As Sulaiman Kakaire reports in the first dispatch of a two-part series, the problem is bound to escalate as many are living in denial, frustrating any efforts to find a remedy.
It is 8am in Nawanyingi village, less than 5km from Iganga town. The sun is shining brightly and all seems well. Along the dirt road that runs through the village, barefoot children are trekking to their school as some adults head to their plantations. Although most of the children are moving in groups of three to four, James Bageya, a pupil in Buwolomera primary school, is limping some metres behind the pack. But his limp is not due to a disability; something is itching him in the feet.
"I cannot walk continuously for ten minutes without stopping to scratch my feet. That's why there is a distance between me and them," Bageya says, cutting a frustrated figure.
On observation, there is an inflammation in the space between Bageya's toes and along the medial border of the feet, one sees fresh wounds. Bageya's infection is a symptom of Tungiasis, a skin disease caused by the female ectoparasitic Tunga penetrans flea commonly known as the jigger. But he thinks this is normal.
"This is something that is common and most of us have it," he says, as he limps along.
The group ahead of Bageya has a few pupils who are proud to say that they too have jiggers, though they are not limping. "I have it, my father has it and almost everyone in our family has it. So, it is not new," says one of the pupils only identified as Grace.
These children will be late because everyone is expected at school by 7:30am. However, due to the leniency of the school authorities, they will not be punished.
"Our pupils come from far and have some issues; so, we allow them into the school after cautioning them to be punctual," says one teacher at Buwolomera primary school.
When asked to elucidate on the issues why children are late for school, the teacher, who declines to be named, retorts that this is a village with jiggers.
"Don't ask too much... children come late to school because they cannot walk to school in time as expected," he says. Apparently, everyone in the administration is scared of talking to the media because of the stigma associated with the problem.
"Our school has suffered a lot ever since press reports started to circulate that it has the most cases of children infected with jiggers. So, just give us a break," says another teacher, as he threatens to call the police if I don't leave him alone.
West Indian:
Records suggest that the jigger is a native to the West Indies. The first case of Tungiasis was described in 1526 by Gonzalo Fernández de Oviedo Valdés, where he discussed the skin infection and its symptoms on crew members from Christopher Columbus's Santa Maria ship, after a shipwreck in Haiti. Through the crew's various travels, the jigger flea spread around the world, particularly to the rest of Latin America and Africa.
Jiggers cause severe pain, itching, and a lesion at the site of infection. Studies suggest that if Tungiasis is not treated in its first stage, the victim could become prone to secondary infections such as bacteremia, tetanus, andBy 2009, jiggers were reported to be present in 88 countries. They are regarded as a public health concern in countries such as Nigeria, Trinidad and Tobago, and Brazil, where prevalence is as high as 50 per cent in poorer communities.
Hidden crisis?
Experts say that the jigger problem in Busoga is an epidemic that could escalate if nothing is done to address it.
"People, particularly politicians, used to (claim) that the jigger issue is being blown out of proportion but there is evidence that this is a disaster," says Francis Kyakulaga, a public health officer from Namutumba district. Kyakulaga is working with Uganda Development Health Associates (UDHA), an association of health professionals from Busoga, to campaign for better health and living standards in the region, with the jigger problem being their main entry point.
However, Kyakulaga says, the problem is underappreciated, in part because it has no statistics.
"We don't have aggregate data because of the laxity in health inspections although the reported cases can give pointers on what is really happening," he said.
Tentative findings by UDHA, corroborated by evidence gathered by the Balunywa Foundation, another non-governmental organisation involved in the anti-jigger campaign, shows the issue is prevalent in the whole of Busoga. The most hit districts are Kamuli, Mayuge, Luuka, Bugiri, Namayingo and Iganga. However, Kyakulaga believes the problem is under reported in Namutumba, Kaliro, Budiope and Buyende.
"We don't have capacity to carry out enough inspection to appreciate the magnitude of the problem although our records also show that it is a disaster," says George Kitakufa, the district health inspector for Iganga, when asked about the magnitude of the problem.
According to Kitakufa, Kigulu North and Kigulu South are the most affected counties in Iganga district. The other affected sub-counties include, Nawanyingi, Nawandala, Namungalwe and Nambale. Based on information from George Mutumba, the health assistant of Nawanyingi sub-county, over 1,000 cases of jigger infestation have been reported in Nawanyingi parish alone.
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"We don't have the aggregate data but what I can confirm is that Nawanyingi village is the most hit and we estimate that over 1,000 cases have been reported so far," he said
According to Umar Mabode, a health assistant for Namungalwe sub county, over 120 households in Namunkanaga parish were found to be affected by jiggers.
In Namutumba at least 100 households are reported to be affected. The most affected villages in the district include Bulange (25), Nsinze (15), Kibale and Ivukula. Although it is a general problem amongst primary schools, findings indicate that the most-hit schools include primary schools of Bubaka, Mawagala, Bunyiro, Nawanyingi Nawandala, Nayibiri, and Buwolomera, where James Bageya struggles to arrive on time each morning.
This Observer feature is published in partnership with Panos Eastern Africa, with funding from the European Union's Media for Democratic Governance and Accountability Project.
In the second part we shall examine why the jigger problem has persisted in Busoga and what threats it poses if not addressed.
