Wednesday, 17 February 2016

Kaote: A community that poisoned itself to avoid starvation

Konzo victims.



AFTER a jolting drive down a winding sandy road, with tree branches whipping against our 4x4 vehicle, we finally arrive at Kaote village, about 60 kilometres south-east of Mongu, Western Province.

Soon we are surrounded by poverty-stricken faces of men, women and children, who emerge from behind mud-and-straw houses. The scene gets even gloomier with the appearance of a small boy in a wheelchair, his feet hanging listless. Across the drab homestead, a young woman hobbles towards us, her body supported by crutches. Another boy follows in similar fashion.

These are the victims of konzo, a paralysing condition caused by cyanide poisoning. Cyanide occurs naturally in cassava, and a monotonous diet of inadequately processed cassava damages the nervous system, causing permanent paralysis.

For generations, cassava has been the staple food for people in this region, which has poor soils to support other crops such as maize.

And the method for processing the cassava has been handed down through generations.

The women usually soaked cassava tubers for seven days in water before processing it into flour.

But for the past three years, this region has been hit by drought, causing critical food shortage.

And as times got desperate, especially in the lean months around August, mothers discarded the age-old method of preparing the cassava and resorted to quicker ways, usually soaking the tubers for about three days. Unbeknown to the women, they were poisoning their own families.


Kaote village was one of the first places to record a case of the disease in 2013, although doctors then had no idea what they were dealing with.

"Our first suspicion was polio, but the symptoms were different," says Dr Francis Liywalii, who is the district community medical officer for Mongu.

But polio has long been eradicated in Zambia, and unlike the viral infection, which causes placid paralysis, the new disease caused spastic or rigid paralysis in its victims.

It took about two years before doctors established the cause of paralysis among the villagers of Kaote, mostly relying on literature about konzo outbreaks in the Democratic Republic of Congo (DRC) and Mozambique.

Munalula Mate, a 31-year-old mother of four, was one of the first victims identified in 2013. She was returning from a local clinic when she suddenly felt numbness in her hip and leg joints. She struggled to walk home, half-dragging her right foot.

Within a week, she could not walk unaided. Her son and nephew had also exhibited the same symptoms but they could not get any help from the hospital. All the three are now crippled.

According to Munalula, before the disease set in, her family’s diet consisted chiefly of cassava. For lunch and dinner, boiled cassava leaves or shombo would be added to the meal.

But what really caused the konzo outbreak could lie in a new variety of cassava introduced in the area.

The new high-yielding and early maturing variety called litale was meant to boost food security for the villagers ravaged by drought. But litale is a bitter variety, and research has shown that the bitterness in the cassava is due to the concentration of cyanide; hence, the more bitter, the more poisonous.


By August 2015, when the disease was identified, the number of victims had risen to about 80.

According to Timothy Masuka, who is the district health surveillance officer, there are currently over 100 known cases of konzo in the area, although the number could be higher, as many of the cases are never reported.

In fact, of the 100-plus cases, only four were reported to a local clinic, the rest were discovered by health teams during surveillance.

"Utilisation of health services is quite low," says Dr Liywalii, who also suspects there could be more unreported cases in the villages.

"Most of the cases occur between July and October when there is absolutely no other food within the communities," says Dr Liywalii.

There have also been reported cases of konzo in other districts of Western Province, but not at the scale of Lwatembo area and its adjacent communities such as Nasenge and Nalikwanda.


Konzo is largely a disease of poverty, and in countries where the disease has been reported before, such as Mozambique and the DRC, the underlying factor has been prolonged drought, even civil war, resulting in famine.

Realising this, Government has been distributing food aid and money through a social welfare scheme to konzo victims since August last year. Other households are also receiving relief food to alleviate hunger and keep them off an exclusive cassava diet.

According to Mongu district commissioner Susiku Kamona, there are currently 26,000 households in need of food aid in Mongu.

But some of the villagers I met say there has been little change in their diet.

Although now the villagers supplement their diet with mushroom, which is in season and in abundance, as well as some fresh produce from their small farms, they are not sure what will happen once these run out.

According to Dr Liywalii, keeping people on a high protein diet can help stop the effect of the cyanide.

"If you have people eating fish in a location, even if they eat this cassava which is not well processed, you will not find konzo," he says.

Research has shown that amino acid from protein has a neutralising effect on the cyanide in the body.

Unlike other parts of Western Province that have access to rivers and fish, there is no fish to talk about in Lwatembo, which only has vast plains. And during the dry season, water becomes a challenge for the villagers.

And to help the villagers diversify their crop, Government last year distributed maize seed and fertilisers to konzo victims, but this is not a maize growing area.

There are also efforts to educate the villagers on how to process the cassava to remove the cyanide. Dr Liywalii says sensitisation efforts are bearing fruit.

"You just need to take one look at a konzo victim to realise that you need to change," he says.


Apart from the physical effect it has on its victims, konzo has also brought about a lot of stereotyping of women. A number of them have been divorced.

"That boy you saw in a wheelchair, his mother was divorced because of konzo," Mr Masuka tells me.

The disease does not affect men and women beyond menopause. The reason for this selectiveness is still a mystery.

Dr Liywalii thinks it could have something to do with the hormones testosterone and estrogen in adult males and women of child-bearing age, respectively.

And so far there is no evidence of the poison affecting unborn children, as most women affected by the disease, including Munalula, have delivered babies with no physical deformities.

The youngest victim ever documented was about two years old and had just been weaned off her mother’s breast. That is the boy I saw in a wheelchair. He is now four.

According to Dr Liywalii, no case so far has involved the arms and the disease is not known to be degenerative. The doctor, however, fears that if victims revert to a mono diet of cassava, they could suffer a second bout of the disease, leading to blindness and deafness.

It is midday and a group of eight boys walk playfully to Lwatembo Primary School each carrying a plate, as the school runs a feeding programme. But even in this small group of youngsters, konzo has its victims. Two of the boys walk with a slight limp.

Silishebo Silishebo, 12, and Simaata Katwende, eight, are the latest konzo victims, diagnosed in January.

Two pupils have already dropped out of school as a result of the disease, according to Mubita Katungu, head teacher at Lwatembo Primary School. Another victim seldom attends class as he lives three kilometres away and has difficulty walking.

The future of Silishebo and Simaata now lies in the hope that their diet will be free of cyanide.

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