The smile on their faces could not hide the pain and suffering that the men, some still in the prime of their lives, go through every passing day enduring a debilitating disease that has no known cure.
For the men, the mention of elephantiasis, also known as lymphatic filariasis, a debilitating disease that affects sex organs and limbs, sends shivers down their spine.
For ages this has been a burden that those infected and affected have had to bear.
But now the World Health Organization says Kenya is on track towards eliminating elephantiasis.
In fact, the WHO and the Ministry of Health are upbeat that the disease will have been eliminated by 2020 as the programme initiated to fight it starts bearing fruit.
Lymphatic filariasis is a parasitic disease associated with painful and extensive disfigurement of legs, arms and male sex organs.
According to Professor Sammy Njenga, a chief research officer at the Kenya Medical Research Institute, the parasite responsible for the disease is a thread-like worm that lives in the lymphatic vessels of humans.
The WHO says elephantiasis puts at risk more than a billion people in more than 80 countries in the world.
Over 120 million are affected with over 40 million of them seriously incapacitated and disfigured by the disease.
WHO country representative in Kenya Dr Rudi Eggers says the disease is endemic in the coastal region, where about 3.7 million people are at risk of infection in all the six counties – Mombasa, Kwale, Kilifi, Tana River, Lamu and Taita Taveta.
In remarks read by WHO Disease Prevention and Control officer Dr Joyce Onsongo during the Dissemination of Lymphatic Filariasis Survey results in Mombasa, it is estimated that about one million people are already infected with the parasite.
The survey carried out in the six counties was done by Kemri.
Thanks to the Global Programme to Eliminate Lymphatic Filariasis launched by the WHO in 2000, there is new hope of eliminating the disease, which is classified as one of the Neglected Tropical Diseases.
“The goal is elimination of the disease by 2020, with the aim of first stopping the spread of the infection and alleviate the suffering of the affected individuals,” said Dr Eggers.
“Fortunately, the disease can be eliminated by stopping the spread of infection through preventive treatment of all people living in endemic areas using safe medicine combinations, repeated annually for four to six years.
“Consequently, the disease is targeted for elimination as a public health problem by the year 2020.”
50 years with disease
In 2016, for example, the WHO donated medicine for the programme worth Sh35 million in addition to technical support for implementation.
The disease is associated with immense pain, suffering and stigma as is the case with 74-year-old Katana, a resident of Mbaoni village, Magarini, Kilifi county.
Katana suffers from swelling of legs (elephantiasis) and scrotal area (hydrocele). His is an example of the trauma men affected by the disease go through every day.
In a candid interview, Katana said the disease has ruined his marital life and stopped him from being productive and putting food on table.
“I have lived with this condition for over 50 years. Elephantiasis was in the past associated with bad omen among the family.
However, that did not hold true because none of my other family members have this condition,” said Katana.
“We are told that the swelling of the sex organ could be treated by surgery, but when I went to inquire the cost was too much for a poor man like me to afford,” he said.
The situation is even more depressing for young men who have been incapacitated and cannot perform their conjugal obligations.
Wilson, 38, said he first noticed the swelling when he was 15 years old and the condition has not shown any sign of reversing.
Laughing stock
He said things took a turn for the worse when a small itchy spot on his scrotum slowly but painfully developed into a gross swelling.
Although he had seen this condition in other men, it never occurred to him that he would be included in the statistics.
“When it started my peers used to laugh at me, but it was not for long because, surprisingly, some of them have also been infected,” he said.
The gross swelling in my private part gives me psychological trauma. Some people tease and ridicule me. I am a football player but I became a mere spectator due to the ugly swelling.”
Walking became a problem for the once energetic and active young man. It was also difficult for him to carry out the tasks he used to perform to earn a living for his family.
Some of the villagers have devised crude ways of removing fluids from the swellings using untreated sharp objects.
Katana says they have attempted all these to get relief from the pain and to reduce the swelling, but it is short-lived because the swelling is usually back in a few weeks.
The Ministry of Health Neglected Tropical Diseases programme manager Dr Sultani Matendechero is upbeat about eliminating lymphatic filariasis by 2020 following commitment by the government, the WHO and other partners who have pumped in money into the project.
Speaking during the dissemination of LF Survey results in Mombasa, Matendechero said the programme suffered setbacks leading to its collapse in 2011, a situation he attributed to erratic funding.
Prevalence gone down
“We restarted the programme in 2015 after getting serious commitment for funding and steady supply of drugs for the mass drug administration from WHO and another donor called the End Fund.
“Since the programme was not consistent, the Kenya Medical Research Institute was tasked to do a survey in 2015 to enable the partners understand how much had been achieved and what needs to be done,” he said.
Kemri established that the prevalence had gone down.
This was attributed to the rolling out of mass distribution of mosquito nets, which had in turn reduced the rate of transmission through mosquito bites.
Kemri’s Prof Njenga, who was the lead scientist in the survey done in October 2015, said the results have indicated a significant reduction in the infection rate in the endemic areas.
In some of the most affected areas such as Galana, Kilifi county, the infection rate was as high as 20 per cent. But this has significantly declined to around one per cent.
“In some areas like Tana River and Taita Taveta we found no new infections. We now need to go back for transmission assessment surveys, which will confirm that transmission has been interrupted and mass treatment is no longer required,” Njenga said.
Consistent funding
According to the survey, Ndau in Lamu county still has the highest infection rate — at around six per cent.
Prof Njenga said the survey indicates that Kenya is on track to eliminating the disease by 2020.
The Kemri survey found that the widespread use of mosquito nets for malaria control has also helped to keep the prevalence of lymphatic filariasis low, even when the community-wide treatments were skipped.
The Ministry of Health, through the NTD programme, now has to increase effort in morbidity management, especially surgeries for the enlarged scrotum and taking care of swollen legs.
Dr Matendechero said the programme has proper and consistent funding from End Fund with an annual disbursement of Sh85 million and free drugs from the WHO.
“We do not see any reason why we should collapse the programme because there is a lot of goodwill from both the Kenyan government and the donor community to eliminate this debilitating disease by 2020.
“The End Fund is also ready to support surgeries and start home-based care for elephantiasis patients in a pilot project to be financed to the tune of $60,000.
Togo is one of the countries in Africa that have successfully eliminated elephantiasis. Others include Burkina Faso, Benin, Ghana, Cameroon and Tanzania.
The victims’ names have not been disclosed.