Françoise Mukandutiye, a 33-year-old resident of Kimonyi Sector in Musanze District, has spent nearly two decades battling podoconiosis, a neglected but preventable disease that causes swelling in the lower limbs. Mukandutiye was just 14 when she first noticed swelling in one leg. At first, she dismissed it, hoping it would go away. But a year later, when the other leg was affected, the pain became unbearable. Unable to continue her studies, she dropped out of school and stayed home, searching for answers. ALSO READ: Up to 7,000 Rwandans affected by non-infectious elephantiasis – WHO For years, Mukandutiye sought treatment at local health centers, but nothing seemed to work. Her condition was often misunderstood, and many in her community believed she it was a curse. The stigma led to isolation, making an already difficult situation even harder for her. It wasn’t until 2013 when she found a turning point. She met a volunteer from Heart and Sole Africa (HASA), a Musanze-based organization that treats patients with podoconiosis in Rwanda. With their support, she received a diagnosis and learned that podoconiosis was caused by prolonged exposure to volcanic soil when walking barefoot. ALSO READ: Innovative strategies for Africa’s NTD burden take centre stage at global conference in Kigali Like many in Mbugayera Village, Mukandutiye spent her childhood working on farms without shoes, unaware of the risks. The disease progressed gradually, but with proper foot care, medication, and protective footwear, she finally found relief. Under HASA’s guidance, the swelling subsided, and her pain eased. Though she still cannot wear all types of shoes, she regained her mobility and confidence. By the time she began receiving proper treatment, returning to school was no longer an option. As an orphan responsible for her younger siblings, she had to find other ways to support the family. In 2015, she got married and is now a mother of three children, aged nine, five, and one. Determined to secure a livelihood, Mukandutiye learned tailoring and can work without further exposure to contaminated soil. “My life has changed completely. I can now walk, work, and interact with my neighbors without fear of discrimination,” she said. ALSO READ: World NTDs Day: A look at common diseases in Rwanda Now, Mukandutiye is an advocate who educates her community about podoconiosis, using platforms like Umuganda (community service), churches, and schools to raise awareness. She shares her story to dispel myths, encourage early treatment, and emphasize the importance of wearing shoes. She urges people to support those affected rather than seeing them as cursed. Urgent need for awareness and treatment Jeanne Uwizeyimana, the Country Director of HASA, highlighted the urgent need to increase awareness about podoconiosis, one of neglected tropical diseases (NTDs). The World NTD Day is marked every January 30 to raise awareness about these diseases, caused by a variety of pathogens, including viruses, bacteria, parasites, fungi and toxins and associated with devastating health, social and economic consequences, according to the World Health Organisation (WHO). Podoconiosis, also called nonfilarial elephantiasis or mossy foot, is common in highland regions of tropical Africa. “Podoconiosis is linked to three main factors; soil exposure, walking barefoot, and genetic susceptibility. If someone regularly comes into contact with affected soil and is genetically vulnerable, they can develop the disease,” Uwizeyimana explained. She stressed that the most effective prevention method is wearing shoes, particularly for those in agriculture, who face the highest risk. “Farmers should always wear boots while working in the fields to avoid direct contact with the soil,” she added. “For those already affected, proper hygiene and treatment can manage symptoms. Patients should maintain foot hygiene, do regular exercises, and soak their feet in vinegar or diluted bleach, depending on the severity of their condition. Bleach is mainly recommended for those with open wounds,” Uwizeyimana said. She warned that without treatment, podoconiosis can leading to mobility challenges, economic hardship, and social stigma. Some patients develop open wounds that release fluids and produce a bad odor, pushing them further into isolation, which in turn hinders awareness about the disease. “Many Rwandans still lack knowledge about podoconiosis. Some believe it is contagious and avoid interacting with patients. Raising awareness is crucial to dismiss these myths and eliminate stigma,” Uwizeyimana emphasized. She added that mapping data shows that podoconiosis is most prevalent in Rwanda’s western districts, such as Nyamasheke, and northern districts, including Musanze. Uwizeyimana urged continued efforts to educate communities, promote preventive measures, and support affected individuals to ensure proper care and social acceptance. Rwanda’s fight against NTDs Podoconiosis is among the eight NTDs affecting thousands of Rwandans annually. Other common NTDs include intestinal worms, schistosomiasis (bilharzia), scabies, taeniasis, cysticercosis, rabies from dog bites, and snakebite envenomation. According to Rwanda Biomedical Center (RBC), studies conducted in 2018 estimated that the country had approximately 6,000 podoconiosis patients. To support them, 13 treatment centers, including those in public health facilities and partner organizations, have been established. However, progress remains slow. Ladislas Nshimiyimana, the Director of the NTDs Unit at RBC, said treatment efforts are still inadequate. “We are not treating as many patients as we should. Only 1,311 individuals have received treatment so far,” Nshimiyimana said. He noted that more efforts are needed, particularly in expanding services to all health facilities and building the capacity of healthcare providers to treat the patients. In the fiscal year 2023-2024, the government allocated Rwf31 million for treatment of NTDs, including podoconiosis. The goal is to increase this budget and extend services to all health facilities nationwide. The government is developing a WASH-NTD coordination roadmap, bringing together stakeholders to improve water, sanitation, and hygiene (WASH) practices as a key strategy for controlling and eliminating NTDs. Globally, the WHO has set ambitious targets for 2030, aiming for a 90% reduction in people requiring NTD interventions, a 75% decrease in NTD-related disability-adjusted life years, and the elimination of at least one NTD in 100 countries. Role of youth in NTDs elimination In Rwanda, young people are playing an active role in eliminating NTDs through “Youth Combating NTDs,” a community-led initiative launched in 2020 as part of the global Uniting to Combat NTDs movement. Yvonne Ninyembabazi, one of the group’s founders, said their mission is to engage, empower, and support communities in becoming disease-free. “We use infographics, posters, and videos to raise awareness and engage various stakeholders. We also advocate for policy changes to ensure NTDs remain on the national agenda,” Ninyembabazi said. Through advocacy efforts, several African countries have already eliminated at least one NTD, and many have signed the Kigali Declaration to end NTDs by 2030. The youth-led group focuses on schistosomiasis, podoconiosis, and WASH-related diseases. They work directly with communities, providing education through schools and community assemblies (Inteko z’abaturage). They train teachers to pass on the knowledge to learners, ensuring sustained awareness. “We advocate for increased investment in NTD elimination at decision-making levels, including the Ministry of Health, Ministry of Finance, and the Parliament. More funding is needed to strengthen NTD programs and support affected communities,” Ninyembabazi said.