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Central African Republic: MSF hands over its sleeping sickness project in Haut Mbomou After five years work the prevalence rate in the region has dropped by 0.5% with 76,000 tests done and 1,500 people treated.
Last July, Médecins Sans Frontières (MSF) handed over its sleeping sickness project in the eastern region of Haut Mbomou to the Central African Republic’s Ministry of Health. In the five years that it has been working there, the organisation’s teams have carried out 76,000 diagnostic tests and provided treatment to more than 1,500 people. African Trypanosomiasis, or sleeping sickness, is caused by a bite from the tsetse fly which transmits a parasite known as the trypanosome. Once in the bloodstream and lymphatic system, the parasite multiplies and, if untreated, it continues to reproduce in the brain and central nervous system. The first symptoms are fever, headache and joint pain, developing into sensory illusions and a disturbed sleeping cycle, with fits and disrupted behaviour that can range from confusion to madness. If the disease is not treated at this stage, the patient lapses into coma and dies. It is estimated that around 60 million people are exposed to sleeping sickness in developing countries and that around 60,000 die each year. Of the 400,000 new cases declared annually, only 40,000 are diagnosed and treated. With a prevalence of up to 10% in some regions, the CAR is the country worst hit by the disease, followed by the Democratic Republic of the Congo (DRC) and Angola. When MSF arrived in Haut Mbomou in 2001, this prefecture was the source of trypanosomiasis with the highest number of cases declared in the country (over half the total) and a prevalence of between 7 and 10% according to the areas. It is a difficult region to access with only 19 health structures – far below what is necessary for a population of 40,000. The project, which MSF worked on alongside the Ministry of Health and the National African Trypanosomiasis Programme (PNLTHA), had two main aims: detecting cases within and beyond health structures by using mobile teams (covering up to 75% of the prefecture’s population), and suitable treatment and later follow-up of patients. This was completed with training schemes for local health staff geared towards encouraging the population to take the test, a vitally important issue in areas in which the disease is often linked to witchcraft. Over the course of the project it became essential to change the official treatment protocol in the prefecture, replacing Melarsoprol with Eflornithine (DFMO). For Carmen Pérez, MSF Field Coordinator in Haut Mbomou, “the previous treatment was very aggressive because it is an arsenic derivative; it is extremely painful and actually kills one in twenty patients”, as well as generating ever more resistance. Eflornithine, however, “can kill the parasite that causes the sickness in 14 days and without as much suffering on the part of the patient”, which also boosts trust in those receiving diagnosis and treatment. “Treating 1,500 people means saving 1,500 lives because sleeping sickness is fatal if untreated and this is a major achievement”, says Carmen Pérez. MSF’s aid work also brought down the prevalence of the disease by an average of 0.5% in the prefecture. Because MSF had planned to run the project for five years, in January 2006 it began the handover process to the Ministry of Health and since then has been working on reinforcing local staff training (for up to 33 workers including nurses, auxiliary staff and laboratory technicians). In order to ensure the continuity of the programme, MSF has also donated equipment, materials and laboratory and treatment kits to the health structures. At the time the Haut Mbomou project closed, it had four expatriate workers (a doctor, a nurse, a logistician and a lab technician) and 39 national staff. Its total cost was over €800,000. The project also provided treatment for malaria using Artemisinin-based combination therapy (ACT). MSF has been working in the CAR since 1997 running malaria and sleeping sickness treatment and prevention programmes and providing aid in emergencies. Given the growing instability along its border with Chad, a new project has recently been launched in the sub-prefectures of Kabo and Batangafo (in the northeast of the country) aimed at improving people’s access to free, quality healthcare and at responding to possible emergencies. Read other articles on Central African Republic
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