In Ethiopia, the fight against mycetoma—a neglected tropical disease that poses significant health challenges—has gained momentum, thanks in part to the efforts of dedicated professionals like Wendemagegn Enbiale. As the Dermatovenerologist at Bahir Dar University, Wendemagegn brings over 20 years of experience in health and a deep understanding of public health issues to the forefront of this critical conversation.

Mycetoma, often referred to as “Madura foot,” primarily affects rural communities engaged in agriculture and livestock herding, leading to chronic deformities and severe socio-economic burdens. In this interview, Wendemagegn discusses the urgent need for increased awareness and better diagnostic facilities for mycetoma, highlighting the barriers faced by patients seeking treatment. He shares insights on the importance of community engagement and collaboration among healthcare providers, policymakers, and researchers to develop effective strategies for addressing this pressing public health issue.

Join us as we dig into Wendemagegn Enbiale’s perspectives on mycetoma, its impact on Ethiopian society, and the collective efforts required to improve healthcare access for those affected by this debilitating condition.

Capital: How common is mycetoma in Ethiopia?

Wendemagegn Enbiale: Mycetoma is a neglected tropical disease that affects many people, especially in poor and rural areas. It has serious health and financial impacts on individuals and their families. Unfortunately, we don’t have much information about how common this disease is in Ethiopia.

To understand the situation better, a national survey was conducted in 2022. Hospital records from 13 hospitals across Ethiopia were reviewed for cases of mycetoma and similar diseases from 2015 to 2022. The results showed that mycetoma exists in almost every region of Ethiopia, but it is most common in the northern regions like Tigray and Amhara. These two regions reported over two-thirds of the cases, even though they only make up about a quarter of the country’s population.

Compared to Sudan, where over 9,600 cases were reported in 30 years, Ethiopia recorded fewer cases—143 in five years. This might mean that many cases go unreported. To find out the true scale of the problem, studies in the community are urgently needed.

Capital: What does mycetoma look like in Ethiopian patients?

Wendemagegn Enbiale: Most Ethiopian patients with mycetoma first notice a wound that doesn’t heal and grows slowly over several years. The wound can cause swelling and start oozing discharge from several spots. The foot is the most common area affected, but the disease can also appear on the hands, back, or buttocks. It can damage the skin, deeper tissues, and even bones.

A key sign of mycetoma is pus that contains grains, which might be black, white, yellow, or red. Most of the people affected are farmers who work barefoot, exposing them to infections from soil.

Capital: How do financial and social factors affect the treatment of mycetoma?

Wendemagegn Enbiale: Mycetoma mostly affects people in their working years, such as farmers, daily laborers, and wood collectors. These people often don’t have shoes or gloves to protect themselves from injuries. When the fungus enters the skin through a cut or injury, the disease spreads slowly if it isn’t treated early.

Many patients cannot afford to see a doctor or don’t live near healthcare facilities. The disease isn’t usually painful, so people often delay seeking help. However, over time, it can cause severe swelling, chronic discharge, and deformities, making it hard for patients to work. On top of that, the stigma and social isolation caused by the disease can worsen their financial and mental health problems.

Capital: What treatment is available for mycetoma in Ethiopia?

Wendemagegn Enbiale: Treating mycetoma in Ethiopia is challenging for several reasons:

1. Limited access to diagnosis: Most dermatology services are located in cities or large regional hospitals, meaning patients have to travel long distances—sometimes hundreds of kilometers—to get a diagnosis. Even at these hospitals, specialized labs to confirm mycetoma are often unavailable.
2. Lack of treatment options: The best medicine for fungal mycetoma is itraconazole, but it’s hard to find in Ethiopia and is expensive. Surgery, which is sometimes necessary, is also rarely done due to a lack of trained specialists.
3. Ineffective practices: Many healthcare providers in Ethiopia use less effective medicines or don’t combine treatment with surgery. As a result, even patients who get medical care often don’t recover fully.

Capital: How do people’s beliefs and attitudes affect treatment?

Wendemagegn Enbiale: Mycetoma can be treated, especially if caught early. However, many people are not aware of the disease, so they don’t seek medical help in time. Instead, they try to treat their wounds with home remedies, which can make things worse.

It’s important for communities to understand that mycetoma does not heal on its own. Proper treatment, which can take up to a year, is essential. In severe cases, surgery may be needed to completely heal the affected area.

Capital: How can we raise awareness about mycetoma?

Wendemagegn Enbiale: Ethiopia’s Health Extension Program is a great way to educate people about mycetoma. Some effective strategies include:

• Teaching communities about the importance of wearing shoes and getting early treatment for wounds.
• Training health workers to recognize the signs of mycetoma and refer patients to specialists.
• Encouraging community involvement to reduce stigma and improve awareness of the disease.

Capital: What do we need to improve our understanding and treatment of mycetoma in Ethiopia?

Wendemagegn Enbiale: There are several gaps in our knowledge and healthcare system that need to be addressed:

1. Understanding the scale of the problem: We need to collect accurate data about how common mycetoma is in Ethiopia and where it’s most prevalent.
2. Improving diagnosis and treatment: Hospitals and clinics need better diagnostic tools, affordable medicines, and trained healthcare providers.
3. Developing guidelines: Ethiopia needs a clear national guide for diagnosing and treating mycetoma to ensure consistent care.
4. Using the primary healthcare system: By integrating mycetoma care into existing primary healthcare services, we can make diagnosis and treatment more accessible, especially in rural areas.

These steps will help us tackle mycetoma more effectively and improve the lives of those affected.