Poverty and the jiggers reality in Kenya

BY DR. NELLY M’MBOGA
Published March 19, 2010

They sat separate from other patients, as if out of shame. Infact, the adults avoided eye contact. Mr. Mwangi, the father, was in obvious agony his feet covered in polythene paper around the ankles. He had admitted to having jiggers, and could not wear shoes. It had been raining the whole week, making Kibera muddy. The nurse had already seen Mr. Mwangi’s legs and confirmed that he had a bad attack of jiggers. She had advised that we clear with other patients first, and the Mwangi family seemed happy with the decision.

The Mwangi’s family was made up of Nyokabi and their three children, Kimani, 9, Njoki, 7 and baby Ndung’u, 2. The family did not look like your average Kikuyu family because they were darker. They also had the tale tell signs of malnutrition among the poor (among the rich it is associated with obesity): they were thin, and the elder children stunted (the equivalent of muscle wasting in adults), while the baby had signs of marasmus. They had started developing maize stigmata, like the so called ‘negro’ nose, more typical of people from Western Kenya.

The Mwangis had just come from one of Kenya’s refugee camps in Eldoret, set up to accommodate victims of the post-election violence in 2008. The violence split up the family. While his family remained in the camp, Mr. Mwangi sought to reedeem his family, but his plans did not work out after he moved to Nakuru, and finally ending up in his rural home in Muranga. His aged parents could not support him and because of the mass jigger infection, and slow village life, Mr. Mwangi headed for Kibera  slums in Nairobi. He rented a one-room shack next to a charcoal selling kiosk, hoping to get a better place when he was ready to get his family.

He quickly made friends and business contacts, and was soon selling charcoal for a friend. He planned to start his own business, save money and go for his family. One month later, he was unable to sleep well. He had pain in one of his toes which painkillers partially relieved. He located a nearby house where he went for a drink after work. Since he didn’t want to spend on beer, he settled for a swig of changaa, which became a regular habit, for soon he could no longer sleep without a drink. With time, Mr. Mwangi drank so heavily that he could never get up on time for work.

Unable to work, Mr. Mwangi soon started tapping into his saving for upkeep and alcohol. He is not sure when the jiggers started, but the throbbing pain in his toe had worsened. He showed it to a neighbor and Njeri, his girlfriend, who confirmed that it was a jigger, and helped remove it. Soon, the more he removed them, the faster they seemed to sprout. Njeri took him to a nearby clinic, where a doctor used paraffin soaked in cotton to cover the wounds. The doctor also gave him tablets, but the problem worsened. Infact, Mr. Mwangi became so ill that he even tested for HIV. At this juncture Njeri realized this was a burden she didn’t want to deal with and contacted his family.

Luckily, Nyokabi was among those IDPs who had received monetary compensation to leave the camp and start life elsewhere. She had planned to invest in a plot of land for the family, but when she received a call that her husband was gravely sick, Nyokabi instead parked all their worldly goods, and headed for Kibera. She was no stranger to the slum, having spent part of her childhood there. She arranged for better living quarters, settled her children, and sought her husband. Nyokabi was shocked at the state of her husband: he was wasted and filthy. Njeri, the girlfriend, had long moved out in order to lessen his dependency on her. Nyokabi decided to take Mr. Mwangi with her.

Mr. Mwangi was brought to the clinic on the third day after Nyokabi’s arrival. He looked frail and weighed only 55 kilograms. He was in great pain. His vital signs were within normal limits; his lower lip was a bit prominent, and bright red in color, a known feature of pellagra, especially when associated with frequent alcoholic intake. His feet were very swollen and the toes infected, but the wounds were clean. Nyokabi had obviously done a good job.

Mr. Mwangi had two things going for him: a dedicated wife keen to offer social and emotional support,  and he also  hailed from a community that did not depend on maize as its main diet. The Kikuyus are mainly vegetarians, however, this is slowly changing because of a decline in food production, which has led to abject poverty in many peasant communities in Kenya.

The jigger menace is therefore growing, because of the weakening nutritional values of communities. Many villagers today considere it a curse because controlling it is difficult, once it starts.

In Kenya, Muranga District is considered the leader in the menace, although most rural communities are affected. Many people are of the opinion that, were it not for the efforts of Cecilia Mwangi, the former Miss Kenya 2005, the jigger menace would still be a big problem. According to Ahadi Kenya, a non-profit organization, which she founded to sprearhead the anti-jiggers campaign, two million Kenyans still need assistance dealing with the problem. However, according to an article by Mutahi Basse published in Africa Review on Dec 8, 2008, a slightly bigger figure is affected, and 10 million Kenyans are vulnerable. The problem is serious all over East Africa and beyond, including Nigeria, where 42 percent of the children population is said to be at risk.

The Jigger (scientific name is Tunga Penetrance) is said to have been introduced to the African continent by European explores in the 16th Century (as was maize). It has been associated with extreme deprivation, and is common among children and single men. Personal hygiene plays a big role in causing it, especially in warm dusty places. The socio-economic impact of the jigger is immense. Most affected communities have a higher school drop out rate, while economic stagnation is the norm.

We counseled Mr. Mwangi on hygiene and the need to stop alcohol, if he wanted to heal. We then put him an anti-pellagra regimen and a high protein diet. We explained to Nyokabi that only a good diet would help strengthen Mr. Mwangi’s immune system, and this would in turn shield him from fresh jigger infestations.

Our government should not allow extreme poverty because the jigger menace is an indication that people are getting more desperately poor.

Dr. Nelly’s journal continues next week.

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