a worry for now. But those who have already gotten
09:52 the disease, like he explained earlier, the damage has been done and the people
09:59 who have the conditions need to be managed. And that's a source of worry.
10:03 And that's why you are hearing this news at this point in time. So yes,
10:08 transmission might have been interrupted. So there won't be new cases. But those
10:15 hundreds of people who are infected and who have had the manifestation of
10:20 various conditions like the hydrocell and the lymphedema, they have to live
10:25 with it for the rest of their life, except the hydrocell that surgical
10:29 interventions can't cure them. So how can we therefore care for these numbers,
10:37 those who have already gotten it, and it looks like we don't have any
10:40 intervention for them? Well, I will not say we don't have any intervention.
10:48 If you listen to Bryce very well, currently we are having some training
10:55 for the people. No, no, no. I'm asking in terms of the people who cannot, with whom we cannot
11:05 really undertake a surgery operation to get the disease off. For example, those
11:09 with the legs and all of them. I'm asking how do we care for them because for them
11:14 we cannot undertake surgery and get the issue off them. Yes, so what we are
11:22 currently doing is management of their conditions. So we're training them on how
11:30 to take care of their conditions, do daily washing, exercise, various packages
11:35 that they need to keep in mind and practice so they can keep their
11:41 conditions at a reasonable level. They can avoid infections, better infections
11:46 or opportunistic infections. Then they can also keep their limbs quite reasonable
11:55 sizes so they can take part in economic activities. So those interventions
12:00 are currently ongoing with Ghana Health Service leading, American Liposuction
12:05 Mission and then Christian Foundation for International Health supporting with
12:13 the little resources that we have so these trainings and capacity building
12:18 can take place. So these are the interventions that we are carrying out.
12:23 It is not something that can cure the condition forever but you can manage the
12:30 condition in such a way that you can begin to see the reversal of the size of
12:35 the limb. Oh okay.
12:37 It is not going to...
12:39 It is good then if you see a reversal of the size of the limb then that's good.
12:44 Let me make a point that even though when you manage it the right way that
12:54 the professionals are teaching them, they can notice reversals in the size of
13:00 the limb but it is not something that will go away.
13:02 I would say, Riverta, we are talking about the fact that the limbs being so huge, if they do it well, the limbs become
13:11 lighter for them to be able to move around. So you may still see the limb
13:16 being big but in terms of the weight it becomes lighter. The limb system will
13:26 start functioning small small and therefore you will not have so much
13:30 accumulation of weight that makes the limb so heavy to be able to move around.
13:35 Okay.
13:36 So that is it.
13:38 So it means that for newborn babies, are there things we need to do to ensure that they do not get exposed to some of these things?
13:48 Well, I think Bright would have spoken about that but for newborn babies, you know,
13:59 this condition is prevented through the Mass Drug Administration.
14:05 The Ghana Health Service, the Neglected Tertiary Disease Program has been carrying out over the years.
14:13 So once we don't, there's no drug that is administered to baby as such, but you might have attained a certain age and it is provided with height.
14:26 So once your height is within the acceptable level, you are provided with a drug and then you take it.
14:35 And once you start taking those drugs, you will prevent any microfilaria in your system that will cause this damage.
14:45 But as he said, we hope that for those districts that interruption of transmission has been interrupted,
14:54 what it means is that people are no longer carrying the active, the microfilaria that the mosquito will bite and take and then give it to another person.
15:05 So hopefully, newborn babies won't stand the risk if those districts have been interrupted.
15:14 Okay. So Bright, for the remaining district that you've not been able to interrupt, what are these?
15:21 So that, I mean, if you are there, you have to seek for the right advice from the health officers to ensure that you are protected.
15:33 Yes, so we have Elembele in the Western region. We have Sunani West in Bono.
15:41 We have Bole and Sola Tunakaba in Savannah and Elora in Upper West.
15:47 So these ones we have been doing the treatment for many years and we are getting there.
15:52 That's that it is slow, but two new ones that we identified just last year are Winti and then Nkranza South.
16:01 And we've also started the Mass Drug Administration and we continue to do the Mass Drug Administration.
16:07 We carry out social mobilization for people to understand the risk so that they can participate in the exercises.
16:15 Many a time for these neglected diseases, people see them very far from them.
16:20 People think that they cannot get this kind of condition.
16:24 And therefore, even when volunteers move around with medicines to give to the people in their own homes,
16:31 some people still refuse because they don't see the risk of getting it.
16:35 And it is something that we are working on. We've been doing social mobilization.
16:39 We've been showing videos for people to see the real risk that is there so they can participate in the free treatment that we are offering.
16:47 And as Solomon said, our aim is to clear the parasite from the system.
16:54 So in future, mosquitoes would be there, but they will bite and they will not find the parasite to pick and then give to another person.
17:02 So the young ones that are being born, once you're able to interrupt the transmission, they don't stand the risk of getting infected.
17:10 And that is how we go about it. And now our biggest problem is those that are living with the condition.
17:19 What do we do for them? And that is why we are building the capacity across the regions.
17:24 So health workers will be able to provide the needed care so they can have improved quality of life and can also increase productivity.
17:36 So these are the things that we are working very hard on.
17:39 And one side that we also want support from the general public is the fact that, as I said,
17:46 most of these patients, because they no longer carry the parasite, the damage has occurred.
17:54 The people rather fear these ones than you and I that are not showing any sign of swelling.
18:00 But rather, most of the individuals that don't have any swelling are those that have the parasite.
18:07 And therefore, the fear that we have for these people is in a way misplaced.
18:13 It's you and I that sometimes even block when the medicines come. That should be feared.
18:18 The patients, you go close to them, you are not going to, they don't even have the parasites anymore.
18:22 They have suffered the damage and they are living with the damage.
18:25 So people associating with these patients will not get the infection just by getting close to these patients.
18:32 And they need our support. They need the support of everybody.
18:36 Because some even sell and people wouldn't want to buy from them. Some lose their jobs, some lose their marriages.
18:43 And it brings about huge mental health effects on these patients, because if they're not taking the medicine,
18:52 they can even get depressed and other related consequences can also come about.
18:59 And therefore, they need our support. We all need to be there for them.
19:03 We are not going to get the infection from them by relating, by doing other things.
19:08 And as I said, it is only through mosquito bites.
19:11 The mosquito might bite somebody that carries the parasite, which could be,
19:17 which mostly are individuals that are not showing any swelling.
19:21 We are those that people should fear. So they need our love.
19:25 We need our care and support so they can live meaningful lives.
19:29 So you still do go about administering these drugs in those districts that still do have it, right?
19:36 Yes, we just finished last month, last July, we did another round of mass drug administration in all the districts that are yet to interrupt the transition.
19:49 We continue to also do assessment to check whether the infection levels are coming down or not.
19:54 And if they are not coming down, we also try to check what factors are leading to such persistence of transmission so we can address them.
20:03 So we are working hard to ensure that in no time we are able to interrupt transmission.
20:09 But the debris which also has is that because countries are not paying so much attention to the individuals already living with the conditions,
20:17 they've added the fact that we need to put in place systems to take care of the patients so that wherever they find themselves,
20:25 they can get care just as you have malaria, you walk into any compound, you can get care.
20:32 They want to see this happening. So we do that even if we interrupt transmission from everywhere,
20:37 we will not be certified to have eliminated the disease.
20:40 And therefore we are working very hard to also help these patients that have unfortunately,
20:48 that are unfortunately having these swellings that are affecting their daily lives.
20:55 So in the district that you have interrupted this transmission, what is the possibility of re-emergence of the disease?
21:07 Yes. So the process is that after you determine that you've been able to interrupt transmission and you stop the treatment,
21:17 you still don't pack your bag and baggage and leave. You put in place severance and you do this for five years.
21:25 So if within these five years that you are not treating, you do periodic assessments and active transmission is not picking up,
21:36 then you can see that the interruption has been sustained and then you start preparing for,
21:42 you start preparing your disease for certification.
21:49 Incredible. That's why it's been, it's been some time I got the drug in my district because we, it used to come,
21:56 they will measure your height and then they will give you the drug for you to take. Let's see how it goes.
22:02 This is the Hunter West. I mean, I used to take that.
22:07 Yes. Hunter West. Yes. Just last year we were able to interrupt transmission.
22:12 So we had a hell of time interrupting in Hunter West, but thankfully last year we succeeded in interrupting the transmission over there.
22:20 Oh, OK. And Hunter West is also another district with very heavy numbers of individuals living with this condition.
22:29 And we've worked over the years and thankfully we've been able to stop the spread.
22:33 And we are also doing surgeries for those with the high risk cells.
22:37 And we also help those with the limb swellings to manage them so that they can have improved quality of life.
22:44 When we were young, we thought it was because we are in a coastal district.
22:48 That's why this was coming. So we're told that this is a coastal phenomenon.
22:54 I didn't know that it could even go to the interior part of the country where they are far from the coast.
23:00 So it is not as though it is a coastal issue. Right.
23:05 No. Yes. So it's along the coast in the middle belt and also in the Savannah areas.
23:11 We have it all over the country. OK. All right.
23:15 So what what is the plan to ensure that that district that are yet to have the transmission,
23:23 how do you call it, interrupted, successfully interrupted and then the new ones that you've identified, you are able to deal with that?
23:31 Yes, because we are treated in these districts for many years, we expected that by now we should have achieved the interruption.
23:39 So we are trying to we've done various studies to understand why it's been quite slow in these places.
23:47 So we have upped our game as far as social mobilisation is concerned.
23:54 We are showing videos to get people participate in this exercise.
23:58 And again, the work by the National Malaria Elimination Program also helps our cause because the same vector that we are talking about.
24:08 So as people receive the mosquito nets, we expect them to use them for that purpose and sleep under them.
24:16 So once you prevent the mosquito bite, you are also preventing getting infection with the lymphatic pleuriasis.
24:27 So we are still doing the treatment and we are trying hard to make sure that the treatment coverage is very high.
24:34 And the few individuals that have persistently refused to participate, those persistent non-compliance,
24:43 we are also talking to them to let them understand the risk that they are posing to the whole community.
24:49 So we are trying to pick all the points where the problems are and addressing them accordingly.
24:58 So we are continuing with the treatment, social mobilisation, and we are encouraging people to participate so that just as others have been able to interrupt,
25:07 they can also be there so we can protect ourselves and protect the future generation.
25:12 OK. All right. Bright, alo, matu. I'm grateful for joining us here.
25:19 Solomon Atimbere, I'll give you the last words before we conclude this discussion.
25:24 Yes. So to re-emphasise the point Bright made earlier, that these people need our support.
25:34 We don't need to discriminate against them. You cannot get the disease by physical contact.
25:41 And therefore, let's include them. And they are so vulnerable to the standard.
25:45 Our government has a special package to support them in terms of most of the government initiative.
25:52 The LEAP, for instance, we want to appeal to the agencies responsible to consider these people as vulnerable people who are not able to take part in economic activities to be able to support their daily lives.
26:06 So roping them into the LEAP would be a good starting point.
26:12 So and then we use your medium to also appeal to the general public to always come in to support these vulnerable people in society.
26:23 OK, thank you for the opportunity. I'm grateful. Solomon Atimbere is the programmes manager for the American Leprosy Promotions.
26:31 OK, and this is still the AM show, but we'll talk about a push in double signed STEM enrolment.
26:38 The education ministry says this initiative is to educate and sensitize the public on the prospect of pursuing science and STEM related courses,
26:46 demystifying the learning of science and STEM and leading to increased enrolment in our respective senior high schools across the country.
26:54 An interesting, you know, project or programme or policy being undertaken by the ministry.
27:00 And I'm excited by this. But what are the details? We'll have them here on the AM show right after this break.
27:08 [Music]