If Symptoms Persist
Dr. Jose Pujalte Jr.

Elephantiasis: A hidden menace




“My flesh is clothed with worms and clods of dust; My skin is broken, and become loathsome.”


The Book of Job 7:5

The Holy Bible, King James Version

VICTIMS of lymphatic filariasis, a little known tropical disease, might as well be characters from "The Twilight Zone." Imagine legs the size of tree trunks or a man’s scrotum so big that they scrape the floor. There’s no doubt that these are the descriptions that justify lymphatic filariasis’ other name: Elephantiasis.

What is it? This parasitic disease starts with a mosquito bite. After 7 to 21 days, an infective stage follows where thread-like worms or filariae invade the lymphatic system of the human body. Practically invisible, the lymphatic system is only noticed when the lymph nodes (kulani) swell and become painful during an infection. Now these worms eventually damage the lymph vessels, a vast network that not only transports fluid nourishment to tissues, but also provides defense against infection. As lymph fluid accumulates, the extremity swells and may infect (lymphedema). In time, the surface of the affected extremity or area reacts by thickening and ridging thus giving the appearance of elephant skin. Aside from disfigurement there is now disability.

Public Health Priority. More than the bird flu that gets so much airtime, lymphatic filariasis or LF is actually more entrenched in tropical regions. The World Health Organization (WHO) recognizes LF as the second leading cause of permanent disability, after mental illness. At risk are 1.1 billion people or 20% of the combined populations of 80 countries. 120 million people are infected with two-thirds concentrated in the Asia-Pacific region. In the Philippines, there are 36 known endemic areas of filariasis.

Team Effort. The magnitude of the task to eradicate LF demands help from all sectors. The cooperation of the WHO, the Department of Health (DoH), the University of the Philippines-National Institutes of Health (UP-NIH), and pharmaceutical firm Glaxo Smith Kline is a grand effort to rid the country of lymphatic filariasis by 2010. The key strategy of MDA or mass drug administration in at least nine Philippine provinces should be a good start.

WHO scientist Dr. Raman Velayudhan notes that the DoH has enough diethylcarbamacide (DEC) pills stockpiled for the mass treatment. For its part, Glaxo Smith Kline has been donating albendazole pills since 2000. The drug giant has also pledged to keep up donations until LF is eradicated. Social mobilization is also necessary for success. For this reason, a local alliance of public health advocates calling itself the Coalition to Eliminate Lymphatic Filariasis (CELF) was formed.

Still, Velayudhan remarks: "At this time, we are not in a position to scale up to 20 million [population for treatment]. We have operational needs and we are not certain we will have sufficient funds to meet them. We are looking at a nationwide campaign for 2005. We need more funds for social mobilization and for the campaign which we do not have. The figure we are looking at is US$200,000. If we really want to go for a massive campaign, we’ll need that amount."

On the other hand, UP- NIH Executive Director Dr. Jaime Z. Galvez Tan, is more upbeat: "Treatment initiatives of this scale have been successfully carried out by the DoH in the past. There is no reason now for an all-out assault on LF to fail."

Combi Plan. The WHO and DoH will accelerate the effort through the Combi Plan where 5 activities are given priority. These are political advocacy, community mobilization, full-scale media advertising, personal selling by volunteers, and maximizing use of points of service (the clinic or hospital) for health education.

The problem with LF is that the greatest risk factor of getting it is being poor. This is not to disparage or be judgmental. But the fact is, the poor have little or no access to medicine and health care. 76% of the established endemic areas belong to 4th to 6th class municipalities. It is as much a medical as it is an economic problem.

In time, lymphatic filariasis may go the way of smallpox. The last case of smallpox was reported in 1977 and in 1980, the WHO declared the disease eliminated.

We need more diseases discussed for historical reasons. LF could be one of those, in 2010.

Billboard. The Rotary Club of Manila (RCM), Asia’s first and largest, now meets every Thursday noon at the Shangri-La Hotel in Makati. Dynamic President Alejandro "Alex" L. Yap, Jr. reminds all members of the club’s participation in this year’s AlayLakad. This will be on September 5, 2004 Sunday. Assembly time is 4 a.m. at the PICC grounds. For details please call the RCM Secretariat at 527-1887 or 527-1889.

Fact/Factoid. Mongolian spots are bluish-grey birthmarks of no consequence appearing mostly in the lower back and buttocks of newborns.

it is a very tragic disease. and i feel sorrow for those that have it. my condolences. but i suggest the scientist focus on having the disease affect the penis. that way, we would be gods among men.

The problem is it is slowdy spreading in many areas in rural Philippines!