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The curse of the Acacia tree

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.

 

Albinos the victims in Africa

A six-year-old albino girl in Burundi has been found dead with her head and limbs removed, in the latest killing linked to ritual medicine. Albinos in the region have been targeted because of a belief peddled by witchdoctors that their body parts can be used for magic potions. The girl, who was attacked, was the sixth person with albinism to be killed in Burundi since September. Armed attackers broke into the family home and tied up the girl’s parents before shooting her in the head, local officials say.

Tanzania is also a country in Africa were albinos are targeted and killed the moment they are spotted. Only the past year 25 albinos were murdered here. Since 2007, 44 albinos have been killed in Tanzania and 14 others have been slain in Burundi, sparking widespread fear among albinos in East Africa. At least 10,000 have been displaced or gone into hiding since the killings began, according to a report released this week by the International Federation for the Red Cross and Crescent societies.

The head of the Burundi Albinos’ Association, Kasim Kazungu, says people with albinism had not suffered any discrimination until other Burundians heard about the lucrative trade in albino body parts in neighboring Tanzania. Not long ago police officers in south-western Tanzania arrested a man who was attempting to sell his albino wife to Congolese traders and two mothers in western Tanzania were also attacked with machetes after gangs failed to find their albino children.

The latest victim was a seven-month-old baby. He was mutilated on the orders of a witchdoctor peddling the belief that potions made from an albino’s legs, hair, hands, and blood can make a person rich. Sorcery and the occult maintain a strong foothold in this part of the world, especially in the remote rural areas around the fishing and mining regions of Mwanza, on the shores of Lake Victoria. Once these poor albinos would seek protection from the sun to avoid skin cancer, now they have to go into hiding just to simply survive and avoid being cut in pieces.

Nobody seems to know why the killings are happening now, but Tanzanian President Jakaya Kikwete is now putting pressure on the police to identify where albinos live and offer them protection but it seems like it’s not going to be easy as long as the witchdoctors persuade people to bring albino body parts.

Albinism

Albinism is a congenital disorder characterized by the complete or partial absence of pigment in the skin, hair and eyes due to absence or defect of an enzyme involved in the production of melanin. Albinism results from inheritance of recessive gene alleles and is known to affect all vertebrates, including humans. The most common term used for an organism affected by albinism is “albino”. Albinism is associated with a number of vision defects, such as photophobia, nystagmus and astigmatism and lack of skin pigmentation makes the organism more susceptible to sunburn and skin cancers.

We want your legs!

The last adult albino to be murdered was Nyerere Rutahiro. He was eating dinner outside in his rural compound, when a gang of four strangers burst in, and threatened to arrest him. As his wife Susannah looked on helplessly, the men began to hack at Nyerere’s arms and legs with machetes. “We want your legs,” they shouted, “We want your legs,” his wife recalls, still deeply traumatized by what she saw. Nyerere was targeted for being albino but he was human in the end and died a horrifying death. He was a man in his 50s, father of two and working as a farmer just like the others in the same area. His body was laid to rest in a cement-sealed grave to protect against grave robbers who often steal body parts of the dead to give to witchdoctors.

Nyerere is buried in a cementgrave

This is the work of organized gangs, according to Tanzanian police in the capital Dar as Salaam. Witchdoctors, middlemen and the clients who pay for albino body parts are among the 173 people in custody so far for these macabre killings but none has been prosecuted.

Ostracised

The sad reality is that albinos, who can afford it, are now flocking to urban centres where they feel a little safer. African albinos endure insults, discrimination and segregation throughout their lives. They also have a high risk of contracting skin cancer in a region where many jobs are outdoors.

Away from the wards, under the shade of a mango tree, a black woman sits with her albino daughter. Ashura and Amina, her angelic looking 9 year old. They may seem an odd couple at first, but the firm eyes of the mother reveals a woman deeply protective of her child. She is a woman who looks older than her years. Ashura and Amina now live on their own, ostracised by the rest of their family. “When Amina was born my husband and the older two children moved away,” recounts Ashura. “They were so ashamed and thought Amina would bring us bad luck, but I am not leaving her, she’s my daughter,” Ashura say.

Every parent nurturing an albino child has good reason to be frightened in today’s Tanzania. The stories of youngsters being snatched from their parents’ arms or attacked on the way to school are horrific but a part of reality.

Mary Owido, 36 years old and mother of 6 lacks pigment that gives color to skin, eyes and hair, says she is only comfortable when at work or at home with her husband and children.”Wherever I go people start talking about me, saying that my legs and hands can fetch a fortune in Tanzania,” she says. “This kind of talk scares me. I am afraid of going out alone.”

The surge in the use of albino body parts as good luck charms is a result of “a kind of marketing exercise by witch doctors,” the International Federation for the Red Cross and Crescent societies said. The report says the market for albino parts exists mainly in Tanzania, where a complete set of body parts including all limbs, genitals, ears, tongue and nose can sell for $75,000. Wealthy buyers use the parts as talismans to bring them wealth and good fortune.

Many fathers in denial
Almost 90 percent of albinos living in the region were raised by single mothers, because the fathers believed their wives were having affairs with white men. Some African communities believe that albinos are harbingers of disaster, while others mistakenly think albinos are mentally retarded and discourage their parents from taking them to school, saying it’s a waste of money. This resembles the witch-hunt that took place in the middle ages were women and girls would be burned at the stake accused of being witches.

Due to a lack of education, many albinos are illiterate and are forced into menial jobs, exposing them to the sun and skin cancer and those who manage to finish school face discrimination in the work place and are never considered for promotions. But one thing is positive and that is that before people would not dare to speak about albinism and would always keep silence. Today, everybody is talking about it and hopefully things will change so that these people can live as a part of the community and not as outcasts.

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