Hydrocele: How Kilifi's free surgeries are lifting stigma

Kilifi County, in partnership with AMREF Health Kenya, has made major progress in treating and eliminating hydrocele and elephantiasis.

More than 300 patients, from children to the elderly, have undergone corrective surgery since the programme began four years ago, with Magarini Sub-County reporting the highest number of cases.

Hydrocele, also known as lymphatic filariasis, is one of the Neglected Tropical Diseases (NTD) spread by mosquitoes and causes fluid to accumulate in the male reproductive organs. Elephantiasis, which affects both males and females, is also caused by lymphatic filariasis and leads to severe swelling in the legs, hands, groin and for men, the scrotum.

Mohamed Kahindi from the Chakama area, one of the patients who underwent surgery, said the condition had greatly affected his productivity, leaving his wife to provide for the family.

“This problem has caused me a lot of discomfort. I have struggled both at home and at work and even my marital life has been affected because of the pain,” he said.

He explained that he had sought help from several government health facilities in Kilifi County before being referred to Marafa Sub-County Hospital, where the surgery is offered free of charge.

“I went to hospitals in Malindi and Kilifi and they finally referred me here. I’m relieved that the swelling will be removed. At some point, the pain and the stigma were so overwhelming that I even thought of cutting the lump off myself,” he added.

At Sosoni village, the county government in partnership with AMREF Health Kenya, has engaged Community Health Promoters (CHPs) to conduct door-to-door sensitisation. Their efforts have encouraged elderly men and women to come forward and seek medical care.

Surgical camps

It is estimated that at least two in every ten men in the affected villages live with lymphatic filariasis. This has prompted the county and its partners to organise regular surgical camps to support patients, many of whom still believe the condition is linked to witchcraft.

The health teams carry out mapping, screening and treatment with at least 200 patients having undergone reconstructive surgery at Marafa Sub-County hospital. They have also been distributing mosquito nets, along with both preventive and curative medication, to residents in the area.

“There are many things people didn’t understand about this condition, and that is why they used to hide,” said Beatrice Katheka, a CHP in Sosoni village. Now they have more information and are coming out to seek medical care. Our role is to educate them and refer them to health facilities.”

She added that many villagers once believed the condition was a curse or a result of witchcraft, causing people to suffer quietly.

“We now explain to them that it is spread by mosquitoes, not witchcraft or curses and the stigma is lifting. Many used to cover the affected areas with shukas,” she added.

According to Magarini Ministry of Health (MoH) officer Walter Kagohu, the programme began after it became clear that many residents were suffering in silence because of these beliefs.

“The overall cost was too high for the patients. They had to raise about Sh15,000 for surgery and still find money for transport and accommodation in far-off facilities. Stigma was also a major barrier,” said Kagohu. He explained that while the standard surgical fee is Sh15,000, AMREF Health Kenya contributes Sh10,000 and the Kilifi county government covers the balance, ensuring that no patient pays for treatment under the programme.

“Since the programme began, we have operated on more than 300 patients, including children. The numbers were dropping thanks to the intervention. In the first round, surgeons handled 149 patients and now only 49 patients are awaiting surgery,” he added.

Stagnant water

Kilifi County and Referral Hospital Medical Superintendent Gilbert Angore said that children affected by the condition from across the county are referred to the facility while adults are treated at Magarini Sub-County hospital.

According to Peter Mwarogo, the County Executive Committee Member for Health, the county has also been distributing mosquito nets and providing both preventive and curative medications alongside surgeries for affected residents.

“We have been distributing mosquito nets to prevent the spread of the disease. Our survey showed that parts of Magarini and Jaribuni are heavily affected due to stagnant water that provides the breeding grounds for mosquitoes,” he said.

Kilifi Deputy Governor Flora Chibule urged residents to encourage their relatives to come forward for screening, noting that lymphatic filariasis is treatable and should not be linked to witchcraft.

“We are prioritising prevention over cure, and we will continue educating communities to use mosquito nets and medication. People should not hide under claims of witchcraft,” she said.

An infected person may first experience itching at the site where the mosquito deposited parasites. These parasites damage the lymphatic system and over time the resulting blockage causes swelling.

After the initial itching, the skin becomes rough and gradually hardens as fluid builds up due to blocked lymph nodes. The affected body part continues to enlarge over time.

The condition commonly affects the legs, hands and groin area. In women, it mainly affects the hands and legs, while in men it can affect the legs and the scrotum.

Residents have been receiving both preventive and curative services, including treated mosquito nets provided by the county and national governments as well as anti-parasitic medicines such as albendazole, ivermectin and diethylcarbamazine, which are given to individuals aged two years and above.