September 19, 2012

Medicine alumnus solves major diseases in Ethiopia with simple methods

Loma Linda University School of Medicine alumnus Larry Thomas, M.D. (class of 1974), approached a woman in Western Ethiopia. She thought he simply wanted to take her photo and kindly obliged.

Dr. Thomas took some general shots, and then moved in closer, focusing on her feet. Both feet were severely swollen and disfigured from a disease known as podo (short for podoconiosis). They were barely recognizable as feet, aside from their anatomical location. He crouched for a better look.

More than three dozen photos later, Dr. Thomas stood to his feet. He wasn't sure exactly what to tell the woman, who had a quizzical expression on her face.

She had clearly concluded that he wanted more than just a tourist's snapshot of an Ethiopian woman in her natural environment.

"What should I tell her?" he remembered wondering. "Should I simply thank her and go on my way?" It was an awkward moment that motivated Dr. Thomas to seriously research this disease that affects four million people in Africa--one million of whom live in Ethiopia.

This awkward moment led to an epiphany for Dr. Thomas. "I realized that I wanted to do something about podo," he said. "I wasn't sure exactly what it would be, but there had to be something I could do to help."

He also noticed another disturbing situation during his travels to the country. "Ethiopia has among the highest incidence of blindness per capita in the world," Dr. Thomas said. "Of those cases, it's estimated that 80 percent are treatable or preventable. Of those treatable, preventable cases, 60 percent are the result of cataracts."

But that isn't the entire tragedy. "When an adult becomes blind in Ethiopia, a family member is typically assigned to stay with the blind person during every waking hour, leading him or her by the hand," he said.

"In almost every situation I saw, the one leading the blind person was a child," Dr. Thomas said. "From the family's point of view, it makes total sense, since a child is the least useful in the sometimes desperate effort to find food during the day to feed the family."

Dr. Thomas was most bothered by the thought of the childhood that child wasn't experiencing. "The child--most often a young girl--cannot go to school, or even play with friends," he said.

This point became especially clear one day as he watched a group of laughing children run by a young girl leading her blind and elderly grandfather. She shot a momentary wistful glance at the children, quickly returning to her expressionless and hopeless gaze.

"Blindness affects an entire family, pushing them even further into poverty," Dr. Thomas said. "At that moment, I resolved to do something about this tragedy."

Dr. Thomas, who is an emergency medicine physician, has done something about it. In 2006, he founded and currently directs the Tropical Health Alliance Foundation, an organization that is not your typical medical mission outreach organization.

The criteria for considering projects to fund can be summed up best by the acronyms SPUD--simple, practical, understandable, doable--and the LPI index--lives positively impacted.

In addition to addressing the conditions of podo and bilateral cataracts, the foundation sponsors projects to treat obstetrical fistulas and uterine prolapses, protect springs in African villages, and send dental students on mission trips.

"We look for widespread public health situations in Africa that are preventable and simple to solve," he said. "Our foundation seeks to impact the largest number of people possible with the funding we provide. We focus on the beneficiary, rather than the benefactor."

Podo is a perfect example. A form of elephantiasis--but not caused by a parasite or infection--the condition results from walking barefoot on the clay soil at higher elevations in Western Ethiopia.

"Podo is not an infection," Dr. Thomas said. "It is actually caused by a fiber found in the clay soil that penetrates the skin and makes its way into the lymphatic system, causing severe inflammation, scarring, and blockage of the lymphatic channels."

It is a condition closely related to poverty, since the poorest are often more interested in their next meal than in shoes.

"The obvious answer is to provide shoes," Dr. Thomas said. "However, it's not that simple. Without education, the shoes will most likely be sold to buy food."

Though incurable, podo is treatable. Ceasing barefoot contact with the clay, improving hygiene, and pressure treatments at night can reverse the condition.

"Many individuals with podo believe that it is a communicable disease, or is caused by an evil presence, walking on coffee grounds, or even stepping in frog urine," he said. "Those afflicted with the condition often withdraw from society, much like the lepers in Bible times."

Dr. Thomas credits Dr. Gail Davey at the Brighton & Sussex Medical School, in England, with raising awareness of podo.

"Less than a decade ago, podo wasn't even included in the World Health Organization's (WHO's) list of neglected tropical diseases--or NTDs," he said. "Thanks to Dr. Davey's efforts, podo is now on WHO's radar."

To combat the problem of bilateral cataract blindness in Ethiopia, Dr. Thomas has enlisted the help of James Guzek, M.D., an ophthalmologist from the northwestern United States. Dr. Guzek has already made four trips to Ethiopia.

Dr. Thomas' foundation collaborates with the Daughters of Charity, an order of Catholic sisters, founded in France in the 17th century, dedicated to working with the "poorest of the poor." On the team's first trip to Ethiopia to perform cataract surgeries, word spread quickly through the villages and the government was needed to control the crowds.

Dr. Guzek was so dedicated to performing cataract surgery that he barely took off time to sleep--let alone tour the countryside. "Every half hour I sleep or do something else means that I leave someone blind," he told Dr. Thomas.

During their mission trips, the team selects only those patients with bilateral cataract blindness, repairing one eye to maximize the numbers helped.

More recently, the clinic hired a full-time Ethiopian ophthalmologist, with funding from the Tropical Health Alliance Foundation.

"I'm most excited about our ability to hire a full-time ophthalmologist," Dr. Thomas said. "It's nice for teams to travel on medical mission trips, but our impact on the blind population will be greatly multiplied with a full-time Ethiopian ophthalmologist on staff."

In addition, the foundation is sponsoring the training of a nurse ophthalmic surgeon who will also be able to perform cataract surgery in the near future. "Our goal is to restore one good eye to 20,000 patients with bilateral blindness."

Dr. Thomas recalls an elderly blind gentleman and his dedicated granddaughter that he met during his most recent trip to Ethiopia. She patiently led her grandfather to the clinic and waited with him most of the day for his turn to be evaluated. The next day, they returned to find out that he was a candidate for surgery.

The procedure was performed, the bandages applied, and she once again led him home. The following day, they were at the clinic for removal of the bandages. At first, the grandfather saw a bright light; then he saw his granddaughter for the first time.

The next day, she was free to return to school and play with her friends. "Her smile returned," Dr. Thomas said. "That's why I do this."

For more information about the Tropical Health Alliance Foundation and its outreach, visit www.thaf.org.

This story was originally published in the Aug. 31 edition of Today.

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