This article is part of HuffPost’s Project Zero campaign, a yearlong series on neglected tropical diseases and efforts to fight them.
UTUT FOREST, Kenya ― “This forest is full of leopards” is not what you want to hear when you’re trekking through the equatorial bush and armed only with two cheap umbrellas.
Especially when leopards are hardly the only threat.
Our party ― two journalists, two health workers and a handful of local guides ― is on an expedition into this forest in Kenya’s Rift Valley to meet people plagued by bloodsucking sandflies that transmit a flesh-eating disease called cutaneous leishmaniasis.
This wilderness is largely uninhabited, but some 300 people live in caves here, and survive by selling charcoal. It’s over an hour on foot to the nearest village, and the few roads or footpaths are impassable even by motorbike.
A group of friends in Kenya's remote Utut Forest, where 300 people live in caves. An outbreak of cutaneous leishmaniasis has plagued the local community. (Photo: Zoe Flood)
We can’t see any leopards prowling around us in the pristine wilderness, which people usually only visit for safaris, but we know they’re near. Our guides, who live in the forest, shout sporadically to alert us to the big cats.
“Hey, hey, hey!” cries James Biharai, one of our guides, presumably keeping the leopards at bay.
“The leopards eat fully grown adults ― one ate a man last week,” he adds.
We’re suddenly pleased about our decision to leave behind the donkeys we’d booked to carry our camera gear through the dense, sweltering forest. However exhausting it is to lug equipment on our backs, it’s better than being led by slow-moving, four-legged leopard bait.
Hiking through the Kenyan bush, en route to the Utut Forest caves. (Photo: Zoe Flood)
We’re so scared of being eaten that we shelve our previous fears of getting infected with the flesh-eating disease we’re here to investigate.
Our mishmash hiking group is heading to an area where the local people infected with cutaneous leishmaniasis have little hope of receiving treatment. At least 400 people around this area have been affected bythe disease in recent years, and reaching them involves covering the Utut Forest to convince them to get proper medical care. Only the odd team of mobile health workers from the government or nongovernmental organizations ever venture out here.
Biharai launches into an elaborate story about how he once survived a leopard attack by holding the animal’s front legs all night so it couldn’t move.
“When it went right, I went right. When it went left, I went left, and so on all night,” he says. The strange dance apparently ended at daybreak with both man and beast so exhausted that they went lumbering off their separate ways.
We are still reeling from this tale when another guide mentions that we should probably be more worried about the lions. Then a third guide chimes in with even more terrifying news: “There are also many, many snakes,” he says, adding that there are also plenty of buffalo in the area.
“In the evening they come to the caves,” he says, stopping to show his scarred back, which he says is the result of a buffalo mauling. “Recently a man was attacked by a buffalo that destroyed his private parts ― took them away completely.”
A leopard sits on a tree branch in a nature reserve hours away from the Utut Forest. (Photo: Goran Tomasevic / Reuters)
But these grisly stories say nothing of the sandflies, which can inject parasites that slowly eat away at the skin, causing deep, horribly itchy sores. Before the trek out to these bugs’ heartland, we had been made to believe that they bit only at dawn and dusk. But, during the drive to the starting point of our hike, we were informed that the sandflies actually feast on human blood all day.
So we douse ourselves in repellant chemicals and put on an extra layer of clothes, even as we trek 9 miles under the blazing sun.
Buffalo grazing in Hell's Gate National Park, near the Utut Forest area. (Photo: Education Images via Getty Images)
With so many dangers present, it’s not surprising that health workers have barely dared to tread here.
Joseph Kariuki is an exception.
Kariuki, 50, has covered thousands of miles over the last eight years. He has talked about health care with people in need ― even though he has his own farm and family to look after and, he claims, even though the Kenyan government has never paid him a salary.
He regularly trudges out to the caves of the Utut Forest to tell people that the lesions spreading across their faces are not due to what they call “shetani” ― meaning the devil, or a curse ― and are, in fact, related to a treatable tropical disease.
Joseph Kariuki speaks to locals about getting treated for the flesh-eating disease cutaneous leishmaniasis. (Photo: Zoe Flood)
Kariuki also says he teaches people about “the dangers of the caves” and encourages them to move above ground. These caves were used decades ago to protect rebels fighting the British colonial government, he says.
Hellen Tarko, 58, recently moved from a cave to an above-ground home made of grass. After 16 years of cave living and 10 years of suffering from cutaneous leishmaniasis, she saw the light and got treatment.
“The wounds got bigger as time went by. But now I am almost healed,” she says, showing the deep pockmarks now dotting her cheeks.
It is extremely difficult to identify small-scale outbreaks, such as the one health workers and staff from the medical charity Drugs for Neglected Disease Initiative (DNDi) recognized in and around the Utut Forest.
Landscape of the Rift Valley. (Photo: DEA / C. SAPPA via Getty Images)
Kariuki also tries to tell the local community to stop using ineffective traditional treatments ― which involve scraping off layers of diseased skin and filling wounds with bitter leaves ― and to instead follow a weeks-long course of injections to the affected area.
But the injections are known to be excruciating. Many people, including 27-year-old Amos Kiptui, only followed Kariuki’s advice once.
“I literally ran away from the treatment,” Kiptui says. “I decided to use these traditional leaves as medicine. But still I haven’t succeeded to heal the wound. If I get another option to treat the wound I would be happy.”
DNDi and partners are researching new oral and topical drugs, which would be easier and less painful for cutaneous leishmaniasis patients to endure.
Until then, disease warriors like Kariuki will keep braving a forest full of leopards, lions, buffalo and snakes to stop people being slowly eaten alive.
Amos Kiptui, 27, sits in a cave. (Photo: Zoe Flood)
DNDi is a recipient of grants from the Bill & Melinda Gates Foundation, which also supports this series. All content is editorially independent, with no influence or input from the foundation.
If you’d like to contribute a post to the series, send an email to ProjectZero@huffingtonpost.com. And follow the conversation on social media by using the hashtag #ProjectZero.
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Lymphatic Filariasis
Lymphatic filariasis, more commonly known as elephantiasis, is a leading cause of disability worldwide, according to the U.S. Centers for Disease Control and Prevention. It affects over 120 million people globally and can cause severe swelling of body parts, including the legs and scrotum. While people are usually infected in childhood, the painful, disfiguring symptoms of the disease only show up later in life.
Onchocerciasis
Onchocerciasis, commonly known as river blindness, is an eye and skin disease that can cause severe itching and visual impairment ― including blindness. Around 18 million people are infected. Of those, over 6.5 million suffer from severe itching, and 270,000 are blind. The disease is caused by a parasitic worm, transmitted through bites from infected blackflies. The worm can live for up to 14 years in the human body, and each adult female worm can be more than 1.5 feet long.
Chagas
Chagas disease is a potentially life-threatening illness. In the first months after infection, symptoms are mild, including skin lesions and fever. But in its second, chronic phase, up to 1 in 3 patients develop cardiac disorders, which can lead to heart failure and sudden death. The disease is transmitted to humans by “kissing bugs,” which live in the walls or roof cracks of poorly constructed homes in rural areas, according to the World Health Organization. Of the estimated 6 million to 7 million people affected worldwide, most live in Latin America, but the disease has also spread to the United States. Around 300,000 people in the U.S. have Chagas disease, according to the Dallas Morning News.
Dengue
Dengue is a flu-like illness that can sometimes be lethal. In 2015, more than 2 million cases of dengue were reported in the Americas. In some Asian and Latin American countries, “severe” dengue is a leading cause of serious illness and death among children. Dengue is spread by the Aedes aegypti mosquitoes, the same type of insect that transmits Zika. To reduce the risk of bites, WHO recommends covering water containers, using insecticide, having window screens and wearing long sleeves.
Human African Trypanosomiasis
Human African trypanosomiasis, commonly known as sleeping sickness, is a chronic infection that affects the central nervous system. People can be infected for years without signs, but in the second stage, patients can suffer behavior changes, hallucinations and even slip into a coma and die. Many people affected live in remote, rural areas that don’t have easy access to quality health services. This makes diagnosis and treatment more difficult. WHO has identified sleeping sickness as a disease that could be eliminated worldwide by 2020 if the right resources are dedicated to it.
Leishmaniasis
There are several forms of leishmaniasis, including visceral, which can be fatal, with symptoms including fever and weight loss; and cutaneous, the most common form, which causes skin lesions, leaving lifelong scars and disability. The disease, spread by sandflies, affects some of the poorest people on earth, according to WHO, and is associated with malnutrition and poor housing. Around 1 million new cases occur annually, causing 20,000 to 30,000 deaths. Leishmaniasis is climate-sensitive, affected by changes in rainfall, temperature and humidity ― which means it could be exacerbated by global warming.
Trachoma
Trachoma is an eye disease, which if untreated, can cause irreversible blindness. It causes visual impairment or blindness in 1.9 million people, per WHO. The disease is present in poor, rural areas of 42 countries in Africa, Latin America, Asia and the Middle East ― but Africa is the most affected.
Rabies
Rabies is almost always fatal once symptoms show up. Initial symptoms are fever and tingling around the wound. As the virus spreads, people with “furious” rabies become hyperactive and die by cardiac arrest; people with “paralytic” rabies become paralyzed, fall into a coma and die. Transmitted by pet dogs, rabies causes tens of thousands of deaths every year. The disease is present on all continents except Antarctica ― but more than 95 percent of human deaths due to it occur in Asia and Africa. It is a neglected disease primarily affecting poor populations, where vaccines are not readily available.
Leprosy
Leprosy is a chronic disease, which when untreated can cause permanent damage to the skin, nerves, limbs and eyes. There were 176,176 cases at the end of 2015, according to WHO. While the stigma associated with the disease means people are less likely to seek treatment, leprosy is curable, and treatment early on can avoid disability. Leprosy was eliminated as a public health problem in 2000 ― meaning there is now less than one case for every 10,000 people worldwide.
Schistosomiasis
Schistosomiasis is a chronic disease that causes gradual damage to internal organs. Symptoms include blood in urine, and in severe cases, kidney or liver failure, and even bladder cancer. Around 20,000 people die from it each year. Transmitted by parasites in infested water, the disease largely affects poor, rural communities in Africa that lack access to safe drinking water and sanitation. “[People] get it as kids bathing in water,” Sandrine Martin, a staff member for the nonprofit Malaria Consortium in Mozambique, told HuffPost. “But the symptoms, like blood in the urine, only develop later ― and then people tend to hide it because it’s in the genital area.”
Chikungunya
Chikungunya is a disease that causes fever and severe joint pain, according to WHO. While it is rarely fatal, it can be debilitating. Since 2004, it has infected more than 2 million people in Asia and Africa. There is no cure for the disease, which is transmitted to humans by infected mosquitoes. The name comes from a word in the Kimakonde language, spoken in some areas of Mozambique and Tanzania, that means “to become contorted” ― a nod to the hunched-over position of people who are affected with joint pain.
Echinoccosis
Echinoccosis is a parasitic disease that leads to cysts in the liver and lungs. While it can be life-threatening if untreated, even people who receive treatment often have a reduced quality of life, according to WHO. Found in every continent except Antarctica, the disease is acquired by consuming food or water contaminated with tapeworm eggs, or through direct contact with animals who carry it, such as domestic dogs or sheep.
Foodborne Trematodiases
Foodborne trematodiases can cause severe liver and lung disease, and on rare occasions death. Most prevalent in East Asia and South America, the disease is caused by worms that people get by eating raw fish, shellfish or vegetables that have been infected with larvae. While early, light infections can be asymptomatic, chronic infections are severe.More than 56 million people were infected with foodborne trematodes, and over 7,000 people died in 2005, the year of WHO’s most recent global estimate.
Buruli Ulcer
Buruli ulcer is a skin infection caused by bacteria that often starts as a painless swelling, but without treatment, it can lead to permanent disfigurement and disability. In 2014, 2,200 new cases were reported, with most patients under age 15. The exact mode of transmission is still unknown. The majority of cases, if detected early enough, can be cured with antibiotics.
Yaws
Yaws is a chronic, disfiguring childhood infectious disease. Affecting skin, bone and cartilage, the symptoms show up weeks to months after infection and include yellow lesions and bone swelling. More than 250,000 cases of yaws were reported from 2010 to 2013, WHO told HuffPost. A lack of clean water and soap for bathing contributes to its spread. Only 13 countries are known to still have cases of yaws, including Ghana, Papua New Guinea and Solomon Islands.
Soil-Transmitted Helminth
Soil-transmitted helminth infections are among the most common infections worldwide and affect the poorest communities. People are infected by worms transmitted by human feces contaminating soil in areas with poor sanitation. People with light infections usually have no symptoms. Heavier infections can cause diarrhea, abdominal pain, general weakness and impaired cognitive development. Depending on the number of worms, it can lead to death. Up to 2 billion people are infected worldwide, according to WHO. But because infections can be light, not all patients suffer, WHO’s Ashok Moo told HuffPost.
Taeniasis
Taeniasis is an intestinal infection caused by tapeworms, which mostly causes mild symptoms, such as abdominal pain, nausea, diarrhea or constipation. But if larvae infect the brain, causing neurocysticercosis, the disease can cause epileptic seizures and can be fatal. People get it by eating raw or undercooked infected pork. The ingested tapeworm eggs develop into larvae and migrate through the body. Taeniasis is underreported worldwide because it is hard to diagnose in areas with little access to health services, according to the CDC.
Guinea Worm
Guinea worm is a crippling disease that it is close to being eradicated. There were only 22 human cases reported in 2015, according to WHO ― down from around 3.5 million cases in 21 countries in the mid-1980s. The disease is usually transmitted when people with limited access to quality drinking water swallow stagnant water contaminated with parasites. About a year after infection, a painful blister forms ― most of the time on the lower leg ― and one or more worms emerge, along with a burning sensation. It is rarely fatal, but can debilitate infected people for weeks. The Carter Center, founded by former President Jimmy Carter and his wife, has been instrumental in efforts to eradicate the disease.
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![Schistosomiasis is a chronic disease that causes gradual damage to internal organs. Symptoms include <a href="http://www.who.int/mediacentre/factsheets/fs115/en/" target="_blank">blood in urine</a>, and in severe cases, kidney or liver failure, and even bladder cancer. Around 20,000 people die from it each year. Transmitted by parasites in infested water, the disease largely affects poor, rural communities in Africa that lack access to safe drinking water and sanitation. “[People] get it as kids bathing in water,” Sandrine Martin, a staff member for the nonprofit <a href="http://www.malariaconsortium.org/pages/who_we_are.htm" target="_blank" data-saferedirecturl="https://www.google.com/url?hl=en&q=http://www.malariaconsortium.org/pages/who_we_are.htm&source=gmail&ust=1480609103751000&usg=AFQjCNG03VPF1XL5zli4__XAjDWpDmBOvw">Malaria Consortium</a> in Mozambique, told HuffPost. “But the symptoms, like blood in the urine, only develop later ― and then people tend to hide it because it’s in the genital area.”](https://s.yimg.com/ny/api/res/1.2/9f9As.sw0iNn_ENR93iBhA--/YXBwaWQ9aGlnaGxhbmRlcjt3PTk2MA--/https://img.huffingtonpost.com/asset/5845a09e1700002500e7dd42.jpg)
