Jiggered

Once a month, the HIV/AIDS staff at the Kilema hospital in the foothills of Mt. Kilimanjaro host a "tea" for the orphans in the area. On Friday, 129 kids showed up looking for a slice of bread and a cup of hot, tea-like water. The hospital started this little tradition in the early 1990s, as a way to eyeball the kids. It not only draws them out of the bush, so they can at least be identified, it also gives health workers a chance to see whether they're too skinny or scraggly or sickly. (SEE STORY BELOW)

It took nurse Adela three solid hours to register the kids, which consisted of collecting their names, ages, schools, parents, grandparents and the Kilema version of assemblyman. Adela also asks the kids when their parents died (or if their parents died -- she shooed away one kid was not an orphan) and who's taking care of them. The assembly man is so that they can find them again when they do home visits to assess their living conditions and sometimes deliver food or clothing or whatever they can spare. Adela says most of the kids lie -- whether out of fear or pride or simply not knowing the answer to a question -- so they like to go and see for themselves how the kids are living.

After the registration, the tea began. Plastic feed buckets were brought out and about 20 plastic cups. One bucket contained fried donuts, which two girls handed out. A bucket of tea was dished out by two more girls. The kids ate 20 by 20, while Adela and a Canadian CIDA intern named Sue handed out some banana cake and some treats brought over by a group of Rotarians. The kids should have been bouncing off the ceiling, but they were relatively well behaved. Out of 129 kids, there were only two who ended up in tears. Adela only lost her cool once, when she was handing out used clothing to some of the kids. When it came to the shoes, pandemonium broke out and we all thought Adela might get swallowed up by the kids. Instead, she started striking whoever was in arm's reach with the shoes and that seemed to bring things under control pretty quickly.

The needies of the needy orphans had a special Christmas dinner last Tuesday, even though it was the end of January. (Pole pole, as they say here, meaning slowly slowly!) The first child to arrive came around 10.30, even though the food wouldn't be served until well after 2 p.m. (That's Eric looking at the camera in the first photo.) He came charging through the blue gates and made a beeline for the HIV/AIDS resource centre, where he waited on the bench just singing and giggling to himself like all 6-year-olds who are left alone with their imagination. No one seems to know much about him. They think he lives with a grandmother but they're not too sure where and he never arrives with any other kids, so they're not entirely sure which direction he even comes from. He behaved a little like a small dog -- he seemed unaware of how little he was and kept taking on the big kids, giving them punches or just annoying them in that small yappy-dog kind of way. But he had dimples, so we all thought he was adorable.

On Friday, both Sue (the CIDA intern) and myself noticed this one child who had raggedy feet. They looked like they'd been chewed by something with jagged teeth and had been left to rot. He said nothing the entire time he was there, didn't seem to know the other kids and it took him about 15 minutes to start actually eating his donut. Adela called him aside at the end and told him to come back on Monday.

"Jiggers!" she pronounced to us in English, as the little boy stood there uncomprehending. An infection caused by a flea laying eggs in his feet. It's endemic in poverty-stricken areas and the biggest preventative is wearing shoes. Adela told us he lives with his grannie somewhere; they've never visited him so she's not entirely sure where. But he was obviously being neglected. Adela figures he's being left to clean his own clothes and take his own baths, and in the way of 8-year-olds, he's doing neither.

This is from a parasitic disease webpage on the treatment for jiggers. Like I said, she asked him to come back on Monday, but he never showed. I wonder if they'll ever see him again. He seemed pretty afraid when he left.

"Treatment consists of the physical removal of the flea by a sharp instrument. The residual cavity should then be surgically cleaned to remove its entire contents. Afterwards, an antibiotic ointment may be applied to prevent secondary infections. Certain chemicals have also proven to be effective, including 4 percent formaldyhyde solution, chlorophenothane (DDT), chloroform, turpentine, and niridazole. These treatments do not physically remove the flea from the skin, however, and therefore don't result in quick relief. They also carry their own risk of morbidity. Physical removal followed by antibiotic ointment and an anti-tetanus prophylaxis to prevent secondary infection (especially that of tetanus) is most effective."

So basically, they were going to take off all his nails -- fingers and toes -- and rub them down with turbo antiseptic wash then dig into them with sharp instruments to dig out the jiggers. They have to get them whole, Adela said, or they simply regrow.

If he doesn't get treatment, they will eventually burst, replicate (each one produces up to 2,000 babies) and eventually cripple him.

Imagine. All because he's eight and he's all alone.

News
So little money . . . so many orphans; TANZANIAGrassroots group must struggle with meagre funds to help AIDS orphans, writes Karen Palmer TANZANIA
Karen Palmer
Special to the Star
1099 words
12 February 2006
The Toronto Star
A12

Kilema, TANZANIA -- Poking out of Patrice Mavia's purple plastic sandals were toes as dark and swollen as blood sausages - ragged and infected as though a small animal with jagged teeth had chewed them.

The tips of his fingers seemed to be in a similar state of painful rot.

"Chiggers," declared nurse Adella Kessy after a hasty consultation at the Catholic hospital in the foothills of Kilimanjaro. Left unchecked, chiggers replicate by the thousands, form painful pustules and lesions, then burrow further and further into infected skin until they reach bone.

The parasite can destroy fingers and toes - its preferred harbour - and can leave its host crippled.

The infection comes from walking barefoot on ground infested with sand fleas, drying clothes on the ground or poor hygiene.

Patrice probably doesn't willingly bathe with any regularity, nor is he likely to hand-wash his thin clothes in a stream.

He also doesn't know that he has to destroy bugs and pests with a heavy, charcoal-heated iron after the clothes come out of the stream.

He is, after all, only 8 years old.

But Patrice was orphaned by AIDS a few years ago - he thinks he lost his parents in 2001 and 2003 - and he is the only one around to remind himself to wash behind his ears and scrub between his toes.

He spoke Swahili in whispers when Kessy told him to come back to the hospital with an adult in three days for treatment.

"No one is helping him care for himself," she said with a shake of her head.

That's why, on the first Friday of every month, she and her colleagues at the hospital's HIV/AIDS counselling centre invite local orphans like Patrice to the hospital for "tea."

The program, funded by the Ottawa-based Canadian Africa Community Health Alliance, helps the aid workers identify orphaned children and sort out where they live and who takes care of them.

More importantly, it gives them an opportunity to see the children.

Are they skinny? Scraggly? Sickly?

At the hospital's resource centre, Anna Anselm says there are at least 265 orphans registered with the hospital.

There are probably just as many hidden in the dense banana fields that cover the region's lush peaks and valleys.

"It's going up, it's increasing," says Anselm.

At the most recent tea, 29 children turned up, some arriving as early as 9: 30 a.m.

Almost four hours later, two industrial-size buckets, a red one and a green one, emerged from the kitchen.

One contained fried balls of dough, the other dark, steaming tea. The children ate and drank in groups of 20, since there were only so many mugs to go around.

It took Kessy three solid hours to register the children, collecting their names, ages, schools and the names of their guardians.

Few remember exactly when they lost their mothers or fathers. Some have lost only one parent, but others were about to be left completely on their own.

Fifteen-year-old Emmanuel Deo's mother had been in the hospital for three weeks and Kessy expected the boy, his two brothers and a sister would be orphaned by the next month's tea.

The aid workers also arrange home visits, consulting community leaders to help them track down the children in the labyrinth of winding red dirt paths in a dense forest of banana trees.

"You see their food supplies and their caretakers and how they are managing," says Anselm.

But the visits are made only when there's something to give: a kilo of dry beans, three or four cups of coarse sugar, a bar of soap or a bottle of oil.

When the women visited 6-year-old Gifty Mosha at the mud-and-stick shack she shares with her grandmother, an uncle, a calf and three goats, she was barefoot wearing a cotton dress from the hospital's stash of second-hand donations.

There was not a scrap of food, other than some green bananas hanging in the surrounding trees.

Meeting her visitors on the rocky red path, the child with curly eyelashes and a nearly bald head offered her tiny hand first to Anselm, then to Kessy, then back again, as the women brought meagre supplies.

Her grandmother told the women that Gifty, who contracted HIV at birth, is coughing at night and is riddled with skin infections. Her mother died three years ago; within a week, AIDS took Gifty's father, too.

"They're missing out," says Anselm. "They're missing out psychologically, they're missing out emotionally and they're missing out physically."

"Most are in poor, poor, poor environments. They're in poor houses, poor environments and have poor food. They can't afford everything that's needed for the essentials of life. They're so limited."

Most of the children the hospital attempts to serve live with a grandparent or other elderly relative.

"These old people are beyond the age of caring for these little ones," says Anselm. "They'll be losing those old people soon, too, becoming orphans for a second time."

The local community can hardly afford to feed the orphaned children and the task falls not to big-name charities or United Nations' agencies like UNICEF or the World Food Program.

Rather, the job falls to small, grassroots groups that receive their funding in dribs and drabs from international donors.

It costs $1 to feed one orphan a balanced meal of rice, meat and cabbage - but the Canadian Africa Community Health Alliance has only enough funds to feed each child one such meal per year.

Back at the hospital, the appointed day for Patrice's chigger extraction has come and gone, but the boy has not turned up.

The treatment that awaits him sounds excruciating: first, all his fingernails and toenails would be removed and then his fingers and toes scrubbed with antiseptic bleach.

A nurse would have to dig into the fleabites and gingerly remove the parasitic larvae with a sharp instrument. The larvae must be removed with precision - even part of one left behind would simply regrow.

No one seems sure Patrice will be seen at the hospital again.