I’ve written before about the shoe charities, companies like TOMS Shoes and their marketing effort that uses the lure of donating shoes to help sell their shoes. One of the items they talk about on their blog is the transmission of helminths (e.g., hookworm), and how important their shoes are for combatting them.
I have found an interesting commentary on that.
From the time of the earliest demonstration that hookworm larvae enter the human body through the skin there have been those who believe that the most practical method of hookworm control is the protection of the skin of the feet. In their zeal, some of these persons have opposed active campaigns for improved sanitary habits and have substituted campaigns for securing the wearing of shoes. They argue that the tropical peasant has not the resources to permit him to build a latrine at his home, and furthermore that if he did build a latrine he would not use it. In some cases they have recognized that it would not cost so much to build a good latrine as to supply a single family with leather shoes for a year and that the latrine would be of service for two or more years. They have then advised the substitution of canvas shoes with rubber soles for the sake of economy. The movement has gainged such proportions that in one West Indian island the number of shoes distributed by charitable organizations for this purpose amounts to several thousand pairs a year.
In fact, the above is from a study, in the American Journal of Tropical Medicine and Hygiene. What the study showed was that the hookworm larvae can pretty easily penetrate various types of cloth-sided shoes. You see, if you step in infected mud, the mud can get on the sides of the shoe and thereby continue into the foot. That is also why flip-flops are not particularly effective hookworm control.
Let’s take a look at a TOMS Shoe:
A Typical TOMS Shoe
Hmmmm. I’d worry about that. (I don’t know if this is the sort of shoe that they donate—maybe their donations are cheap knock-offs.)
The thing is, if you wear a full leather shoe in the tropics, you will in all likelihood very quickly develop quite a fungal infection. And the study says that cloth-sided shoes, which at least let in a bit of air (but probably not enough), let in the hookworm larvae.
So why waste your time and money on shoes? Why not work on decent latrines that not only stop the spread of things like hookworm, but really dangerous and deadly diseases like cholera or dysentery? Why not work on clean water supplies?
Oh, and by the way, that study was published in January, 1929: Penetration by Infective Hookworm Larvae of the Materials Used in the Manufacture of Shoes. Some people are just so wedded to donating shoes that they just cannot see anything else.
As I’ve said before, a decent donation would be PeePoo bags, available at Peepoople.com.
Ahcuah 
Hmm I never contemplated the idea that the shoes TOMS and other places were giving away would be ineffective at stopping the spread of hookworm. You also made a great point about the other problem that arise from lack of sanitation that shoes can not fix. I also can’t help wondering weather or not in these tropical environments, the wearing of shoes isn’t spread fungal infactions that don’t exist in barefoot populations, such as Athlete’s Foot. This would in fact be ironic that the shoes are causing more problems instead of solving them. Once again, it goes to show that bare feet are best!
Yes, latrines would help in those places where people have no sanitation. But that is NOT the majority of places in Africa, these day. The easiest way to get rid of hookworm is a) teach people to not walk in sh*t and b) put floors in schools. In fact b) is what has been done and frankly, hookworm is just not that big of a problem. I’ve lived in Africa for most of the past 6 years (in a small town in Namibia, at the moment) and I’m barefoot all the time and it’s not an issue for me, or most of the people I know.
It’s just like the “glass” that everyone in the developed world tells you to watch out for. Open your eyes. Do not step on glass. Do not step in feces. It’s as easy as that. . .
The whole Tom’s shoe thing is a total freakin’ scam. As is the “donate your shoes” thing. Africans don’t need your shoes (though most watch enough hip hop videos to WANT them). Those donated shoes end up as a business for someone (or many) who SELL them.
Regarding latrines, don’t forget that the study was written in 1929. I assume that they figured out the latrine thing in the last 80 years 🙂 (as you say). I might also consider reversing your “do not walk in shit” and stress “do not shit where people will walk.”
And yes, it does look like the shoes are wanted as status symbols. (Do you have any thoughts on athlete’s foot occurring there in Namibia because of their feet being in warm, dark, moist shoes?)
Oh, let me add two more things about hookworm in particular.
The life-cycle of hookworm is such that, quite often, by the time the eggs in the feces hatch and the larvae have become active, the feces have fallen apart and are indistinguishable from soil. At that time, you cannot tell that you are walking (or standing) on shit. Thus, it is better not to shit where people will walk.
Also, Namibia is too dry for hookworm, so it is not surprising that you don’t have a problem there. Hookworms need a fairly damp environment, so it is the more northern, tropical areas of Africa that have the problem.
Born in Texas in 1933, I had long heard of hookworm as a (then) current problem and shoes were considered the solution. People go barefooted in the summer almost as frequently as back then in the more famous depression, yet there is no mention of hookworm. Thanks for explaining the reason is plumbing, not shoes.
You did fail to mention the problem of leather shoes in tropical rain forests that unless major efforts are taken to keep the insides dry, they will rot rather quickly. Hardly a responsible investment of time and money in a subsistence economy.
Well, for the most part, people, at least in the places I’ve lived/visited (Kenya, Uganda, Tanzania, Namibia, Cameroon, Togo, Benin, DRC) don’t sh*t where people walk. They do it “in the bush”. But kids often run off and play in the bush. Yet, there are so many other health reasons to teach & build latrines, that this seems like a much better long-term plan than shoes. Shoes really seem a lot like “blaming the victim.”
Interestingly, except for some places on the coasts, most of the places in Africa that are really wet are pretty temperate in climate and the places that are hot are dry. So, you don’t really have the problem of leather getting moldy. I lived in the Solomon Islands for nearly a year and whoo boy, you do NOT want to have anything leather there. It gets ruined within days.
That being said, a foot inside a sock (almost always made of the cheapest Chinese nylon) inside a shoe in even a temperate environment is a perfect breeding ground for fungi. And if the number of products sold in the shops are any clue, it is definitely a problem here. At least among the affluent. Truth is, easily 75% of the population still wears flip flops ’cause that’s what they can afford, except in the richer countries that require shoes as part of the school uniform. And then, kids take ’em off as soon as school is out in order to a) not ruin them, since they need to last at least a year and b) play football, which most of them find too difficult with shoes on (“can’t feel the ball” a kid told me).
[…] were a couple of comments in an earlier entry, “Shoo! Donations”, that got into a discussion of hookworm. There was also a question about barefoot running in […]