Blessed are the healers

Author: Mark Reynolds

Maurice Antoine’s feet are too bloated and misshapen to fit into socks. Wrapped in white muslin cloths, they look like canvas potato sacks on the floor of his shack in Haiti. From his bed, the 48-year-old plops each foot onto the sole of a giant sandal and fastens cargo-size Velcro straps. He stands up, slowly hoists his left leg forward and repeats the same motion with his right. Lumbering like an elephant, he steps out the door and onto a sunny footpath.

Antoine has elephantiasis, or what Haitians call "Gro Pye’’ — Big Foot. The ailment is an advanced form of lymphatic filariasis, a preventable parasitic disease that affects an estimated 120 million people around the world. Depicted in ancient Egyptian murals, the scourge is thousands of years old. It is especially common in tropical places like Antoine’s town of Leogane, a flat seaside region at the base of soaring mountains. The climate here is perfect for mosquitoes, which spread the disease from one person to another. More than 50 percent of the population is infected.

Until recently, most people in town assumed they were healthy. After all, they didn’t feel sick, and they didn’t look like Antoine, whose deformities spurred wild speculation. Some wondered if he had kicked a set of voodoo dolls lying on the ground. He, too, wondered if he was cursed. He was a recluse. He says he once went for about seven years without having a lengthy conversation with anyone. “I was ashamed, embarrassed; people did not like to come close to me,” Antoine recalls.
Things have changed in Leogane. At Hopital Sainte Croix in Antoine’s neighborhood, a team of doctors, scientists and others are developing efficient, cost-effective methods for snuffing out the parasites that cause filariasis among large groups of people. Their work has put Leogane on the front line of a worldwide crusade, the Global Alliance for the Elimination of Lymphatic Filariasis, to eradicate the disease within the next 20 years.

Last fall, the Haitian team — funded by a partnership that includes the hospital, Notre Dame and the U.S. Centers for Disease Control and Prevention — launched an elaborate public health campaign that dispensed parasite-killing drugs to more than 108,000 people and dispelled the myths that had made Antoine and others like him untouchable for decades.

That campaign makes a lot of sense to one of the program’s coordinators, Father Thomas Streit, CSC, an assistant professor of biological sciences at Notre Dame who has lived in Haiti intermittently since 1993. Modern science has developed good tools for fighting filariasis, but the disease still poses a threat to an estimated 1.1 billion people around the world. "We can sit in our lab and come up with great solutions,’’ Streit says, “but we have to apply those solutions in the field.”

A sudden outpouring of good will is one of the reasons Streit and others are optimistic about the potential for finally bringing the appropriate medicines and techniques to the people who need them. Drug companies recently pledged to donate the medicines required for global elimination. Governments are making commitments. And so are private individuals. The Leogane program, for example, received through Notre Dame a $5 million grant from the Bill and Melinda Gates Foundation last year.

The parasites

Vanquishing filariasis involves fighting a parasitic worm that lives almost exclusively in the human body. People in Haiti have carried these threadlike parasites since the 17th century.

The worms lodge in a person’s lymphatic system, a vast network of nodes and vessels that maintains the fragile balance of fluids in the blood and tissue. They live there for years, giving birth to millions of baby worms that circulate in the blood. Filariasis spreads from one person to another when some of these baby worms, known as microfilariae, are picked up by mosquitoes and given to other people. Most people never detect the worms because the parasites don’t disturb bodily functions in any overt way. Others aren’t so lucky.

Somehow, the full-grown parasites mysteriously disrupt the flow of a person’s lymphatic system. The problem usually starts in areas where the parasites like to nest, the legs, breasts or genitalia. Fever and excessive swelling, caused by an accumulation of fluid, are the first tangible symptoms. Meanwhile, the disruption of lymph flow impedes the work of antibodies trying to help the skin ward off a constant assault of infectious microbes.

“The microbes will get in there,” Streit says. “They will start forming a little colony. They will take advantage of the fact there’s improper flow. You have to think about the battle between microbes and our own bodies as a war. . . . The parasite disrupts the balance of the war and it sets up that particular part of the body for defeat.”

Without proper treatment, infections flourish. Scarring follows each infection and elephantiasis sets in. It is disfiguring, disabling and permanent for people like Antoine. “You can’t do surgery on tissue that’s no longer fed by and drained by the circulatory system,” Streit says.

This is one of the reasons the Global Alliance is coordinating a worldwide effort to kill the parasites before the worms have a chance to cause more elephantiasis cases. Streit and others believe they can stop the disease from spreading, and eventually eliminate it, by medicating everyone whose bloodstream carries baby worms. They want to annihilate all the juvenile worms.

A complicated campaign

When Streit came to Leogane in 1993, one of the first projects he got involved with was an attempt to eliminate filariasis from a village situated in the middle of some sugar cane crops on the outskirts of Leogane. Nadine Fredlyng, 13, was one of the first people he worked with. She lived in a cluster of small shacks near an open drainage trough filled with mosquito larvae. Streit counted 210 juvenile parasites in a single drop of her blood. Her siblings also tested positive. Seven out of eight boys in a neighboring family were infected, too. One woman’s leg was swollen with lymph fluid. The program treated Fredlyng and others in her village with annual doses of two drugs that kill only the juvenile worms.

Five years later, the remaining adult worms are reaching the end of their four-to-eight-year life cycles and dying; no juvenile worms remain to take their place. Streit says the villagers are clearing their bodies of the infection for good and avoiding re-exposure. But lymphatic damage caused by filariasis is still here; keeping it from causing elephantiasis will require careful monitoring and treatment. Still, the program appears to have broken the lineage of parasites that caused suffering for hundreds of years.

“It’s helping us a lot because the children are not going to get the disease,” says Nadine’s father, 46-year-old Vilsom Fredlyng. Says Nadine, now 18, “I think I’m feeling better now.”

After the Gates funding arrived, the staff of the informally named Filariasis Program embarked on a bigger and more complicated campaign to bring the same success to the entire region last year. They recruited and trained more than 2,000 volunteers to help distribute medicines at more than 200 different locations in Haiti. They coordinated hundreds of promotional workshops and sponsored other publicity. Both a filariasis song and an announcement by a well-known Haitian comedian aired on four local radio stations. The program treated more than 108,000 people in a span of 16 days last fall. Later this spring, the first 4,000 of these people will be tested.

Streit is hopeful. Technicians who continually test mosquitoes in the region are finding that the bugs show fewer signs of carrying the parasite.

The filariasis elimination project continues to grow. About 75 percent of Haiti now has been evaluated for filariasis and other hot zones will soon receive attention. “We were the first ones to distribute medication in the community like that,” says the program’s young administrator, Jean Marc Brissau, “so the world is following.”

Getting better

Across the street from the gates of Hopital Saint Croix, Antoine has kept an eye on the developments as he tries to make a living selling candy. Each day, he stands mutely next to a squat wooden stand that displays a couple dozen lollipops and other sugary treats.

The program’s clinicians have taught him how to make up for the shortcomings of his damaged immune system by keeping his lower extremities impeccably clean. His feet and legs still look like the boots of an astronaut, but they’re smaller than they were about four years ago, and they don’t smell as bad. The worms are long gone. The ostracism has lifted. Throughout town, people understand the biology of his disability.

Antoine is still a shy man who longs for simple things: A wife and family, a job that could provide a more dependable source of income. Nonetheless, the recent improvements are fueling his confidence.

“I have big legs,” he says, “but I think I can work.”

Mark Reynolds is a staff writer for The Providence (Rhode Island) Journal.