STADIUL ACTUAL AL CUNOAŞTERII

Vulnerabilitate şi aspecte sociale în elefantiazis

 Vulnerability and social aspects in elephantiasis

Roxana Mihaela Barbu, Maria Cristina Gavrilescu, Carmen Daniela Ababei, Răducu Ionuţ Popescu, Bogdan A. Stana

First published: 27 noiembrie 2018

Editorial Group: MEDICHUB MEDIA

DOI: 10.26416/Pedi.51.3.2018.2073

Abstract

The lymphatic filariasis (elephantiasis) is a parasitic patho­logy, having as a cause the infection with Wuchereria bancrofti, Brugia malayi and Brugia timori worms, with extremely deforming effects upon the human body, affecting both the lymphatic and tisular components of the organism, with predominance in the genital and the lower limbs areas, developing hydrocel, adenolymphangitis and lymphedema. The important negative effects are felt on both the human psychic and the human body, with the development of specific disabilities. The fact that the majority of people affected are mainly from underdeveloped countries, such as those from Africa and Asia, with real endemic areas, where psychotherapy, indicated in these situations, cannot be accesible easily or sometimes does not even exist, represents a real issue. In the case of certain little possibilities to realise this, the psychotherapist will have to confront challenges like frailty, vulnerability and discrimination of these persons within family and society, especially in the case of archaic society (villages from Africa, Asia or India). Nevertheless, its presence is still available for modern societies (modern ones from Europe and USA), where such cases have been reported, triggering a high level of awareness regarding these patients, who develop most often depressive, anxious and social isolation episodes. 

Keywords
elephantiasis, lymphatic filariasis, Brugia malayi, Wuchereria bancrofti

Rezumat

Filariasisul limfatic (elefantiazis) este o patologie para­zi­ta­ră având drept cauză infecţia cu Wuchereria bancrofti, Brugia malayi şi Brugia timori, cu efecte extrem de de­for­man­te asupra corpului uman, care afectează atât com­po­nen­tele limfatice şi tisulare ale organismului, predominând în organele genitale şi membrele inferioare, dezvoltând hidrocel, adenolimfangită şi limfedem. Efectele negative importante sunt resimţite atât la nivel fizic, cât şi psihic, cu dezvoltarea unor handicapuri specifice. Faptul că ma­jo­ri­tatea persoanelor afectate sunt în principal din ţări sub­dez­voltate din Africa sau Asia, cu zone endemice, unde psihoterapia, indicată în aceste situaţii, nu poate fi ac­ce­sată cu uşurinţă sau, uneori, nici măcar nu există, re­pre­zintă o problemă reală. În cazul unor posibilităţi re­du­se de a realiza acest lucru, psihoterapeutul se va con­frunta cu provocări precum fragilitatea, vulnerabilitatea şi discriminarea acestor persoane în cadrul familiei şi al societăţii, în special în cazul societăţilor arhaice (sate din Africa, Asia sau India). Cu toate acestea, psihoterapia este dis­po­nibilă pentru societăţile moderne din Europa şi Statele Unite ale Americii, unde au fost raportate astfel de cazuri, de­ter­minând un grad ridicat de conştientizare faţă de aceşti pa­cienţi, care dezvoltă cel mai adesea episoade de depresie, an­xietate şi izolare socială.

Introduction

Discrimination in ethics exists from ancient times, aspect revealed by writings and depictions of Ancient Egipt, Ancient Greece, Ancient Rome, followed by medieval times, Christianity years, Renaissance, to present times. With reference to discrimination or non-discrimination regarding corporal deformity, the limphatic philariasis was considered in Ancient Egypt a positive factor, having as symbolistics the divine elevation, with the existence of cultural acceptance. The Ancient Greeks had an opposite view on the matter and, later, Ancient Rome followed its model, having as reason artistic and cultural issues due to which physical deformities were not accepted. Being seen as a punishment from the Gods (perception that also continued during Christianity years), in Sparta parents had to get rid of their deformed children. During Renaissance, several ethical questions regarding deformity were raised in the religious literature of those times. In present times, mass-media, through commercials, magazines, shows and movies, brings again a discriminative perspective to corporal deformity(1).

The development of infection

The lymphatic filariasis (elephantiasis) is a parasitic pathology having as cause the infection with Wuchereria bancrofti, Brugia malayi and Brugia timori worms, with extremely deforming effects upon the human body, affecting both the lymphatic and tisular components of the organism, with predominance in the genital and the lower limbs areas, developing hydrocel, adenolymphangitis and lymphedema. The hydrocel appearing at a scrotal level, determines lymphatic fluid accumulation in excessive amount, within the testicular bags, determining their distruction gradually; adenolymphangitis reffers to the inflamation of the lymphatic vessels, becoming palpable at the level of the lower limbs, and lymphedema means the accumulation of excessive lymph in diverse tissues, causing deformities of most parts of the body(2,3). Therefore, important negative effects are felt on both the human psychic and the human body, with the development of specific disabilities(3,4). Elephantiasis can also affect the entire leg, arm or breast, making these look three times larger than normal and full of lymphatic fluid, in the last two cases being mainly the situation of women(2,3,5).

Social and ethical aspects

Important negative effects are felt on both the human psychic and the human body, with the development of specific disabilities. The fact that the majority of people affected are mainly from underdeveloped countries, such as those from Africa and Asia, with real endemic areas, where psychotherapy, indicated in these situations, cannot be accesible easily or sometimes does not even exist, represents a real issue. In the case of certain little possibilities to realise this, the psychotherapist will have to confront challenges like frailty, vulnerability and discrimination of these persons within family and society, especially in the case of archaic society (villages from Africa, Asia or India). Nevertheless, its presence is still available for modern societies (modern ones from Europe and USA), where such cases have been reported, triggering a high level of awareness regarding these patients, who develop most often depressive, anxious and social isolation episodes(3,4,5).

Not only dangerous for the individual, but also for the society itself, these physical and psychological states are the ulterior manifestations that these patients could experience, a compensation becoming nocive for the other members of the community, in most cases. On the other hand, the medical institutions and the society have the duty to assure these people the optimal treatment schemes for physical diformities, such as albendazole combined with ivermectin or albendazole in combination with diethilcarbamazine, with the purpose of reintegration of the patient suffering from this pathology within colectivity and preventing the ulterior possible sources of infection(2,3,4).

As an example, in central-east Africa, but also in Asia, India and South America, there were several cases of patients infected at an early age, not being able as adults to find a workplace and to earn a living. There were also reported some cases thought to be of elephantiasis in people who were still working the land and doing their daily life activities. However, what mainly affects them from a psychological point of view is their own perception about themselves, being disfigured, as stated by a person from Tanzania complaining about this issue, his case being mentioned within the elephantiasis eradication programme brochure. Seen as a neglected disease for years, GlaxoSmithKline company addressing to endemic areas, created in 1998 an eradication programme that would eradicate the disease by 2020, mainly by administrating the right doses of albendazole, twice a year, for five years, to the entire endemic population, including children in schools, from an early age. These doses would mean 600 million albendazole tablets(6).

The economic component

Reported not only in these oriental countries, but also in Europe and the USA, the elephantiasis operation is also very expensive, being performed several times, in particular situations. The scrotal elephantiasis operation raises to 100,000$ in the USA and aproximately 22,000$ in Taiwan, where another operation of this sort was performed in the case of legs elephantiasis. Generally, patients with such deformities don’t have enough money to pay for these life-saving interventions that could also reintegrate them within society, with the development of a greater frustration, involving also the socio-economic component.

Psychological vulnerability in elephantiasis

The main psychological issues involved consist in depression, anxiety and very low self-esteem, in correlation with social stigma that includes sexual disfunction and social isolation, regarding both sexes, happening mainly in the oriental countries aforementioned, where people suffer from lack of education regarding these diseases, as there are some cases in the USA that could be able to adapt their lives, get married, have children and continue working. But the operation and its costs are still very much the most important issues.

The main purpose of the indicated psychotherapies is, therefore, in these situations, to determine the patient to start reappreciate himself/herself within a different context and to try to manage frustrations, and learn each time at psychotherapy sessions new coping techniques. There is the possibility of individual or group therapy, with the family and the close ones. The levels of anxiety should first be tested through certain anxiety state questionnaires (e.g., Liebowitz social anxiety scale), followed by certain psychotherapeutic methods of diminishing it, like behavioral and cognitive therapies, in correlation with specific medicines like antidepressants or tranquilizers. The social anxiety, shame, inadequacy, general anxiety and depression is in interference with low self-esteem, issues which the experienced psychotherapist could try to solve, listening to what the patient has to say, making the person discuss more about his/her affection and emotions, trying to develop a better perspective upon the psychological problem(7).  

Conflict of interests: The authors declare no conflict of interests.

Bibliografie

  1. Sullivan R. Deformity-a modern western prejudice with ancient origins, Proc. R. Coll Physicians Edinb. 2001; 31:262-266.
  2. Luca M. Medical Parasitology and Mycology, “Gr. T Popa” Publishing House, Iaşi, 2005.
  3. Elephantiasis, WebMed. Retrieved from http://www.webmd.com/a-to-z-guides/elephantiasis.
  4. Lymphatic filariasis, Fact sheet No. 102, Updated March 2014, World Health Organisation (WHO) Media Centre.
  5. Dan Heeren’s Elephantiasis Page. Retrieved from http://www.bio.davidson.edu/courses/immunology/students/spring2006/heeren/eleph.html;
  6. The fight against lymphatic philariasis, Neglected Tropical Diseases, GlaxoSmithKlein, Factsheet 1: November 2012, v. 1.
  7. Psychotherapy to treat depression, WebMD Medical Reference. Retrieved from http://www.webmd.com/depression/psychotherapy-treat-depression.