Wednesday, June 01, 2011

The Foot-Washers of Ethiopia

A mysterious disease, misdiagnosed for decades, finds healing in Christian hands.

Physician Larry Thomas remembers a luncheon two years ago in Addis Ababa, Ethiopia, where many folks interested in a dreadful, newly discovered disease called podoconiosis—"podo" for short—met for the first time.

"As we were about to eat, I asked, on an impulse, if anyone would mind if we thanked God for the food. The response was startling," says Thomas, also the founder of Tropical Health Alliance Foundation. "Not only did everyone want to pray, they began to share about their faith. We soon realized that we were all fully vested Christians."

Not everybody interested in podo is a Christian. But a thread of Christian faith and mission runs through everything that's being done to fight the disease. A remarkable diversity of believers are involved in the fight—the man who first discovered the disease, the octogenarian doctor who developed treatment for it, and the leaders of today's scientific research. Add the activism of Catholic sisters and a highly successful young entrepreneur with a line of hip shoes, and the unfamiliar disease is at last gaining the world's attention.

Podo is grotesque. In severe cases, the victim's feet appear to be turning into cauliflower—horrible, rotting cauliflower—or something that grows under a rock in 20 feet of water. These are nightmare feet, seeming to bubble and melt, producing unbearable odors.

An estimated one million Ethiopians suffer from podo, as do perhaps three million more, mostly Africans. In affected areas—typically mountains with red volcanic soil—1 out of every 20 people have it. A village of 2,000 will have 100 victims, permanently disabled. In certain areas of Ethiopia, the podo infection rate surpasses that of HIV/AIDS.

Though prevalent and severe, the disease was not identified until 35 years ago. Doctors had been diagnosing the symptoms as infectious elephantiasis until a Christian doctor named Ewart Price realized that the diagnosis didn't fit.

Using geological maps, Price connected the symptoms to Ethiopia's volcanic soil. Then, examining tissue samples, he found tiny silica crystals embedded in victims' lymphatic tissue. He guessed that the silica found its way through the skin of feet and ended up scarring or blocking lymphatic channels, causing swelling and deformity. (Filarial worms create this problem in infectious elephantiasis.) Price's deductions still remain the best explanation for the cause of the non-communicable disease. Exposure to soil is surely crucial, but other factors, such as genetic predisposition, likely play a part.

For a long time, Price's discoveries prompted little reaction. The first organized responses to podo began 14 years ago, and then in only a few remote parts of Ethiopia. The disease made the World Health Organization's list of neglected tropical diseases in February.

Why so long? By and large, those who cannot afford shoes are most susceptible. Podo is almost unknown in urban areas and rarely if ever infects soldiers or tourists. Gail Davey, the leading researcher on podo, puts it succinctly: "It is clearly a disease of the most voiceless." Because of the stigma, many victims hide. So the disease remained invisible until some people determined to see it. This is their story.

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