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In the clinic area, some 150 people gather together for the daily painful ritual. The common thing between these poor souls is the thick stick they all support themselves on. They are all infected by Kala Azar. The treatment is extremely painful as the patient gets a high dosage of medicine injected on the seat muscle. During the 17 days of treatment, most of the patients have to be hold down by 3-4 people and to manage to walk afterwards; they have to use a walking stick. But even though the pain, these patients are the lucky ones. Some children have to walk days with high fever just to reach the clinic, and others never make it there.

The eruption

Life goes on in the villages as women carry water and children playing around. The big acacia tree looks beautiful at sunrise and sunset and the children likes to play around it. But it is here that the black sand fly is that infects 500,000 people a year. It is when the sun is on its way down that the fly’s swirls around the red tree. Children up to the age of 4 are most affected that attacks the skin, eyes and mouth.

2010 has been the year with large eruption since the largest epidemic happened in Sudan on the west side of Upper Nile under the civil war in 1980 and 1990’s. 100,000 people lost their life and many villages were left empty.

The reason for the epidemic can be explained by the large amount of refugees returning back after the peace deal between north and south in 2005 and an increased number of internally displaced in the states of Upper Nile and Jonglei.

South Sudan has been battling with the worst epidemic of the deadly kala azar disease during the last 8 years, with tens of hundreds of people infected according to medical charity Medecins Sans Frontieres.

If the patient is untreated, the parasitic disease, spread by the bite of an infected fly, is fatal in almost 100% of cases. By the end of November, MSF had treated 2,355 south Sudanese for the disease. By the end of October 2010, more than 9,330 cases in south Sudan had been reported to the World Health Organisation (WHO), most of these were children. Almost 5% of those who received treatment at medical facilities later died, according to the WHO.

What is Kala Azar?

Click at the picture for a larger image

Kala Azar is a deadly disease caused by parasitic protozoa Leishmania donovani, transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight, diarrhea, and fatigue and if it is left untreated, it kills. The disease suppresses the immune system so that the patient is vulnerable to other infections. Kala Azar was first discovered of Western doctors in 1824 in Jessore, India (today’s Bangladesh) thinking it was malaria. The name Kala Azar is derived from Kala which means black in Sanskrit, Assamese, Hindi and Urdu and the Persian Azar for disease. It is regarded as the second disease after Malaria taking lives.

Current situation

The disease is endemic in three countries; Bangladesh, India and Nepal and approximately 200 million people in the Region are “at risk” from the disease. The disease is now being reported in 45 districts in Bangladesh, 52 in India and 12 in Nepal. The total number of districts reporting Kala Azar exceeds 109. Of the estimated 500,000 people in the world infected each year, nearly 100,000 are estimated to occur in the Region. In the endemic countries, Kala Azar affects the poorest as they have little knowledge about the disease and unlikely to seek early treatment and most of those who start treatment cannot afford to complete it.

Treatments

The Indian medical practitioner, Upendra Nath Brahmachari, was nominated for the Nobel Prize in Physiology or Medicine in 1929 for his discovery of ureastibamine (an antimonial compound for the treatment of Kala Azar) and a new disease, post Kala Azar dermal leishmaniasis.

Even with recovery, kala-azar does not always leave the person unmarked. Sometime after successful treatment, a few months with African Kala Azar, or several years with the Indian one, a secondary form of the disease may set in, called post Kala Azar dermal leishmaniasis, or PKDL. This condition shows up as small, measles on the face, which gradually increases in size and spreads over the body. Eventually the lesions may form disfiguring, swollen structures resembling leprosy, and occasionally causing blindness if they spread to the eyes.

The medicine is expensive and the treatment very painful. The fact that this disease affects the poor and malnourished is making it worse. Most of the doctors working in the cities do not have the possibility to get to many villages or to transport the medicine for various reasons. To help these people, much needs to be done, and much money is needed for medicine and transport. The fact that children have to walk for days under the burning sun for days with high fever and extreme pain is sad and hard to imagine for us but unfortunately true.

 

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