How Sierra Leone is beating tropical diseases

SIXTEEN years ago Hannah Taylor woke up with a fever. Her legs began to swell to four times their normal size. They have been that way since. People shunned her because of their putrid smell. “For six years, I thought my big fut was caused by evil witchcraft,” she said outside her shack in Freetown, the capital of Sierra Leone.

The lymphatic filariasis (elephantiasis) ailing her was caused by a mosquito-born infection that could have been treated safely with a pill costing no more than $0.50 before it progressed. Instead, microscopic worms infested her body, causing catastrophic and irreversible damage.

Elephantiasis is one of 17 neglected tropical diseases (NTDs) that affect 1.5bn people, disabling children and keeping multitudes poor. Huge progress has been made against these diseases since an agreement in 2012 by pharmaceutical firms to donate billions of dollars’ worth of drugs. Even so, many African countries struggle to get the necessary pills to those in need.

Strangely Sierra Leone, one of the world’s poorest countries, is doing better at beating back such diseases than almost anywhere else in Africa. This is despite a devastating civil war from 1991 to 2002 that claimed 70,000 lives and wrecked the health system. What little remained of it was gutted by an Ebola outbreak in 2014 that killed lots of doctors and nurses. As a result the country has only some 400 doctors to treat its 7m people. Corruption also makes the nation sicker. Most people have to pay bribes to doctors and nurses for basic treatments.

Fifteen years ago as much as half the population was infected with the worm that causes onchocerciasis, or river blindness (see map). Many villagers in the southeast used to think it was perfectly normal for people to go blind after 30, says Mary Hodges, from Helen Keller International, a charity that works on blindness and malnutrition. Yet by 2017 only 2% of people carried the worm, and there had been no new cases recorded of people going blind from onchocerciasis in a decade. Elimination is expected by about 2022.

Other illnesses are also being beaten. Schistosomiasis, also known as snail fever and bilharzia, is a parasitic worm infection that slowly destroys the kidneys and liver. It, too, is in retreat among children. So are soil-transmitted helminths, infections caused by roundworms that can stunt mental and physical development. The worm that caused Hannah’s elephantiasis was also once widespread. But there have been no new cases since 2011.

There are several reasons why Sierra Leone has pulled off this remarkable feat. Paradoxically, one of the reasons is the extraordinarily high prevalence of NTDs. Because the entire population was exposed to at least one NTD, the government made it a priority early on, says Dr Joseph Koroma, who managed its programme.

In the case of schistosomiasis, Sierra Leone has had a national control plan in place for almost a decade. That is in contrast to South Africa, a relatively wealthy state that still does not have a mass treatment programme for the illness—even though it suffers some 3m infections, says Thoko Elphick-Pooley, from Uniting to Combat NTDs, a coalition of aid agencies, companies and charities.

Common sense also helps. Instead of dealing with these diseases separately, which donors unwittingly encourage by giving different pots of money for each one, Sierra Leone tackles them all at once. Each year it provides drugs for four major diseases to everyone at risk. Treating people at roughly the same time reduces the chances of them reinfecting one another. It also saves money because health workers can visit each village only once instead of several times a year.

Ending the stigma is also important. Radio programmes where panels of experts, victims and local leaders answer calls from listeners about their concerns have helped to break down misconceptions and encourage people to get treatment. It is no good just lecturing villagers about how river blindness is caused by the black fly when they think it is witchcraft, says Dr Hodges. There has to be a conversation.

Hannah, who was depressed about her condition for years, later put on a brave face and campaigned to raise awareness about it and to break down taboos. “De bodi fine,” she said, slapping her swollen legs with a cheerful smile, “de bodi fine.” Hannah, who passed away last week, recently said she was pleased her children would not suffer as she had.

Correction (June 25th 2018): The top picture accompanying this story has been changed. The original image showed a woman from Kenya.