Eliminating Lymphatic Filariasis in Sierra Leone and Dispelling Rumors of Witchcraft: The Story of Mama Rukoh
People suffering from bigfut in Kagbo village a community once plagued by bigfut, now experiencing fewer cases of the disease.
People suffering from bigfut in Kagbo village a community once plagued by bigfut, now experiencing fewer cases of the disease. Photo credit: Act | West/Helen Keller Intl

In Sierra Leone, certain neglected tropical diseases (NTDs) have long been associated with witchcraft and other forms of malevolence attributed to those affected by the diseases. 

This is particularly true for lymphatic filariasis, locally known as "bigfut", one of the four NTDs that the country is endemic to. The other three include Onchocerciasis (Oncho), also known as river blindness, schistosomiasis (SCH) locally called mansoni, and Soil-transmitted helminths (STH) termed worrum in the local language.

Mama Rukoh Kanu is a courageous 60-year-old vegetable grower, mother of six, and grandmother of seven, who resides in Binkolo, one of the last remaining strongholds of lymphatic filariasis in the northern provinces of Sierra Leone. Born into a family of peasant farmers, she and her parents never had the opportunity for formal education. As a result, she grew up as a farmer and petty trader, with great potential. She eventually got married and lived happily with her husband, with whom she had six children.

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Mama Rukoh poses for a photo just outside her home in Binkolo town. Photo credit: Act | West/Helen Keller Intl

Mama Rukoh's life took a dramatic turn when she was accused of practicing witchcraft due to her illness. Abandoned by her husband and left to care for her six children, she faced taunting and eventual banishment from her village. Her only "crime" was being afflicted with bigfut, a condition that was widely misunderstood.

Living in various villages that shared the same stigma, Mama Rukoh finally received validation when a doctor diagnosed her with lymphatic filariasis, manifested as elephantiasis—overtly large limbs. Since her diagnosis, she has been receiving ivermectin coupled with albendazole —the medications prescribed for controlling lymphatic filariasis among other NTDs, from Musa Tarawalli, one of the 30,000 well-trained community drug distributors in the country. In addition to the medication, Mama Rukoh has been educated on managing her swollen foot in order to avoid further complications. 

"I now live a normal life… I tend to my backyard garden, cook, handle most household chores, things I could not do for a long while”, said Mama Rukoh as she expressed satisfaction since she began receiving her free doses of ivermectin and albendazole. She has hope not only for herself, but for future generations.

Almost a decade ago, neglected tropical diseases affected all 16 health districts in Sierra Leone, putting over 9.5 million people

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Today Mama Rukoh lives happily with her younger children and her grandchildren with the hopes of all of them completing school and reaching their true potential. Photo credit: Act | West/Helen Keller Intl

at risk of developing at least one NTD. These diseases disproportionately affect the poor and vulnerable, particularly women and children. However, as of 2022, with support of USAID’s Act to End NTDs | West program, 9 million people are no longer at risk for bigfut, as 15 out of the 16 districts have achieved the criteria for discontinuing Mass Drug Administration (MDA).  

Three out of four hotspot districts with persistent cases of bigfut have met the criteria to stop MDA. This signifies a significant reduction in the prevalence of lymphatic filariasis, thanks to enhanced community engagement and the effectiveness of MDAs. 

Today the country's NTD program is on the right path to eliminating a once-endemic disease. All these is possible with the support, among other partners of the United States Agency for International Development’s (USAID) Act to End NTDs | West Program led by FHI 360 in partnership with Helen Keller Intl.