"For people who reach the second stage, the frequently used arsenic-based treatment is toxic, thus causes side effects. In 5 to 10% of cases, the side effects may even result in the death of the patient", says Bertrand Draguez. "This is why Médecins Sans Frontières is taking part in a scientific project designed to streamline another therapeutic protocol, DFMO (Difluoromethylornithine). A larger quantity of product is required per patient but it is less toxic." The project is also designed to conduct clinical trials with another product, Nifurtimox, to be used in combination with DFMO.
Hunting down the tsetse fly
Another cornerstone of the Médecins Sans Frontières' operations in Isangi is the "anti-vector campaign". In other words, the idea is to catch the tsetse flies so as to reduce the propagation of the trypanosome. "We place floating traps that change colour from black to blue ", explains Bertrand Draguez."The glossina is the only insect to be attracted by these traps, where they are allowed to enter but not to leave. The trap placing operation is seconded with active screen activities so as to make it easier to interrupt the disease transmission cycle."
Isangi covers an area half the size of Belgium, hence many health districts are difficult to reach, which creates a tremendous logistical challenge: it often takes several days of travelling by canoe to reach certain remote districts. Médecins Sans Frontières is due to set up several decentralised bases, including Yambula and Yabaondo, so as to make it easier to reach the less accessible communities.
"Hidden killer"
It is plain to see: the trypanosomiasis campaign is more than a mere medical intervention. It has to combine knowledge about the geographical origin of disease, the breakdown of the community per village, the water take-off points used by the people, knowledge that the community has of the disease, but also a procedure for monitoring the trap locations, the screening exercise and so on. Consequently, an in-depth information and awareness-raising campaign is vital for the success of the programme. "Due to the trypanosome incubation period (which may be as long as three weeks) and the fairly common symptoms that develop over a period of several years, many sufferers die before they even know they have contracted trypanosomiasis", stresses Bertrand Draguez. This is undoubtedly why trypanosomiasis is sometimes called the “hidden killer". What is more, faced with unexplained deaths (including people who die from trypanosomiasis) in the wake of disorders of consciousness, and certain sorcery-based practices or beliefs, people are often designated scapegoats and banished from the community, sometimes for ever. So it is crucial for communities to be offered information about the disease and to see that people who are "bewitched" can become healthy again after receiving medical treatment.
An overlooked disease
The AHT programme in Isangi is bearing its fruits and has shown how effective it is. When duly carried out, the campaign can produce spectacular results: within a few years a district may virtually be rid of what was previously a public health scourge. "When the project was launched, the prevalence of trypanosomiasis was equal to 14% of the communities surveyed in the case of some villages", says Bertrand Draguez. "This percentage has fallen dramatically with the result that the short-term aim is to have the prevalence of AHT fall to less than 1% in the three most seriously affected health areas. In most other areas, the percentages were already between 0.1 and 0.5% in early 2006."
However, trypanosomiasis continues to be a disease that is overlooked to a great extent. It is raging only in certain developing countries (in Latin American and Africa – in various forms) and strikes solely in rural areas, far away from policy-makers. It is also quite an expensive disease to tackle, compared with other tropical diseases. There is no doubt that these factors explain the reluctance shown to develop appropriate diagnostic, methods and treatments and establish effective strategies for combating the disease. According to the World Health Organisation figures, trypanosomiasis is continuing to kill between 300,000 and 400,000 people a year in Africa alone.
