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 ― Amos Kiptui is no stranger to hardship. He was born in a cave 27 years ago and still lives in one, despite run-ins with wild buffalo, deadly snakes, leopards and lions.
So when thick, itchy welts began to appear on Kiptui’s right cheek, he took a sharp rock and scraped off layers of his skin, then packed the bleeding wound with traditional medicine made from bitter leaves.
“You put the leaves on a piece of iron and make a fire,” he said, demonstrating with a small, battered metal sheet.
“You leave it to dry and crush it to powder,” he added. “Then you rub your wound with a stone until the blood starts oozing out and apply the powder.”
In the Utut Forest in Kenya’s Nakuru County, this treatment is believed to help heal a condition that people living here call “shetani,” meaning curse or devil.
As the disease gained ground on Kiptui’s face, he kept hacking away clumps of flesh and rubbing in the balm, hoping to exorcise the demon he believed to be behind the itchy sores.
Amos Kiptui, 27, sits in a cave in a remote part of Kenya where an outbreak of cutaneous leishmaniasis has plagued the local community. He is among those afflicted with the flesh-eating disease. (Photo: Zoe Flood)
Kiptui was actually the victim of a rare flesh-eating disease called cutaneous leishmaniasis, which is spread by blood-sucking sandflies living in rocky areas and caves. Without medical treatment, the injected parasites can keep growing and gnawing their way through the skin, causing insatiable itching, disfigurement and, often the greatest pain of all, social exclusion.
But for Kiptui and some 300 other people living in caves ― for lack of a better alternative ― in the heart of Kenya’s Rift Valley, even basic health care is hard to find.
Nestled in between huge swathes of private land reserved for wildlife and farming, these cave dwellers carve out a meager living by burning trees to make charcoal. It’s an hour’s trek to the nearest village ― through land teeming with dangerous predators. It’s hours more over rocky mountain passes to the nearest hospital in the small town of Gilgil.
“We live in terrible conditions here,” said Kiptui, standing outside an almost bare cave that he can only sit or lie in. “We don’t have water, and food is hard to come by.”
Kiptui has for some years suffered from the disease – which eats away at the top layers of skin. (Photo: Zoe Flood)
A localized outbreak of cutaneous leishmaniasis has spread here in recent years, though the disease is not commonly found in Kenya. Around the world, about a million new cases are reported annually, especially among people living in poor conditions whose immunity has been worn down by hunger and hardship.
For most people with cutaneous leishmaniasis, the only available treatment involves weeks of excruciating injections straight into the affected area, often on the face and always into the dermal layer where nerve endings cluster. The treatment is said to be 90 percent effective, but many patients do not stay the course.
“Some patients have been absconding especially due to the pain, whereas others abscond due to distance,” said David Kamau, the local disease surveillance coordinator for the Kenyan government.
Kiptui was thrilled to find out that his condition was medically curable, and that the treatment was free, after volunteer health worker Joseph Kariuki spotted him and his lesions on one of his regular treks through the bushland to visit this cave community.
“My major work is to create awareness of leishmaniasis,” said Kariuki, who works with the local government health ministry. “I stop people thinking it’s a form of HIV/AIDS, or some kind of demon.”
Community health worker Joseph Kariuki advises people who live in the Utut Forest to seek medical treatment, rather than use folk remedies for cutaneous leishmaniasis. (Photo: Zoe Flood)
But the pain Kiptui endured at the clinic was more than he could bear.
“I was injected the very first time and it was so painful, I literally ran away. I abandoned the treatment,” he said.
Kiptui went back to slicing away at his face with a sharp rock and filling the wound with hot ash.
Other people with the disease have used knives or machetes heated in a fire to sear off the lesions, and packed the wound with traditional cures that are ineffective and sometimes harmful.
“Some of the herbs they are using are highly poisonous,” said Kamau.
“They are seriously toxic and have even been causing complications” that make the disease harder to cure, he added.
Kamau’s team has recorded over 400 cases of cutaneous leishmaniasis in this rural corner of Kenya, but only half have sought the notoriously painful treatment.
Nearly 300 people live in and around a series of caves in this remote part of central Kenya. It's at least an hour's trek to the nearest village. The sandflies that transmit cutaneous leishmaniasis gather in rocky areas like this one. (Photo: Zoe Flood)
Children shy away from the injections, but “men especially have been absconding after a few injections because of the pain,” said Kamau.
The kids are less able to hide because a team of health workers holds weekly mobile clinics, including one at a school near the caves.
It’s traumatic enough watching children receiving injections straight into the nose or eye socket, as tears roll down their cheeks while health workers hold them still.
Headteacher Job Nganga, whose office sits opposite the room used for treatment, finds the piercing screams and sobbing haunting.
“If I’m a grownup and I’m not able to hold myself when an injection is being put into my own body, how about that small kid? I feel so bad,” he said.
Nganga sees children afflicted with the disease becoming so preoccupied with the belief that they are cursed that they fall behind in class.
“Mostly, we Africans, when we find that there’s something that’s disturbing us that has no solution, we rush into saying that it’s witchcraft,” he said.
Daisy Chepsang, 10, bears the lesions caused by cutaneous leishmaniasis, which has plagued her impoverished community in a remote part of Kenya where even basic healthcare is far away. (Photo: Zoe Flood)
In poor countries, health systems are overburdened and under-resourced. To help government health workers like Kamau and Kariuki fight cutaneous leishmaniasis, which persists in the most deprived pockets of Kenya and other developing countries, international charities like the Drugs for Neglected Diseases Initiative, or DNDi, are working to improving testing and treatment.
Cutaneous leishmaniasis is so neglected that the medicines administered were formulated for a disease called visceral leishmaniasis, or kala azar, which is also transmitted by sandflies but is very different and much deadlier.
“We have tried to reduce the pain by adding lidocaine, and by applying ice to the area before the things,” Kamau said. “But there is much more still to be done so that patients stick with the treatment.”
Florence Wambui, 15, endured 57 injections to her face over two months, because she wanted to get rid of the facial sores she found so ugly.
What started as a pimple got worse, despite the application of traditional herbs, until “the wounds were full of worms,” she said.
“I thank God that the wounds are healed,” Wambui said. I thought they would never go.”
Schoolgirl Florence Wambui endured nearly 60 agonizing injections to the face to stop the spread of the rare disease. (Photo: Zoe Flood)
The teenager now drags her terrified 8-year-old cousin out of class for treatment, and watches anxiously as he screams in pain.
Although the mobile clinics have solved some of the access issues for this disease, they are not bringing all of its sufferers out of the shadows.
“There are still people hiding in their homes because of the injections,” said Nganga, describing parents at the school whose lips have “peeled off” due to cutaneous leishmaniasis.
“It not something you want to see,” he said. “One of their ears was almost destroyed.”
A young schoolgirl holds an ice block to her face to numb areas that will be injected with the painful treatment for cutaneous leishmaniasis at a mobile clinic in rural Kenya. (Photo: Zoe Flood)
The county government has sprayed insecticide in some homes in affected areas to kill the sandflies. But the people living in caves or herding their livestock and farming around them have no respite from the swarms of sandflies.
The real hope for stopping the disease lies in finding a better cure ― ideally in the form of a topical cream or an affordable oral pill ― that sufferers in remote areas could take away and stick to. In the meantime, further reducing the number of injections needed, and the pain associated with them, would stop people like Kiptui from abandoning treatment.
“I still haven’t managed to heal the wound,” he said, toying with the sharp rocks he uses to gouge at his face.
“If I get another option, I’ll be happy,” he added, looking up, then swiftly turning his face away to hide his scarred cheek.
Kiptui will never forget the immense pain of the first time he was treated for the disease. (Photo: Zoe Flood)
DNDi is a recipient of grants from the Bill & Melinda Gates Foundation, which also funds HuffPost’s Project Zero series. All content in this series 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.
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.
Gottlieb's repeatedly courted controversy in his media role and will reportedly continue to host his nationally syndicated radio show while coaching Green Bay.
All five of these hitters were drafted highly in fantasy baseball leagues. So far, they have not lived up to their ADPs — and that's an understatement. Scott Pianowski analyzes.
In one scenario, Dallas makes Prescott the highest paid player in NFL history. In another, the Cowboys decline that commitment, at which point another team will make him the top paid player in NFL history.
Budgeting apps can help you keep track of your finances, stick to a spending plan and reach your money goals. These are the best budget-tracking apps available right now.
A year ago, Usyk would have been at least a 2-1 underdog in this fight. But with these little hints of Fury on the decline all while Usyk has continued his steady march toward heavyweight domination, those odds have shifted.
![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)
