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Reaching the Unreached

Lymphatic filariasis (LF), often known as elephantiasis, is a devastating parasitic worm infection spread by mosquitoes that affects 120 million people in 43 countries around the world. The disease is one of the world’s leading causes of disability and the economic cost of working days lost as a result of LF runs into billions of dollars.

Commissioned by GSK

In early 1998 GSK announced a collaboration with the World Health Organisation (WHO) to spearhead a global effort to eliminate lymphatic filariasis. Over the past 21 years this has evolved into a major public-private partnership known as the Global Alliance to Eliminate Lymphatic Filariasis. For the 20th (and upcoming 25th) anniversary, GSK required photography to illustrate LF, how the disease is managed and the ongoing initiative to eliminate it.

How the photography is being used

Published globally by GSK and partners - including WHO, The Gates Foundation, The Carter Centre, African and Central Asian health ministries, academia and global advocacy groups - the pictures help to engage potential partners, the general public and those at risk about the devastating effects of LF and the continuing international effort to combat it.

The pictures were also exhibited at American Museum of Natural History in New York, the Natural History Museum in London, The Carter Centre in Atlanta and WHO in Geneva.

All photographs: Ecce Opus / © Copyright GSK

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Healthy children playing in the streets of Karaikal in Tamil Nadu, India - one of the areas where lymphatic filariasis has been targeted. Photograph: Ecce Opus / © Copyright GSK
 

Above: Healthy children playing in the streets of Karaikal in Tamil Nadu, India - one of the areas where lymphatic filariasis has been targeted.

Cover image: Reaching the unreached. A neglected tropical diseases team, led by the Indonesian Ministry of Health and funded by GSK, begin their long journey into the jungles of West Papua to assess remote communities. West Papua, Indonesia.


Lymphatic filariasis (LF) threatens almost one sixth of the world’s population, yet few people outside the affected countries have ever heard of it. LF is found in the tropical and sub-tropical areas of Africa, Asia, the Pacific, the Middle East and the Americas.

Although the disease is not life threatening, infected individuals with physical symptoms are usually affected during their most productive years. The disability and the incapacitating acute attacks leave them unable to work, which can lead to a life of poverty. Added to this, those affected are often stigmatised. They can be considered undesirable for marriage, normally an essential source of security.

 
Usha fell ill when she was 13 years old and her leg started swelling. She wanted to study maths but quit school in the 9th grade because she was being teased. Her condition made it difficult to find suitors for her, so she never married. Lymphatic filariasis has meant that Usha has missed out on a lot in life. She now runs the family house for her nephew and his wife, but continues to suffer pain and fever associated with the disease.  Lymphatic filariasis can be prevented with two pills which kill the parasitic worms. However, for those who have developed the condition, with the exception of men with hydrocele, the lymphoedema, tissue damage and the compromised immune system cannot be reversed.  Regular washing is essential to minimise skin deterioration, although this can be a challenge for many patients who don't have easy access to clean water. Recognising and treating the condition early is essential. Photograph: Ecce Opus / © Copyright GSK
 

Usha fell ill when she was 13 years old and her leg started swelling. She wanted to study maths but left school in the 9th grade because she was being teased. Her condition made it difficult to find suitors for her, so she never married. Lymphatic filariasis has meant that Usha has missed out on a lot in life. She now runs the family house for her nephew and his wife, but continues to suffer pain and fever associated with the disease.

Lymphatic filariasis can be prevented with two pills which kill the parasitic worms. However, for those who have developed the condition, with the exception of men with hydrocele, the lymphoedema, tissue damage and the compromised immune system cannot be reversed.

Regular washing is essential to minimise skin deterioration, although this can be a challenge for many patients who don't have easy access to clean water. Recognising and treating the condition early is essential.

 
Darai Lal-Bahadur, an LF patient, returns home with a little food for his livestock of two - a buffalo and a cow - his main source of income. In addition to struggling with LF, Darai also broke all of his fingers in an accident when he was younger. (The running cows do not belong to Darai, and they didn't knock him over.) Jagir Goan, Salyantar, Nepal. Photograph: Ecce Opus / © Copyright GSK
 

Darai Lal-Bahadur returns home with a little food for his livestock of two - a buffalo and a cow - his main source of income. In addition to struggling with lymphatic filariasis, Darai also broke all of his fingers in an accident when he was younger. (The running cows do not belong to Darai, and they didn't knock him over.) Jagir Goan, Salyantar, Nepal.

 
Degbe Ablavi is a woman most busy mothers can identify with. Here she finally sits down after another long day. In the morning she collected water, then carried her maize and cassava to the local miller for grinding.  In the afternoon she worked in the family's yam field before sweeping the yard and preparing dinner for the family in the evening. All the while she allowed us to follow her and her daughter, Sitchope, to take pictures. Now, all that's left to do is tidy the kitchen, clean the cooker and put Sitchope to bed before the sun goes down. Degbe has lived with LF since 2005. Agbati, southern Togo. Photograph: Ecce Opus / © Copyright GSK
 

Degbe Ablavi is a woman most busy mothers can identify with. Here she finally sits down after another long day. In the morning she collected water then carried her maize and cassava to the local miller for grinding. In the afternoon she worked in the family's yam field before sweeping the yard and preparing dinner for the family in the evening. Now, all that's left to do is tidy the kitchen, clean the cooker and put her daughter Sitchope to bed before the sun goes down. Degbe has lived with LF since 2005. Agbati, southern Togo.

 
A scene replicated around the world - Silvi Degbe's son hangs around the family kitchen waiting for his dinner. Silvi, who has lived with LF since 1993, works as a corn saleswoman. Tsave, southern Togo. Photograph: Ecce Opus / © Copyright GSK
 

Silvi Degbe's son hangs around the family kitchen waiting for his dinner. Silvi, who has lived with LF since 1993, works as a corn saleswoman. Tsave, southern Togo.

Below: With a compromised lymphatic system, the body is less able to resist common skin infections, and simple cuts become badly infected.

Adama Zoundi finds the spirit to share a joke with Mme Kabre (Ministry of Health, Burkina Faso) whilst she washes his infected foot.

Adama is part of a newly established group of LF patients who meet regularly to share their experiences and to support each other. Ouagadougou, Burkina Faso.

Stage 4 lymphedema caused by lymphatic filariasis. The skin condition has rapidly deteriorated following an ill advised procedure by a poorly qualified plastic surgeon. Regularly washing limbs affected by lymphatic filariasis plays a key role in minimising skin infections which can otherwise spiral out of control.

 
A community health worker rides between villages to educate families and communities about malaria, lymphatic filariasis and maternal health care. Simple images, discussion groups and a little humour ensure that the message is clearly understood. Tandahimba district, Tanzania. Photograph: Ecce Opus / © Copyright GSK
 

A community health worker rides between villages to educate families and communities about malaria, lymphatic filariasis and maternal health care. Simple images, discussion groups and a little humour ensure that the message is clearly understood. Tandahimba district, Tanzania.

Below: In order to rid the world of lymphatic filariasis, affected communities need to be educated about the disease and motivated to take the drugs to stop it. This requires dedicated local teams working remotely in countries often experiencing funding shortages, conflict issues and battling other chronic diseases.

 
In order to rid the world of lymphatic filariasis, affected communities need to be educated about the disease and motivated to take the drugs to stop it. This requires dedicated local teams working remotely in countries often experiencing funding shortages, conflict issues and battling other chronic diseases.  The picture shows a drug administration team encouraging a young boy to take medicine in order to combat lymphatic filariasis. The yellow measuring stick is used as an effective guide for calculating the required dose for each person and is much quicker than weighing or assessing a person's age, which may not always be known. Photograph: Ecce Opus / © Copyright GSK
 

A drug administration team in Tanzania encourage a young boy to take medicine in order to combat lymphatic filariasis. The yellow measuring stick is used as an effective guide for calculating the required dose for each person and is much quicker than weighing or assessing a person's age, which may not always be known.

 
Entrepreneur, Mtumwa, bakes bread to sell at the local market, providing an income for her family. Mtumwa also suffers from lymphatic filariasis (LF), and is seen here visiting a nurse in the district health centre. Such visits ensure that patients understand how to effectively manage their condition, limiting the impact LF has on their lives. Pemba, Zanzibar. Photograph: Ecce Opus / © Copyright GSK
 

Entrepreneur, Mtumwa, bakes bread to sell at the local market, providing an income for her family. Mtumwa also suffers from lymphatic filariasis, and is seen here visiting a nurse in the district health centre. Such visits ensure that patients understand how to effectively manage their condition, limiting the impact LF has on their lives. Pemba, Zanzibar.

 
Bhagwati Thapa typifies the spirit of many LF patients who opened their homes and shared their stories to help us document lymphatic filariasis. In the photo Bhagwati is inviting us to stay for tea - which we gladly accepted. Bungmati, Nepal. Photograph: Ecce Opus / © Copyright GSK
 

Bhagwati Thapa typifies the spirit of many LF patients who opened their homes and shared their stories to help us document lymphatic filariasis. In the photo Bhagwati is inviting us to stay for tea - which we gladly accepted. Bungmati, Nepal.

 
Sauda chats with her friend at Bandamati School in Zanzibar. The pupils have been given Albendazole, Ivermectin and Praziquantel to control lymphatic filariasis, soil transmitted helminths and schistosomiasis. The three conditions are being targeted by the WHO as part of a global campaign to eliminate neglected tropical diseases. Photograph: Ecce Opus / © Copyright GSK
 

Sauda chats with her friend at Bandamati School in Zanzibar. The pupils have been given Albendazole, Ivermectin and Praziquantel to control lymphatic filariasis, soil transmitted helminths and schistosomiasis. The three conditions are being targeted by the WHO as part of a global campaign to eliminate neglected tropical diseases.

 
Miftahudin owns a small but successful tailoring business which he runs from home. The effects of lymphatic filariasis are not life-threatening. However, it is important for those with this condition to find work and a lifestyle that lowers the risk of damaging affected limbs. Pekalongan City, Indonesia. Photograph: Ecce Opus / © Copyright GSK
 

Miftahudin owns a small but successful tailoring business which he runs from home. The effects of lymphatic filariasis are not life-threatening. However, it is important for those with this condition to find work and a lifestyle that lowers the risk of damaging affected limbs. Pekalongan City, Indonesia.

 
It takes courage to invite a media team into your home like Amli Devi did. And when you can’t read or write, paperwork and foreigners can suddenly seem overwhelming. Enter Kanchan. A keen student at school, Kanchan understood her mother’s anxiety and remained at her side during our visit. Strong and vigilant, she reassured her as we documented Amli’s experience of living with lymphatic filariasis (LF), which would help other sufferers by showing them how to better manage the condition.  Whilst LF can be prevented, for those who have developed the condition, it is not possible to reverse the lymphoedema or the associated tissue damage. With a compromised immune system, regular washing is essential to minimise skin deterioration, although this can be a challenge when clean water is not easily accessible. Bihar, India. Photograph: Ecce Opus / © Copyright GSK
 

It takes courage to invite a media team into your home like Amli Devi did. And when you can’t read or write, paperwork and foreigners can suddenly seem overwhelming. Enter Kanchan. A keen student at school, Kanchan understood her mother’s anxiety and remained at her side during our visit. Strong and vigilant, she reassured her as we documented Amli’s experience of living with lymphatic filariasis, which would help other sufferers by showing them how to better manage the condition.

 
Edou Komlan can now be confident that his son is highly unlikely to develop and suffer with lymphatic filariasis (LF). Togo is the eighth country in the world, and the first in Africa, to have officially eliminated LF as a public health concern. Kpove Zion, Southern Togo. Photograph: Ecce Opus / © Copyright GSK
 

Edou Komlan can now be confident that his son is highly unlikely to develop and suffer with lymphatic filariasis. Togo is the eighth country in the world, and the first in Africa, to have officially eliminated LF as a public health concern. Kpove Zion, Southern Togo.