LEOGANE, Haiti — The clinic at St. Croix Hospital is clean and tiled and brightly lit, but the spirits of voodoo have not entirely loosed their hold on the elephantiasis patients who go there for treatment.
Many of them still believe that magical powder sprinkled in their path caused the disfiguring disease that made their legs permanently swollen. Most sought treatment first from voodoo priests and traditional healers — and too late from physicians.
As Haiti carries out a decade-long effort to eliminate lymphatic filariasis, the mosquito-borne infection that causes elephantiasis, the old view is finally losing some of its power. Patients are now willing to consider a medical cause alongside a magical one.
“It is not easy to differentiate the natural causes from the fetish causes,” said a man attending a support group at the hospital. “But it is possible. You need to consult both medical doctors and witch doctors.”
Luccene Desir, a 35-year-old Haitian physician who has treated elephantiasis here for more than a decade, has seen a change in people’s thinking.
“If they see someone in the market with a large leg, people may say, ‘You need to go to the hospital,’ ” Desir said.
Some voodoo priests, he added, sometimes give that advice as well.
Leogane is a commune — roughly a county — of 150,000 people west of Haiti’s capital, Port-au-Prince. Sugar cane is grown here, as, in the past, was rice. Both are associated with a high prevalence of lymphatic filariasis. By one measure of infection, about half of Leogane’s people were carrying the parasite in the late 1990s.
If the country succeeds in eliminating the disease through mass drug distribution, the achievement will come too late for the St. Croix patients. They enter the hospital through a side door that is labeled “big foot,” the condition’s local name. Just inside is a tiled area with benches and four spigots where patients can scrub their legs.
The organism that causes the disease, Wuchereria bancrofti, can block veinlike vessels called lymphatics. Lymphatic fluid that is usually delivered back to the bloodstream leaks into tissue. Binding the limb can squeeze some of it out, but only temporarily.
Treated in its early stages, the swelling of elephantiasis can often be reversed. Once it has become extreme, it can’t be. Further enlargement — and painful, feverish exacerbations — can be prevented by keeping the leg clean and elevated.
Desir and a staff of 15 people do clinical care and research on lymphatic filariasis. Their salaries are paid by a charitable foundation affiliated with the drug company Abbott Laboratories. One of their activities is a monthly support group called “Hope Club” where patients talk, sing and pray. Desir invited some of its members in to talk to visitors.
Nearly all were women; they ranged in age from 30 to 88. The younger ones were in pants, the older ones in dresses. Some sat with a leg up on small stools the clinic has in abundance.
Mimose Louissaint, a 56-year-old woman with pigtails, said she believes her case came from two abscesses she got escaping a burning factory where she worked as a teenager. But she is not willing to rule out a voodoo cause for some of the other patients’ afflictions.
“You could simply be in trouble with someone, and they might have an evil powder,” she said.
Eline Antoine, 30, pulled up the left cuff of her jeans. Her leg was the worst in the group. It was covered with thickened skin, dry and deeply fissured.
“The reason it has gotten that bad is because I believed it was a fetish,” she said, meaning sorcery.
She now wishes she had not put so much confidence in herbal healers.
Marie Muracile Joseph, a thin 36-year-old with a mild case, said that in cases of sorcery the condition proceeds quickly and that “it may produce multiple toes.” She was referring to wartlike excrescences that can form on the front of the foot in severe cases.
With Haitians now willing to consider infectious causes of the disease, the stigma associated with elephantiasis has lessened a bit.
Elizabeth Ajax, 45, was fired from her teaching position more than 20 years ago.
“Back then I was put out of society,” she said. “It is less humiliating now.”
Poline Guerrier, also 45 and wearing a large straw hat, said she was still embarrassed to walk on the street.
“Everybody’s eyes are on you,” she said. “They call you ‘yam leg.’ ”
Desir explains to his patients that their disease is caused by a parasite with a complex life cycle and an insect vector. He does not belabor this. However, he is not beyond making a point.
A few years ago a voodoo priest came in for treatment. Desir said he asked him why he did not just treat himself:
“He said, ‘No, I cannot. I have to see a doctor.’ So I asked, ‘Why do you receive those that come to you?’ ”
The doctor laughed ruefully as he recalled the priest’s response: “He said, ‘I have to make money!’ ”