Ajay, 75, (not his real name) makes a living by preparing and selling egg balls, plantain chips, channa and sometimes sugar cakes in his corner shop. Nowadays, however, Ajay can no longer easily prepare these local favorites since his left leg is swollen double its usual size.

It all began just over 10 years ago when his left leg first showed signs of swelling. When he spoke to the Guyana Chronicle, he recalled visiting a doctor after his condition prolonged and he was diagnosed with Lymphatic Filariasis (LF) or ‘Filaria’, as it is more commonly called. To him though, it was just “Big Foot”.
LF affects the body’s lymphatic system, which functions to remove unwanted fluids from the body and transports ‘lymph’- a fluid which contains white bloods cells that help to fight infections.

The World Health Organisation (WHO) states that this disease is caused by infection with parasitic worms called nematodes, classified as ‘filarial worms’. The three main types of filarial worms are:
• wuchereria bancrofti
• brugia malayi
• brugia timori.
In Guyana, according to the Coordinator of the Neglected Infectious Disease Programme and the National Coordinator for the Elimination of Lymphatic Filariasis Campaign, Dr. Fabu Moses, filaria is caused by the bancrofti worm and is transmitted from human to human by the culex mosquito.

Unfortunately, persons can be affected by this disease and only discover their infection until several years later since the manifestations of the disease develop in stages.
Dr. Moses explained that the conditions of LF may be asymptomatic, acute or chronic. While there are no external manifestations for the asymptomatic conditions, the body’s lymphatic system may still be affected.
And even though someone may be infected, it may take many years before it develops into chronic conditions.

Attesting to this was Ajay’s 37-year-old daughter, Molly (not real name) who related that he had been infected for more than 20 years, as said by his doctors, before his leg began swelling.

IRREVERSIBLE
For persons like Ajay, however, the chronic signs (swelling of his leg) signal the point of no return.
“There is no cure, prevention is our best option,” Dr. Moses said. The chronic manifestations are irreversible.

Another man who has been infected with the lymphatic disease, John (not real name) a market vendor, explained that he has been living with his swollen leg for 18 years and he has learned to not let it be an impediment to his daily life.

“I does be selling [at the market] everyday, so I don’t get to take care of my leg a lot,” John disclosed. On Sundays, however, he only plies his trade until midday, and as such, he related, “On Sundays I go home and I wash the leg properly; I clean it out and so and I treat it.”

This Sunday-regime is part of what Dr. Moses calls the ‘CARE’ system. While there is currently no cure for Lymphatic Filariasis, CARE is an acronym used to guide its treatment. She explained that it is cleaning the affected area, applying treatment, raising the affected area when sitting and above the level of the head when lying down and of course, exercise.

John explained that he learnt about this from his numerous visits to the clinic for his infection and over the years, he has learned to take better care of himself. However, he made no mention of exercising overall or exercising his leg, which according to the doctor is instrumental in caring for oneself.
The overall application of ‘CARE’ is important in abating the morbidity of filaria and it helps to foster good overall health for the person infected.

MASS DRUG ADMINISTRATION
While there is no cure for filaria, promoting the holistic prevention of filaria is now one of the major health focuses in Guyana despite failing before in a mandatory WHO programme. The country has lagged behind in fulfilling its mandate to eliminate LF and is now one of the four countries in the Americas (in addition to Haiti, The Dominican Republic and Brazil) left to eliminate the disease.
Alarmingly, nine out of the 10 administrative regions of Guyana are considered endemic with filaria, according to Dr. Moses.

At the beginning of October this year, the Ministry of Public Health, in conjunction with the Ministry of Education and through support from the Pan-American Heath Organisation/ World Health Organisation (PAHO/WHO) launched a revitalised and re-conceptualised MDA seeking to eradicate the disease from all regions.

 Read more: Gov’t steps up fight against filaria

DEC and Albendazole (ALB) are the tablets being administered to eliminate the bacteria and they must be taken once every year for five consecutive years for them to be effective.

In addition disseminating the tablets in public places, the Education Ministry was recruited to join the campaign to disseminate the pills in schools because this time it was discovered in the previous campaign that the group before that failed to meet the 65 per cent mark for taking the medication was children.
In addition to the MDA, junior Public Health Minister Dr. Karen Cummings related that the ministry is employing other tactics to eliminate filaria.

“We have these areas fogged, to kill the mosquitos and the larvae and for pregnant women, we have been giving mosquito-treated nets,” she said, adding that a coordinated effort across many of the sectors under the Health Ministry has been employed as a strategy to eliminate the disease carrying mosquitoes.
She highlighted that in addition to actively tackling the spread of the disease through disseminating drugs and suppressing the spread of mosquitoes, another major tenet of the campaign is awareness.
While John was apprehensive of the MDA, he did contend that awareness is a critical part of eliminating the disease. As he stood beside his market stall, he postulated: “You see this gutter here- you see how it full of grass? People got to understand that these things do breed mosquitoes and they [the mosquitoes] does bring all kinda disease, [sic] not only filaria.”
The Health Ministry has been carrying out awareness sessions in areas where evidence-based studies have shown are more endemic.
The collaboration with the education sector, however, not only seeks to encourage youths to take their pills to safeguard from the disease, but to also provide a holistic approach to the awareness of the disease, including the other measures of prevention and the signs and symptoms.

A FILARIA-FREE GUYANA
“We are one of the few countries that still have this disease in this part of the Americas,” the public health minister bemoaned and due to cognisance of this, she highlighted that her ministry has been working assiduously to entirely eliminate it.
Dr. Moses, like the health minister explained that the disease is compounded by other issues such as accessibility (reaching out-lying regions), lack of human resources and the general stigmas associated with the disease.
“A lot of people do not go to the clinic because they tend to hide their disease since it is very stigmatised- especially when people use words like ‘bigfoot’ and ‘goadie’,” Dr. Moses said.
Both filaria victims: Ajay and John would have mentioned that they were faced with stigma and discrimination, especially in their professional lives.
“My customers never really said anything to me, but now and then somebody gon come and say something and me and them does gotta go up the road,” John remarked.
Despite the prevalence of the disease and the challenges that accompany it, there is much hope still.

(Statistics courtesy of Chief medical Officer, Dr. Shamdeo Persaud)
With these strides in mind, it is now up to the general population to take their pills and safeguard against mosquitos. As explicitly stated by Dr. Moses, “The goal of our programme is eliminating filaria as a public health problem; that means getting filaria under one percent in the entire population.