Hispaniola Makes Strides Against Disfiguring Disease

It was many years ago, but Mercedes Sola remembers when her illness came on. She was 30 years old and pregnant with her third daughter.

“I was sleeping, and I woke up at about 3 in the morning saying, ‘Mom, I have a high fever, I feel bad.’ I thought I was in labor,” said Sola, who lives in Barahona, Dominican Republic. “I didn’t know what it was.”

She was not in labor. Eventually Sola learned she was experiencing an acute episode of lymphatic filariasis (LF), a parasitic tropical disease that impairs the body’s lymphatic system. The lymphatic system normally drains fluid from the body’s tissues, but LF causes fluid to accumulate in limbs — most frequently the legs — which can swell to painful, enormous proportions, leaving patients permanently disfigured. The Dominican Republic and Haiti, which together comprise the island of Hispaniola, bear 95% of the lymphatic filariasis burden in the Americas.

The Carter Center’s Hispaniola Initiative works with both countries to eliminate LF transmission and malaria from the island. The Carter Center assists with health education and mass administration of the drugs albendazole and DEC in endemic areas. These drugs kill the transmissible form of the parasite, thus preventing transmission to other people, but the drugs have limited ability to reverse the effects for those already infected.

The disease is painful in many ways, said Sola, whose legs are severely swollen.

“It has affected me financially,” she related.

“And I feel like I’m not the same. I’m embarrassed when I go out and notice people looking at me. It’s not easy for me or my family. I have been ruined by this disease. It brings sadness in the house.”

Sola’s husband, Miguel Antonio Pineda, helps her in important ways, gently washing her legs to prevent secondary infections and applying moisturizing cream daily to keep the skin supple.

“I think you’re very cute,” he told her.

Sola also benefits from the support of other lymphatic filariasis patients who meet regularly in a Carter Center-sponsored support group, a practice that was originally developed for LF patients in neighboring Haiti.

“I feel good about the support they give me,” Sola said. “These are people who have suffered as I have suffered. They treat me well.”

Sola and her peers may be among the last people in the Dominican Republic to endure lymphatic filariasis. Assisted by The Carter Center, the country’s Center for the Control of Vector-borne and Zoonotic Diseases recently conducted a transmission survey and found no evidence of the parasite that causes LF, paving the way for them to present documentation so that the World Health Organization can officially declare that the Dominican Republic has eliminated lymphatic filariasis as a public health problem.

Challenges do remain, however, especially on the Haiti side of the island, where worsening insecurity, political instability, and fuel shortages abound.

Nevertheless, in 2022, the Haitian Ministry of Public Health and Population and its partners conducted mass drug administration for LF in seven of Haiti’s 18 remaining endemic districts. In addition, surveys in three areas where drug treatment was halted because of good progress indicated that transmission remains interrupted. Furthermore, the ministry was able to halt mass drug administration in five districts and one subdistrict.

“Haitians should be proud. Dominicans should be proud,” said Dr. Luccène Desir, the Carter Center’s country representative for Hispaniola.

This is all encouraging news for people like Mercedes Sola.

“I feel good because Haiti and the Dominican Republic have come together to fight this disease,” she says. “I feel very good that this is fixed.”

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The Carter Center's Hispaniola Initiative