What Doesn't Kill You...

...may leave you permanently disfigured, disabled, and shunned, if we're speaking about infections.  In particular this is true of a group of ailments known as "neglected tropical diseases", or NTDs.  These are infections that disproportionately (and in most cases exclusively!) affect those in developing countries across the tropics.  We may be tempted to think that because they do not leave millions of deaths in their wake, they are not an important health topic.  This could not be further from the truth.  Take infection with the parasite Onchocerca volvulus, for example.  This worm infects the eye, and causes terrible scarring of the cornea as the immune system tries desperately to kill off the parasite.  Never mind the maddening feeling of a worm twitching and rolling in one's eye; the most impactful outcome of this disease is the corneal scarring.  Patients are left blind, hence the common name for the infection of "river blindness".  Those affected are often left unable to work, hunt, farm, and otherwise maintain their economic security.  

A young South Sudanese woman with river blindness due to Onchocerca volvulus (Photo from http://therefugeeroad.blogspot.com/ )

Perhaps more infamous among these diseases is elephantiasis (or lymphatic filariasis, clinically speaking).  This is caused by a few different species of parasitic worms including Wuchereria bancrofti and Brugia malayi, and is characterized by intense swelling of individual limbs, causing them to resemble the limbs of elephants.  The limbs are swollen with lymph fluid and adult worms.  If a patient is able to access anti-parasitic medications such as ivermectin or albendazole, this will only keep them from transmitting the disease to others.  It will not cure them.  If every living worm was killed, the disfigured limb would remain.  Similarly, the stigma would remain.  Though elephantiasis is transmitted by a bite from an infected mosquito, the perception of patients as unclean is widespread.  Affected persons are often unable to find a willing employer even if they are physically able to work.  Some are shunned by their families.  This disease may not kill, but to pretend it is therefore unimportant is a fallacy.

An elephantiasis patient in Bhutan (Photo: Mark Brazinski) 

How can one help solve this problem?  Prevention of infection is key.  This means widespread access to medication or more ideally the development of preventative vaccines.  Since these will by definition be unprofitable endeavors, research studies to discover and develop them are often funded by Federal governments, international agencies, or charitable foundations such as those run by Jimmy Carter and Bill and Melinda Gates.  In addition to politically or financially supporting research, there are other ways to address those already infected.  A growing number of companies seek out NTD patients as employees as part of their business models.  One of my favorites is Global Girlfriend, which employs women as artisans to hand-make clothes, jewelery, and accessories and sell them worldwide via the internet.  Most touching, every order includes the story of the woman who made the product.  My particular favorite is my Congo Solidarity Skirt ("river"): it was made by a woman who lost the use of her leg due to polio, and was abandoned by her husband.  She now has an income and a home.  There are many ways to have an impact on these non-killing, life-shattering diseases.  Please remember them.