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All this started when a friend who works with NGOs travelled to eastern Uganda. It was very shocking for him to see a human body consumed with flea parasites, only two hours from the capital. My friend showed me a picture of Yusuf Kagwa, a 45-year-old farmer.
The problem of the so-called jigger parasite - female sand fleas that burrow their way under skin - is widespread in eastern, northern and northeastern parts of Uganda.
A housefly sits on a female sand flea, removed from a sufferer, as the parasite lays its eggs.
Left untreated, the parasite can lead to secondary infections that can be fatal.
Jiggers usually affect the feet, but volunteers counted 2,555 burrow marks all over Yusuf’s body.
That really surprised me and made me want to document this for myself. The U.S. NGO Sole Hope, working on the ground, was very willing to help me.
Yusuf became the face of my story. His case, the most severe I came across, had a big impact both on me and on those around him.
He had become an outcast after locals said his infestation showed he was possessed. When his condition became really severe, only his brother was prepared to run the risk of helping him, putting Yusuf in a hut on his own for him to die.
Sole Hope heard about Yusuf’s plight through their grassroots monitors.
Treatment normally lasts a few days, rising to 10 days sometimes. Yusuf spent 21 days undergoing treatment.
The first phase, washing the affected area, is painful. The jiggers are then removed with safety pins or razor blades.
There’s no way of numbing the body. I saw even adults brought to tears.
After Yusuf returned to his village, news spread quickly that he had come back not only alive but jigger-free. People gathered in large numbers to ask him questions and shake him by the hand.
At his worst, Yusuf wasn’t able to walk and had to drag himself along on his bottom. Now here he was, wearing shoes, standing upright and smiling.
That had a very positive impact. Many people came forward for treatment. Yusuf is now treated like a hero and, he told me, he’s looking forward to finding a wife and getting married.
I went into this assignment with mixed feelings. Taking the photos was very difficult. I couldn’t understand that this was really happening to people and initially it made me feel totally helpless.
It was shocking to see the pain, the blood, the cutting - especially because this is very simple to avoid.
Sole Hope started operations in Uganda in 2013, running workshops in Jinja town, where it has health facilities to treat infestations. The charity employs two nurses but otherwise depends on volunteers to do the painstaking work to remove jiggers.
I met volunteers from Korea, Japan and Canada. There were also many from Uganda.
The NGO first wanted to identify a local initiative that was tackling the issue but there was none.
The problem of jiggers is mainly due to poor hygiene as very few people are able to afford even sandals. However education also comes into play, not least as locals often talk about infestation as a sign of being possessed.
Encouraging people to cover their feet is part of the battle against the parasite. Once treated, children especially get so excited when the NGO gives them new shoes, made from donated jean material and old tires.
Another person who stood out for me was an elderly gentleman. After he was treated he couldn’t stop thanking the volunteers, he said so over and over.
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Slideshow
A boy sits in a doorway wearing his new shoes.
A schoolgirl holds a photocopy on which a Sole Hope volunteer will draw the location of jiggers.
A schoolgirl sucks a lollipop to soothe her as jiggers are removed from her foot.
Toes of a baby that are hosting jiggers under nails are seen before undergoing jigger removal.
A Sole Hope volunteer examines the foot of a man infested with jiggers before removing the parasites.
A female sand flea, removed from a sufferer, lays its eggs.
An employee of the charity Sole Hope makes shoe soles.
An employee makes shoes.
A volunteer helps fit a boy with shoes.
Volunteers take selfie pictures with schoolchildren.
A volunteer secures boxes of shoes onto the top of a truck.
