Saturday, October 2, 2010

Jiggers: are the Basoga too poor or simply filthy?!

Just this week, The Daily Monitor (Thursday, 28 September) reported a case of a three months old baby who died as a result of jigger infestation. This was in Bugiri district, which is part of the controversial Busoga Kingdom. Controversial because two years since Kyabazinga Henry Wako Muloki passed on, my people probably don’t know who their new King is. Anyway, The Monitor further reported that nine people, including six from the baby’s family had been hospitalized. A shameful disaster! And yet these are just a few of the many Basoga suffering from this parasite. Some people have largely blamed this situation on poverty and poor hygiene. However, on comparing the poverty and hygiene levels of Busoga with northern Uganda, Mr. Daniel Kalinaki, Managing Editor of The Monitor, and I am risking to say, a musoga, doubted whether poverty and hygiene could explain Busoga’s jigger dilemma. He joked, I believe, that his brothers were “too poor to care and poor because they have been conditioned to mistake peace for prosperity”. But is that all we can say when people are dying and others are being incapacitated? Is there anything we can do to help the situation? Who is responsible and who can help?
First and foremost, I think it is important that we understand and appreciate these little bugs. Jiggers, also known as sand fleas, are scientifically referred to as Tunga penetrans. For some strange reason, this name revolves around piercing and penetration. Well the Tungas are the smallest of fleas, measuring about 1 millimiter in length. That is close to the size of the tip of your pen. These insects mainly dwell in warm sandy soils and feed on decaying organic matter. However, the breeding female prefers to burrow into the skin of mammals, mainly the feet, to get a better diet from the skin and blood vessels prior to laying a battalion of eggs. Jiggers infest the feet most because they cannot jump beyond twenty centimeters. But if a person sleeps on the ground, as is the case in many poor rural families, then the entire body is one hell of a buffet.
The life cycle of a jigger. Source: CDC, Parasites and health.
After two weeks of intensive feeding the female lays its eggs, dies off and the eggs drop to the ground hatching three to four days later. The numerous offspring are mature and ready to breed in just one month. A single episode of a jigger attack is nothing to write home about. All you do is endure the constant itching and then pluck the ‘pregnant’ madam out with a needle or safety pin. An infestation is, however, a totally different scenario all together since it can lead to ulcerations, infections, pain, trouble with locomotion, incapacitation and, as recently reported, anemia. And even death!
According to the New England Journal of Medicine, these insects are mainly endemic to tropical Africa, South America and subtropical Asia. They are, in essence, not a ‘Basoga problem’ but a problem of the tropics. In fact, Joyce Wangui in her article titled “Poor Kenyans still grapple with jigger infestation” gave a graphic detail of the problem in Kiangage village, Muranga district in southern Kenya. This region is about 500 kilometers away from Busoga Kingdom! The only common things between Kiangage and Bugiri, besides the jiggers, are poverty and hygiene. 
Hands infested by jiggers: Source EAif

But it is not simply enough to rub the issue aside by just calling this “a problem for the poor and unhygienic”. I was born into the family of a relatively rich medical doctor who had a very good sense of hygiene. He had a farm in Busoga on which I spent the earlier years of my life. We, however, occasionally suffered from jiggers despite the fact that we were neither poor nor dirty. Luckily enough, ours did not get to the level of an infestation because our parents endeavored to contain the situation. I have spent most of my life in peri-urban Buganda but have not at any one time suffered from a single jigger. Nor have I seen or heard of a jigger infestation in Buganda, despite the fact that we have lots of poor and dirty people in Buganda. The slums of Kampala are a good example if you are in doubt.       

What point am I trying to make here? Jiggers may be endemic to Busoga not just because its people are poor and filthy! It could be that the environment and conditions in Busoga are simply more favorable for them to thrive. We have heard of other insect related infestations in different parts of the country: river blindness (Mbale, Gulu, Kasese, Kabale etc.), Guinea worm (West Nile region) and Elephantiasis (Kamwenge, Kapchorwa). I have also come across stories of Bilharzia in Busia and other parts of the country. Fortunately, some of these problems have been successfully managed.  
How can we manage the problem? We first need to recognize it as a genuine and serious problem that can affect the productivity of our workforce just like disease and malnutrition do. We need to appreciate that these so-called poor people are the majority in Uganda and they are responsible for producing the food that we eat. They provide the manual labor for various industries/sectors. They do all the menial jobs that most of the educated people shun. They sustain us. And we somehow ought it to them. We can borrow a leaf from Kenya’s NGO: Ahadi Kenya Trust. These guys set up a campaign code named “Help remove my jigger.” Ahadi used the former Miss Kenya 2005, Cecilia Mwangi and journalists to champion this cause. They have embarked on massive education of the masses, treatment of those afflicted as well as fumigation of homesteads. This is something we can also do. The Basoga have prominent sons and daughters in the media who can highlight this cause. We also have prominent artistes such as Afande Gen. Mega Dee, Rachel Magoola and many others who can act as ambassadors towards this cause. They can also ‘edutain’ our folks through their music and tell them that jiggers are neither hereditary nor a curse but something that can be managed. Schools in Busoga region can also borrow from the approach used in Busia to sensitive locals on Bilharzia. According to Health Exchange, school children, through the “Acting against worms” project, were used to act skits with the objective of educating locals.
Our local leaders should encourage such approaches instead of threatening to arrest those with jiggers, as was the case in 2008. They should also not shy away from finding solutions to the problems their voters face. “When you tell them they need to bathe and maintain cleanliness around their homes, they say you are abusing them and that they will not give you their vote the next time round.” Irresponsible statements like this one, from Ms. Robinah Namukose, area woman district councillor for Bugiri should be discouraged. Jiggers are not a result of spontaneous generation. And they cannot be eradicated by simply taking a shower every day, wearing shoes and disposing garbage in the right place. And I am also yet to hear that the destitute of Kampala, who sleep on the streets and eat from the bins, are suffering from jigger infestation.

To claim that the Basoga suffer from jiggers because of poverty and poor hygiene is like saying that the Baganda of Rakai/Masaka, or whichever tribe inhabits that region, suffered a lot from HIV/AIDs merely because they were poor, ignorant, promiscuous or plainly unlucky. If the nation had looked at it that way and stopped at that, we would have missed the point and would have been unable to make the sort of progress we see today in the fight against HIV/AIDS.

We need to clearly understand why the jiggers thrive in this area. Or maybe we don’t even need to! We just have to accept that they thrive. We have to be seriously committed, as government, local leaders and civil society, to develop and adopt strategies to educate our people and to eradicate jiggers. We must remember that the government has in the past, with the help of the Carter Center, been able to manage river blindness and guinea worm through vector control, treatment and education. This too can be done for jiggers. But as we wait for the problem to escalate, so that government can put it on its agenda, we as the Basoga can also take a stand.  
If Angella Katatumba can set up “For You Gulu” for the people in northern Uganda, why can’t Gen. Mega Dee launch “Rid Busoga of Jiggers”?! I am sincerely looking forward to hearing of such an initiative by our well placed sons and daughters so that I can ‘put my behind on their campaign’. And I am sure many other Basoga would be glad to add theirs as well.
Can popular artiste, Gen. Mega Dee, one of Busoga's prominet musical sons, command the battle against 'Busoga's notorius bugs?'

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