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Reference : V-P-SD-E-02659
Date : 12/11/2019
Country/Region : SUDAN
Caption : Khartoum, National Authority for Prosthetics and Orthotics (NAPO). This young man, 26, lost his leg as a teenager to mycetoma, or Madura foot, a chronic inflammatory skin and tissue infection.
Photographer : WELLS, Crystal Ashley
Confidentiality level : public
Publication restrictions : publication without restrictions
Copyright : ICRC
Description : ICRC website, article, 03.12.2019. Faris Ibrahim seldom shares his story, not for fear he will be judged, but because he doesn't feel different than anyone else.
Ten years ago, Faris, 26, lost his leg to an insidious tissue infection known as Mycetoma. Three years earlier, Faris' mother passed away from heart disease, leaving him and his siblings to fend for themselves. The infection came slowly: first, his foot swelled, then his leg. Eventually, it became so painful that he could no longer walk, only crawl.
"My family took me to traditional healers," Faris said. "This made the situation worse. I was then taken to Bashaier Hospital in Jebel Awlia (40 kilometres south of Khartoum) where they did some tests and then transferred me to a bigger hospital in Khartoum."
The results came back scribbled down on a paper in English. Faris found someone at the hospital to translate. "They told me that the infection had severely damaged my leg and that it needs to be amputated," he said.

A crumbling health care system
Years of war and economic turmoil have corroded Sudan's health care system. In Khartoum and larger towns, hospitals and clinics often do not have enough drugs and the ones that are available are too expensive for many Sudanese to purchase. Doctors are chronically underpaid and opt to leave Sudan to work abroad, draining the country of its health care workforce.
The situation in remote areas is grimmer. Many Sudanese live in areas without nearby health facilities, largely because clinics and hospitals were destroyed in conflict or decayed by chronic under-investment.
This makes preventable and treatable diseases and infections tragically dangerous.
In the case of Mycetoma, which is caused by bacteria or fungi that enter most often through a cut in the foot or leg, early diagnosis is critical to curb the infection before it spreads and irreversibly destroys tissue. With little investment in Mycetoma globally and Sudan's health care system crumbling, Faris and thousands of others like him often seek treatment when the infection is so severe that the only option is amputation.
In the case of Mycetoma, early diagnosis is critical to curb the infection before it spreads and irreversibly destroys tissue.

No different than anyone else
The International Committee of the Red Cross (ICRC) has worked with the National Authority for Prosthetics and Orthotics (NAPO) in Sudan since 1990 to provide prostheses, orthoses and other mobility devices and physical therapy services.
Today, NAPO's main rehabilitation centre, which sits in the heart of Khartoum, cares for about 2,500 people with physical disabilities each year, 20 percent of which stems from Mycetoma. There have been nearly 9,000 cases of Mycetoma registered by a local research centre in Khartoum.
It was this centre where Faris was fitted for his first prosthesis in 2010.
"I lost my leg, but I was physically fit," he said. "I wanted to work with the associations [for people living with disabilities] and help them with anything. After I received my prosthetic leg, I would show up to workshops as a case study...I try my best to contribute and help students learn because they benefit other people."
His prosthetic leg also allowed him to carve out a life in Khartoum no different from his peers. He eventually found work in a bakery, where he is on his feet nearly all day, mixing, kneading, and rolling dough. When he finishes work, he dashes off to workshops and classes around town.
Faris recalls a time that he went to the bakery and people were astonished he could work as an amputee.
"I am not a showoff. I didn't want to show them my true abilities, but after they left, I told my colleague that we need to work fast," he said. "We did and finished hours earlier than a normal shift. We were so fast that when we went to wake up the workers for the next shift, they were very shocked that we finished all the flour we had!"
In late October, Faris was fitted with a new prosthesis that uses a polycentric knee joint. He is the first patient at NAPO to receive this technology, which mimics a real human knee and will allow him to kneel, squat, and all-round move more efficiently.
"I have never seen anything like it," Faris said. "It is extraordinary. It is much easier and takes no longer than two minutes to put on. It gives me much more time." For someone who wants to maximize every minute of the day, time is precious for Faris. The amputation of his right leg has not slowed him down yet, and he has no intention of it setting him back now.
"I never lose hope," said Faris. "I am planning my future. I have ambitions to work in the electronics trade, continue my studies, and hopefully start a family."
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Orientation : portrait
Colour/B&W : colour