There are countless stories about how maggots have cleaned wounds throughout the ages.
One of the more recent tales tells of how an orthopaedic surgeon on the battlefields of France in World War I finally got around to treating a soldier who had extensive wounds to his abdomen and a compound fracture of the femur.
Despite it being several days since the man was wounded, he was in good spirits and had no fever, and when they inspected the wounds they found them full of maggots.
There are even reports that Indigenous Australians and Native Americans knew maggots would eat the dead tissue and not touch the live.
Today in Kenya what is now known as maggot debridement therapy or MDT is experiencing something of a renaissance.
Doctor Kimani Wanjeri has treated a number of patients at the Kenyatta National Hospital.
“They showed remarkable improvement in terms of wound healing and removal of the dead tissue from the wound which impedes healing. It was remarkable,” he said.
The maggots that are used today are being specifically bred for the purpose of consuming necrotic tissue.
The Kenyan Agricultural Research Institute (KARI) is home to several cages about the size of a moving carton.
They are encircled by fly screen mesh and a low buzz is audible the whole time.
To get maggots you need flies to lay eggs. To encourage that you need a foul-smelling mixture of beef liver combined with wheat germ placed in a tupperware dish in the cages.
The flies lay their eggs in the mixture and then the maggots are extracted 24 hours later.
KARI entomologist Pheobe Mukiria explains just why these maggots are so effective in treating necrotic wounds.
“That maggot is the one that will now start secreting saliva on that tissue. That saliva has got properties that liquefy that tissue. And it sucks that liquid. In that process it is cleaning up the wound etc. It’s remarkable,” she said.
Western medicine last resort in developing world
Back at Kenyatta Hospital a patient is waiting to be treated with maggots. Peter Maloungu normally works at a quarry, but he has been off work a while by the time he winds up on the trauma ward.
Some weeks earlier a rock and sand wall had collapsed onto him. The crush wound severely damaged his left foot. Like many people in Kenya he turned to local medicine and religion first.
In those precious early days the flesh on the underside of his foot started to rot. When the doctors unwrapped it ahead of the application of the maggots, the stench was overwhelming. His foot was rotting.
Dr Wanjeri explains that maggots will be put on the wound and it will be sealed up. Mr Maloungu agrees.
“I’m not too worried, even though I’m in some pain. I’m praying to God that I will get well,” he said.
Dr Wanjeri is particularly enthusiastic about MDT.
He tells me that in a country like Kenya, patients like Mr Malougu are not exceptional. In developing countries people treat hospitals and western medicine as a last resort rather than a first priority.
He explains that the maggots have a tool that no drug or surgeon has been able to replicate yet. The saliva has antibacterial properties that eliminate the need for antibiotics.
Two days later Mr Maloungu’s foot is unwrapped and there is a noticeable difference.
For starters the maggots are no longer a couple of millimetres long, about the thickness of a thread of linen.
They are now closer to 20mm long and are fatter than the USB charging cable plugged into your phone.
They are also much more active and the doctors need to use tweezers to remove the wriggling larvae from cavities and under the now clearly visible and exposed tendons on the underside of the foot.
It is not pretty. Dr Wanjeri says a second treatment will be needed to clean up all the dead black flesh.
He also says MDT saves valuable resources.
“There’s no going into the operating room to use implements with many personnel to remove tissue,” he said.
“There’s none of that. It’s cheaper. You only need one person, probably two at the most to clean the wound and apply the maggots.
“So that cuts down on the costs significantly. And time also.”
And that is probably the main reason why there is a resurgence in MDT in Kenya.
It is cheap and it is effective. Even if it is a little gross.