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A woman suffering from hydatid in Turkana. Patients have been found with cysts on the eyeballs, necessitating the physical removal of the eye.
Photo by Joe Ombuor |
To the Turkana, the dog is more than just a best friend because, as they say up there, "it is unthinkable to live without one".
While the dog plays askari (Guard) in an area prone to cattle raids from hostile neighbours, it serves a sanitary purpose as well by licking babies' bottoms to clear bowel mess. A majority of Turkana mothers know no better napkins nor toilet papers. Napkins? Not in an area where good old precious water is such a rarity.
Turkana dogs look healthy even in the hardest of times, a reflection of the care and attention they enjoy from their human friends. When animals are slaughtered during the many traditional rituals and ceremonies, the offals are a clear-cut share for the dog.
Often, this explicit 'dog chow' is infected with cysts resulting from parasitic infections. Where humans also want a share of the offals, cysts are painstakingly removed and thrown to the salivating dog. Sadly, it is this practice, born out of ignorance and sheer resistance to change, that renders the dog the worst enemy of the Turkana and other pastoral communities inhabiting northern Kenya, Southern Sudan and Eastern Uganda.
Premature worms grow into adults
Unknown to them, dogs and their cousins, collectively known as canines (hyenas, jackals, foxes) provide hydatid, a kind of tapeworm with the natural host for growth into a reproductive adult capable of producing eggs and proliferating.
Hydatid cysts consumed by the dog contain premature worms (protoscolises) that, depending on the size of the cyst (some resemble balloons), could be in their thousands or hundreds of thousands. Once inside a canine's digestive system (most likely a dog), these premature worms grow into adults that lay millions of eggs passed out through the faeces.
Once in the small intestines, the eggs hatch and the larvae so produced penetrate the gut and into the blood circulation to be carried to any part of the body where they lodge themselves on organs and grow into cysts, each replete with many protoscolices. The wall of the cyst is formed by the body as its defence mechanism to contain the immature worms in one place so that they do not proliferate in other parts of the body. Each protoscolex is a potential cyst.
In human beings, hydatid cysts are more likely to occur in the liver (55-70 per cent) and the lungs (18-35 per cent). The two vital organs can be affected simultaneously with critical consequences.
Dr John Wachira, a surgeon who under the aegis of the African Medical Research Foundation (Amref) has operated on hundreds of cases in Kakuma, Lokochoggio and Loliondo in Northern Tanzania, says he has come across cysts on virtually all body organs with the curious exception of the testicles.
Cysts on the eyeballs
On the lungs, Dr Wachira says that hydatid cysts are known to cause respiratory distress in the patients, dry cough and high blood pressure.
Where the cyst occurs in the pelvis, it can be accompanied by primary infertility in women.
In Turkana District, said to rank among regions with the highest incidence of hydatidosis in the world, patients have been found with cysts on the eyeballs, necessitating the physical removal of the eye during surgery. Eyelids are also affected with great inconvenience to sufferers.
Acute hydatidosis where huge cysts affect multiple organs in the abdominal cavity are also common in Turkana, according to Dr Wachira. "At times we come across cysts the size of a basketball or large pumpkin," he says citing a recent operation he performed at Kakuma Mission Hospital that yielded a cyst with fluid and proscolices with a volume of 12 litres.
Parasitologist Mr Eberhard Zeyhle, who has worked at an Amref health facility in Lokichoggio for the last 20 years and helps with operations at Kakuma Mission hospital, says the biggest cyst ever seen in Turkana measured 26 litres (more than two buckets of water) from an affected middle-aged woman.
