The pain from a blister on his right toe haunted him every day. Eddie Ndirangu, 50,says it began after a long walk. What had started as an itch later grew into a pimple then it became a blister. In four months, the pain was unbearable.
Initially, the toe was the same colour as the rest of the skin. But a week later, it became darker, round, and gave way to a painful abscess. The wound also became rough around the edges. Then Eddie began limping. He couldn’t wear closed shoes because the blister on his right toe was too sore. He couldn’t step on the floor confidently. When his legs gave way he winched. As a sportsman, his feet had known the grass and turf for the last two decades and the thoughts of an amputation stressed him to the bone, pun intended.
Christopher Kibiwott treats Eddie Ndirangu using maggot therapy to treat a wound. Photo courtesy Standard newspaper.
Retirement from sports seemed nigh. But Eddie was not the kind that gave up. As a diabetic, the chances of this wound recovering after four months were slim and his doctor placed three options on the table;
- Maggot therapy
- The third option was that he had to urgently arrive at a solution of either of the first two.
The first option made his chest tighten into a knot. The proposed amputation sounded like an extended nightmare. His toes and feet were his livelihood. And his right foot was also his greatest asset at the weekends as he drove his family out of town.
He was unsure what to do next. To arrive at a decision, he looked towards the three F’s that compliment his life; Friends, Family, Fortitude and Food. He decided on maggot debridement therapy after consultation with his wife, Lucy who is a nurse. He also had to restrict his diet to promote recovery after the removal of the dead tissues. He appreciated that maggot therapy had been around for about three centuries ago before we all became fully reliant on conventional medicine.
Eddie Ndirangu has a 4-month problematic diabetic wound on his leg. Photo by John Wambugu
The application and removal
Infection Prevention and Control nurse Christopher Kibiwott had a knowledge-sharing session with Eddie and his family where they discussed how the maggots work. The wound was measured and Bernard Wanyonyi from the Kenya Agricultural and Livestock Research organisation was commissioned to grow the sterile maggots for Eddie’s wound.
Eddie has been diabetic for 15 years and manages the condition through a strict diet regime, insulin injections and ensuring that he regularly exercises. Diabetes is one of the conditions that affects how fast an injury or a wound recovers. The high levels of blood glucose has been found to affect the nerves and also leads to poor blood circulation that is necessary to promote skin repair.
For persons with diabetes, minor wounds can turn into serious foot ulcers that can grow into deep ulcerations. Did you know that diabetic wounds are the leading cause of amputations?
Eddie with his daughter Ivy Nyaguthii. Photo by John Wambugu
Back to Eddie now.
The maggots were applied on 9th April 2017 at home and they were removed 48 hours later. For one cubic centimetre of the wound, eight maggots are needed for the job. For Eddie’s wound 2,000 maggots hatchlings measuring about a millimeter each were applied on his wound. They were secured using gauze and bandage that also left aerations for the maggots to breathe as they ate away the dead flesh.
How did he feel? The first 36 hours were fine. “I hardly noticed their presence. However as the hours to remove to remove got closer, I had an itchy feeling that felt like a baby was tickling my toes and the soles of his feet,” Eddie says. There was no pain at all, Eddie added. By the second day, Eddie noted that the outer covering had become wet due to the liquefied dead tissue.
On the D-Day, Kibiwott and Bernard were on set to remove the maggots after the micro-surgeons has worked for 48 hours. As the bandage was removed, the maggots had remarkably grown ten-fold to about 10 millimetres. The agile maggots ones were ‘excited’ to be released from the wound. They moved on their bellies in search of the next spot to eat the dead tissue, but their assignment had come to an end.
The maggots are destroyed after the job to prevent them developing into houseflies.
The maggots were then placed in a plastic bag and drowned to prevent them from developing into flies. The task was done; A clean and painless job.
Kibet later cleaned the wound with saline solution and applied clean dressing that we changed routinely until the wound closed.
“The maggots ate all the dead flesh. I am happy because I kept all my toes,” Eddie said.
In another three weeks, the wound became smaller and it eventually healed. He later graduated to wear shoes and could also take a walk before he was back to driving his family.
The creepy friends had given him a second chance.