Podoconiosis — You Can Call Me Podo!

A bad disease with the simplest of solutions continues to afflict the lives of millions in rural Ethiopia

There is a little bit of an irony in podoconiosis — the mineral related disease that puffs your legs and feet, cracks your skins, and causes many sores and pains for life — at least until recently. 
You get to suffer from it because of going barefoot too much, partly from poverty and partly from custom. For some of the sufferers shoes were already with in their income range, but they do not get one. 
Some workers in the field have observed some rural people in the Amhara region of Ethiopia slinging their shoes by their laces on their long walking sticks, which they rest on their shoulders, as they walk barefoot. Why? Because the rough road will damage their shoes. They will take their shoes down and wear them as they enter into town.
“Changing the attitudes of the people will be one of the challenges,” said a worker in the field. “Soft feet are considered sign of weakness.”
The bad rural earth, red clay soil of volcanic origin specifically, they spared their shoes from is also bad for their feet. In endemic areas, years of walking barefoot leads to the absorption of some bad minerals through the skin of the soles of the feet. A 2011 study says that a fifth of the surface of Ethiopia, with close to 20% of the population, has such soil. It is also fertile, because of which rural people, who work their fields without wearing shoes, become easily exposed and develop the disease after some years. 
Not all people, though, which has incited interest to find if there is genetic predisposition. 
Podoconiosis, also called elephantiasis, like the similar disease caused by worms, was recognised by the WHO as one of the Neglected Tropical Diseases (NTDs) only in 2011.
The swelling causes severe pain which could last days at a time and has a bad smelling ooze, which could contribute to ostracization. “Patients became bed-ridden because of frequent attacks of red, hot legs and swollen and painful groin,” said the Wollga study.
Significantly more women than men are believed to suffer from podoconiosis, although the Amhara study shoes almost equal distribution.
In Gulisa woreda in West Wollega, Oromia, researchers have reported finding 1,935 affected people, whereas in another research in east and west Gojjam, published in 2012, there were 1704 cases in two woredas.
The Guliso and Gojjam researchers give respective prevalence of 2.8% and 3.3%, but it may be difficult to compare the two as some parameters were not uniform.
Podoconiosis is predominantly a rural problem, but the Guliso study, which focused solely on rural residents, has considered both urban and rural population in its denominator. If it had considered only the rural population in its computations, the prevalence could have been 3.1%. Or if, like the Gojjam study, it had considered only the proportion of population 15 years and older, it could have somewhere around a 5.4% prevalence. Likewise, if the Gojjam study has considered the entire population, instead of just 15 years and above, its prevalence would have been just 1.9%.
Such discrepancies may not make much difference as pretty much of what one needs to know about podoconiosis is already known. It has been 46 years since the problem was linked to irritant minerals in the soil. Prevention (and elimination) is as simple as washing the feet and wearing shoes. 
A more recent mapping undertaken in 2013 by the collaboration of various stakeholders, indicates that 35 million people in 345 woredas in Ethiopia are at risk. Most are in Amhara, Oromia and the South, with some cases in Tigray and Benishangul Gumuz.

“Podoconiosis can be prevented, early forms of the disease can be treated, disease progression can be curbed and the disease can potentially be eliminated as a public health burden,” reads the research on Gojjam.
Yet, affected people are forced to be inactive (do no work) for as long as three months in a year because of the recurring pain they suffer, which is enormous in lost working hours and revenues.
“Although the disease is both preventable (by avoiding contact with irritant soil) and treatable (through simple, inexpensive foot hygiene and protection), there are as yet no government-backed assistance programs for addressing prevention and treatment of podoconiosis,” laments the National Podoconiosis Action Network (NPAN) in its website.
There were studies conducted over 40 years ago on the problem in Amhara, but nothing was done about it until 2010 when an NGO, the International Orthodox Christian Charities (IOCC) started a program in East Gojjam.
Important interventions are now made by churches: Catholic Church in Wollega and Mekane Yesus Evangelical Church in Wolelga and Illubabor. Action on Podoconiosis Association (APA) works in Wolaita, Gamo Gofa and Dawro Zones of the South, while Mossy Foot Project and OpenWay work in Wolaita and Sidama zones, respectively. 
Most of those working in the field have treatment and prevention activities going on, including workshops for some where shoes are made to fit the swollen feet of the sufferers. Hundreds of thousands of shoes have been distributed over the years, even if those shoes are mostly summer shoes unsuitable for the rainy seasons.
In Amhara region alone over 25,000 people are said to have been resorted to normality, able to find shoes that fit them in the market. 
For those affected, the very simply treatment regimen includes the following, according to the APA: daily washing of the lower legs and feet, application of anti-microbial emollient, and, if necessary, compression bandages. These “can produce remarkable improvement in the majority of cases.”
“When the above treatment programs can be implemented effectively, dramatic results can be obtained in weeks or months. In most, oedema and infection are reduced and controlled to a level where appearance and function are relatively normal. … This cure should last a lifetime,” APA says in its website.
Photos show feet that pretty much look like the way they did before swelling began.
The irony mentioned above is that people get the disease for not wearing shoes, and they get better by wearing shoes. Simple as they are, the interventions, water and shoes are still beyond the reach of many, and core issues that need to be dealt with.
2016 could be the year when the Ministry of Health will finally be actively involved. It has finalized a five-year master plan for 2016–2020. The dream is to eliminate podoconiosis by 2030.