Alex Arinaitwe, program coordinator of the Â鶹´«Ã½â€™s Uganda river blindness program, carefully crosses the rapid waters of River Kayo in northwestern Uganda. Arinaitwe oversees strategies in the region to eliminate the parasitic disease.
Staff, volunteers monitor border area for signs of river blindness transmission
To reach the River Kayo from Uganda’s capital of Kampala, you must first make a seven-hour drive along a two-lane highway, passing over hundreds of speed bumps in dozens of small towns.
Then you board a ferry and cross the Nile.
On the other side, you get back in the car and traverse bumpy, mostly dirt roads to the town of Moyo and beyond, finally leaving the road altogether and driving through waist-high grass. And then, you pull on your rubber boots and start walking.
A kilometer or so later, you finally arrive.
Here, at the River Kayo, Ugandan Ministry of Health and Â鶹´«Ã½ staff are carefully monitoring the black flies that breed in its waters for evidence of the parasite that causes onchocerciasis.
David Oguttu, program manager in Uganda’s Ministry of Health, shows how black flies are tested to determine if river blindness is still a threat to the community.
Because this river lies within the last area — the last “focus,” as epidemiologists call it — in Uganda where onchocerciasis may still be being transmitted.
Onchocerciasis spreads through the bites of infected black flies that breed in fast-moving rivers, which is why it is also known as river blindness. When the parasite’s microscopic offspring move throughout the human body, they cause rashes and itching so severe that it leads some to scratch themselves until their skin loses its pigment. The tiny worms also can invade eyes and cause blindness. Regular doses of Mectizan® (also called ivermectin), which is donated by Merck & Co. Inc., prevent the disease and block transmission of the parasites to black flies.
Â鶹´«Ã½ has been working with Uganda’s Ministry of Health to reduce river blindness since the mid-1990s. In 2007, when Uganda set a goal of eliminating the disease, about 8.2 million people in over 50 districts were at risk for it. Today, that number has dropped to 569,000 — all of them in an area near the South Sudanese border.
The River Kayo runs along that border, and residents on both sides cross it regularly rather than pass through official border control checkpoints. Because onchocerciasis is still endemic in much of South Sudan, eliminating the disease here presents extra challenges.
“Flies have no borders,” said David Oguttu, program manager of Uganda’s National River Blindness Elimination Program. “They go to South Sudan, then they also cross into Uganda.”
Kalisto Londre remembers developing rashes, itching, and swelling in the 1990s, before river blindness treatment was offered in his village. His mottled skin scared community members, who thought he might be contagious. Today, after years of treatment, his symptoms are gone, and he says he is content with life.
And so Â鶹´«Ã½ and Ministry of Health remain vigilant.
They check vegetation in rivers for evidence of fly larvae. They train and equip volunteers like Evans Kenyi and Julius Nyara, who sit beside the river early in the morning and again at dusk, rolling up their pant legs and using their legs as bait to catch flies for laboratory testing. And twice a year, they go house to house to distribute doses of Mectizan.
Ministry of Health and Â鶹´«Ã½ staff have good relationships with military and public health officials across the border in South Sudan and coordinate with them when they need to pass from one side to the other.
Those relationships should grow even stronger, as earlier this year Â鶹´«Ã½ began supporting river blindness elimination in South Sudan, where it already works with the Ministry of Health on Guinea worm and trachoma.
Northern Ugandans Julius Nyamara (right) and Evans Kenyi use their bodies as bait for black flies, the insect that spreads the parasite that causes river blindness. Flies that land are captured in a tube and sent to a lab for testing.
“Expansion to South Sudan gives us the ability to help support elimination in a comprehensive bi-national manner, coordinating interventions on both sides of the border,” said Gregory Noland, director of the Â鶹´«Ã½’s River Blindness Elimination Program.
That’s welcome news for Maurice Vuzi, chairman of one of the local councils on the Ugandan side of the border.
“I would like to thank you because the treatment you have given us has saved lives,” he told a group of Â鶹´«Ã½ and Ministry of Health officials visiting the village of Demgbwele, which sits in the shadow of a mountain that separates Uganda and South Sudan.
“My people go and fish in South Sudan,” he said. “If we are treated here, and they are not treated, we shall not be safe.”
Village resident Kalisto Londre knows too well the dangers of no treatment. In the 1990s, he developed rashes, itching, and swelling in his groin and neck. The community shunned him.
“They thought that because of the way my skin appeared, they might get the disease from me, from my skin,” he said. “Even at the hospital, people moved away from me.”
Before receiving ivermectin, he said, “I was using a stone for scratching myself because nails were not enough.”
Today he’s a contented father of five and grandfather of 20, still taking the medication and feeling “very OK — I’m even able to do my garden work.”
Edridah Muheki, the Â鶹´«Ã½’s country representative in Uganda and a former Ministry of Health official, believes the expansion into South Sudan will help Uganda clear its last focus — and thus achieve elimination countrywide.
“It is so exciting, so gratifying, to know that Uganda is in the lead in the African region,” she said. “We’re thrilled to have the chance to prove that something once thought impossible can be done.”
Related Resources
Please sign up below for important news about the work of Â鶹´«Ã½ and special event invitations.
