In the uplands of Ethiopia, at least 1.6 million ordinary people are living lives of quiet desperation, the victims of a skin disease known as Podoconiosis (commonly known as “Podo”; from the Greek words for “foot” and “dust”). Podo is a form of elephantiasis, the main symptoms of which include grotesque swelling and deformity of the lower legs and feet. It is caused simply by bare-foot farming on certain types of ancient, red volcanic soil. The disease starts with the mundane – thick dry skin on the sole cracks and splits, allowing invasion of irritant soil, damaging lymphatic vessels, leading to full-blown elephantiasis.
The typical landscape of the region is depicted here. The endlessly lush, beautiful and dramatic vistas are a far cry from the dusty plains of Michael Buerk’s reports in the 1980s - an image many still hold of Ethiopia. However, this nutrient-rich soil is both the giver and taker of life. On the one hand, it provides a living to around 11 million Ethiopian farmers. On the other, it quietly, cynically robs life from more than 10% of those that work it through the agony and shame of Podo.
The Curse of Podo
It is impossible to convey the human tragedy of Podo in a few words. Normally lithe, sinewy legs balloon to caricature, cartoon proportions. The smell of Podo, the sickly stench of stubborn infection, enters a room before a patient’s physical presence. Finally, there is the shame of Podo. Sufferers are routinely mistaken as infectious, cursed by god, possessed by spirits. Wives are evicted, children live with the family’s livestock, men wither, one becomes unhuman. Forced from home, village and community, many starve or take their own life.
In an eight-day trip I met hundreds upon hundreds of Podo sufferers who had gathered in local remote communities upon hearing the news that the ‘farangi’ (white person) was coming. What that signifies to those who have been totally forgotten by their own, is a representation of hope, love and perhaps even a solution or some help. Simply by turning up lives were changed - many not being able to believe or understand why white people from a far away land had bothered to make the effort to come and see them. The hope and love passed on in this transaction was remarkable and overwhelming to witness. Travelling with the NGO ‘Action on Podo’ we were there to deliver more than hope and love, because the solution to this terrible disease is surprisingly simple (detailed further down the page). Tears, hugs, kneeling in appreciation, singing, shouting - we witnessed it all over and over, everywhere we went. It’s surprising what simply turning up somewhere can offer to those who have largely been forgotten.
The following 54 beautiful faces and their Podo-stricken feet showcase the effect of Podo in its most literal sense, and also the deeper impact the stigma has on the soul and spirit of the person. I wanted to capture, convey and contrast the face and the feet next to each other to display the difference in how I see these people (the left image, the human, the person) compared to how they see themselves thanks to the social stigma (the right image, the smelly, rotten feet which represent pain, no work, no family, no friends).
It’s a mere snapshot of the wider problem with an estimated 1.6m-2m in Ethiopia alone - Podo is rife in many other countries throughout the world. But… there is hope. There is a solution. Read on to find out more.
The Remarkable Solution to Podo
Because soil can only enter cracked, dry skin, Podo can be both prevented and treated with the simplest of materials:
3. Petroleum jelly
Importantly, no expensive drugs are necessary.
The first three heal and maintain skin barrier function. Shoes protect feet from irritant soil and are essential to both prevention and treatment. Incredibly, if patients wear shoes and treat their skin faithfully every day, swollen legs and feet can return to a normal size in six months to a year.
The images below depict the existing shoes of patients, showing how unsuitable they are for a muddy environment where Podo thrives. The customised, leather shoes made in the APA workshops aim to alleviate this problem.
Hope For the Future – “Action on Podo”
Action on Podo (APA) is a local Ethiopian NGO, co-founded by Paul Matts and Zelalem Mathewos in 2012, with a vision to eradicate Podo from Ethiopia. We provide treatment kits, we train Government Health Centre staff to treat Podo and we monitor progress carefully. We have started seven small shoe factories to make custom over-sized shoes for those with Podo. APA is also TOMS Shoes’ Shoe-Giving Partner in Ethiopia.
Since 2012, APA have treated over 31,000 patients, made over 4500 custom, over-sized shoes and distributed over 270,000 pairs of TOMS Shoes to school-children.
Part of the solution going forward is to equip and empower local people to help fight Podo on the ground. This team portrait - taken on our trip in October 2018 - depicts the current intake of young people being trained to make customised, over-sized shoes (for Podo patients with very large feet) under the watchful eye of expert cobblers. Even as this exhibition runs, these trainees will take their newly-learned skills and start six new small shoe factories in the Dawuro zone of Southern Ethiopia, passing on their knowledge to others - earning a living whilst simultaneously helping sufferers of Podo.
Many pictured here have had Podo themselves or have been directly affected by the disease through the suffering of family members and friends. This is the solution. This is the future.
The London exhibition of Podo, held at The Oxo Tower, April 2019