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KILEMA, Tanzania
Poking out of Patrice Mavia's purple plastic sandals are toes dark and swollen with blood, ragged and infected as if chewed by jagged teeth.
His fingers seem to be in a similarly painful state.
Adella Kessy, a nurse at the Catholic hospital in the foothills of Tanzania's Mount Kilimanjaro, said tiny sand fleas are to blame. Left unchecked, the insects form painful pustules and lesions, destroy fingers and toes, and eventually leave a victim crippled.
They come from walking barefoot on ground infested with sand fleas, drying clothes on the ground or poor hygiene. They are a clear sign of neglect, said Ms. Kessy.
Patrice probably doesn't bathe with any regularity, nor is he likely to hand wash his thin clothes, or know that he has to destroy bugs and parasites with a heavy, charcoal-powered iron. He is, after all, only 8 years old.
Patrice was orphaned by AIDS maybe five years ago -- he thinks he lost his parents in 2001 and 2003 -- and he is the only one around to remind himself to wash behind his ears and scrub between his toes.
"No one is helping him care for himself," said Ms. Kessy, shaking her head.
As communities across Africa struggle to cope with the growing number of children left parentless by AIDS -- a number expected to reach 18 million by 2010 -- the United Nations Children's Fund (UNICEF) said recently that less than 10 percent of AIDS orphans receive any form of support.
"Most are in poor, poor, poor environments. They're in poor houses, poor environments and have poor food," said Anna Anselm, a clinical officer at the hospital's patient resource center.







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