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Where Shoes Are A Luxury.....

07/17/2018 05:31 am ET
Where Shoes Are A Luxury, A Nightmarish Disease May Be Lurking
In rural Ethiopia, something in the soil can trigger a deforming disease.
Tom Gardner On Assignment For HuffPost
Tom Gardner for HuffPost
Wosani Wolanchu at a clinic in the village of Waro in southern Ethiopia. Wosani suffers from advanced stage podoconiosis.
Tesfaye Bezabh in the village of Gesabale in southern Ethiopia has mild podoconiosis and says he rarely wears shoes.

WARA, Ethiopia —The district of Dawro in southern Ethiopia is farming country, its fertile soils brimming with life.
On steep hills, farmers eke out a living from corn and teff, yam and banana. When the thin air thickens with mist and rain, the copper-colored ground turns to mud.

But this fecund earth, a blessing for Dawro’s farmers, can also be a curse. Something in the soil triggers a disfiguring disease that may hobble even the hardiest folk.
“I am quite young but now I look old,” said Wosani Wolanchu, a 40-year-old mother of five waiting for an appointment at a clinic in the village of Wara.
She eases off an oversized plastic sandal to reveal a bloated, swollen foot riddled with scabs and moss-like warts. It took her two hours to hobble from her home to the clinic, a journey that once took little more than 30 minutes.
Wosani is living with podoconiosis, a non-infectious skin disease experts say is entirely preventable, were she able to afford proper footwear.
Here in Ethiopia’s remote highland villages, where farmers plow the soil barefoot while wives and children at home pad across dusty, uncovered floors, shoes are still a luxury. So in places like Wara the disease sometimes known as “mossy foot” endures, while the world remains largely ignorant of its ravaging effects.
Unlike the similar but much more common lymphatic filariasis (commonly called elephantiasis), which humans contract when mosquito bites transmit a parasitic worm, podoconiosis stems from prolonged exposure to red-clay minerals in volcanic soils.
Tom Gardner for HuffPost
Children near the village of Gesabale in southern Ethiopia, where 37 of 235 residents suffer from podoconiosis.
The causes are not fully understood but it is thought that soil particles, which enter through cracks in dry skin on the sole of the foot, damage lymphatic vessels, eventually causing swelling and a mushroom-like thickening and folding of the skin. This is often accompanied by recurrent malaria-like episodes, which render feverish victims incapacitated for as many as 90 days each year.
Podoconiosis currently afflicts an estimated 4 million people worldwide, 1.5 million in Ethiopia alone, making this almost certainly most affected country. Reliable estimates from other heavily affected countries, such as Cameroon, don’t come close.
A countrywide survey of Ethiopia in 2013, the first of its kind anywhere, found the disease to be more widespread than previously thought. The disease is endemic in some 40 percent of the country’s administrative districts and roughly 35 million people are at risk.
Podoconiosis was eliminated in Europe centuries ago, thanks to urbanization and the widespread use of footwear, but in Ethiopia, around 80 percent of the population still live in rural areas. A majority make their living from traditional, non-mechanized farming.
Ethiopian children start wearing shoes at age 12 ― and often much later in the case of those with podoconiosis, estimates Dr. Kebede Deribe, epidemiologist and research fellow at Brighton and Sussex Medical School. In places like Dawro, where the soil can be thick and sticky, footwear is generally considered unsuitable for outdoor labor.
Tom Gardner for HuffPost
Tesfaye Bezabh in the village of Gesabale in southern Ethiopia has mild podoconiosis and says he rarely wears shoes.
“I’m faster and more active without shoes,” said Tesfaye Bezabh in the village of Gesabale, a few miles from Wara, where 37 of 235 residents have the disease.
“Why would I wear them?”

Poverty and a barefoot tradition are compounded by a lack of understanding of the disease. Many suffer in silence for decades, unaware of the cause ― or a treatment for ― their condition.
Though scientists have evidence there is a genetic, hereditable component to podoconiosis, this is often misunderstood by patients to mean it is inevitable or untreatable.

“I don’t know the reason. All I know is that every day my foot is growing bigger and bigger,” said Wosani, the mother in Wara. “It would be good if I died today.”
For those like Wosani suffering from especially advanced podoconiosis, minor surgery might ease some of the discomfort in her foot by removing the worst lumps and inflammation, but much of the deformity will probably be with her for life.
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