An­other War Front

Cu­ta­neous leish­ma­ni­a­sis, also known as ori­en­tal sore, trop­i­cal sore, chi­clero ul­cer or Aleppo boil, af­fects hu­mans in a big way. It is cur­rently a ma­jor is­sue in Afghanistan and poses a se­ri­ous health haz­ard.

Southasia - - CONTENTS - By Hafiz Inam

A se­ri­ous epi­demic that needs to be fought on a war foot­ing.

The in­flux of a wide ar­ray of mil­i­tants into Afghanistan from dif­fer­ent parts dur­ing the Afghan-Soviet war of 1980s is now hav­ing se­ri­ous im­pli­ca­tions for the coun­try. Ml­i­tants poured into the coun­try when the cur­rent Afghan war started in 2001. This phe­nom­e­non of in­flux has brought man­i­fold dev­as­ta­tions for the Afghan pop­u­la­tion. Among many oth­ers is a flesh-eat­ing trop­i­cal dis­ease which is spread­ing like wild­fire. The dis­ease orig­i­nally stemmed from Latin Amer­ica and the Horn of Africa. It has now reached the Mid­dle East and Afghanistan and claims around 40,000 lives an­nu­ally. It is the se­cond largest par­a­sitic-killer dis­ease in the world af­ter malaria.

Cu­ta­neous Leish­ma­ni­a­sis (CL) is a vec­tor borne dis­ease which is found in the trop­i­cal re­gions. It is caused by a par­a­site trans­mit­ted by a tiny sand­fly which leads to se­vere scar­ring of the spot bit­ten by the fly. Usu­ally the ex­posed part of the body like nose, face, ear or hands is af­fected by the bite. It is not a fatal dis­ease but its other form, Vis­ceral Leish­ma­ni­a­sis is life-threat­en­ing as it dam­ages in­ter­nal body or­gans. The ul­cers caused by the par­a­site, if they re­main un­treated, lead to dis­fig­ure­ment and can take many months to cure. That is why it is called one year sore.

Kabul is wit­ness­ing the worst out­break of cu­ta­neous leish­ma­ni­a­sis, as con­firmed by the World Health Or­ga­ni­za­tion. Ac­cord­ing to Dr. Richard Peep­erkorn, a WHO rep­re­sen­ta­tive in Afghanistan, 15,000 cases of the dis­ease were re­ported in Kabul in 2012. There are around 200,000 es­ti­mated cases of CL in the coun­try whereas in Kabul alone, the num­ber of the vic­tims surged to 67,500 in 2016. Su­raya Dalil, for­mer Afghan Min­is­ter for Pub­lic Health, be­lieves that Afghanistan is a cu­ta­neous leish­ma­ni­a­sis en­demic coun­try as 40,000 new cases are reg­is­tered by the min­istry each year.

“It is a dis­ease of de­struc­tion,” says Toby Les­lie, a re­searcher from the Lon­don School of Hy­giene. It is not a fatal dis­ease but the so­cial stigma at­tached with it can turn one’s life into a night­mare. The stigma from the scar­ring can in­duce so­cial os­tracism of the af­fected per­son as a mis­con­cep­tion about the dis­ease pre­vails that it is di­rectly con­ta­gious. The preva­lence of such a fal­lacy is ev­i­dent from the fact that in­fected moth­ers are pro­hib­ited from touch­ing their chil­dren while young girls with dis­fig­ur­ing scars are deemed in­ap­pro­pri­ate for mar­riage. Even chil­dren with the con­di­tion are de­prived of ed­u­ca­tion be­cause of the con­cerns that other chil­dren may get af­fected by the dis­ease.

Rahima hails from the Khost prov­ince and is a vic­tim of so­cial ex­clu­sion. The 22-year old girl knows lit­tle about the dis­ease she is suf­fer­ing from, but what she is aware are the con­tin­u­ous stares of passers-by at her due to the pur­ple-coloured open sore she has on one of her hands. “I have hid­den my hand be­cause peo­ple are hor­ri­ble to me,” Rahima com­plained.

An­other young girl, Farzana, has faced a sim­i­lar trau­matic ex­pe­ri­ence. In her words: “Peo­ple are re­ally mean to me and say bad things, although they know they can’t catch this dis­ease from me.”

Rea­sons for the ram­pant epi­demic are many. The fore­most is the pop­u­la­tion dis­place­ment as the coun­try has seen many mi­gra­tions over the past decades. In 2016, 600,000 Afghans re­turned from Pak­istan and Iran and 623,000 fled their homes to set­tle in the ur­ban ar­eas in­side the coun­try, to avoid the con­flict. This has re­sulted in over­crowd­ing of the ci­ties, giv­ing rise to pa­thetic san­i­ta­tion, poor hous­ing and over­stretched health ser­vices in Kabul and other ur­ban ar­eas. The mi­gra­tion has paved the way for the wide spread of the dis­ease as the Afghan mi­grants are re­turn­ing from var­i­ous coun­tries where the oc­cur­rence of the dis­ease is al­ready high.

It is true that Leish­ma­ni­a­sis pri­mar­ily af­fects the marginal­ized com­mu­nity in ru­ral ar­eas or ur­ban slums where poor san­i­ta­tion, shoddy hous­ing schemes and over­crowded con­di­tions fa­cil­i­tate the growth of the sand­flies that breed in rub­bish and spread the par­a­site. This is also hap­pen­ing in Afghanistan where the wretched sight of eco­nomic de­pri­va­tion pre­vails in Kabul, Badakhshan, Zabul and other ci­ties. The poverty-stricken pop­u­la­tion is at high risk of catch­ing the dis­ease. This ar­gu­ment holds wa­ter given the fact that the im­pov­er­ished peo­ple lack per­sonal pro­tec­tive mea­sures and are de­nied ac­cess to med­i­cal as­sis­tance due to the heavy cost.

“We must act now if we are go­ing to have any chance of con­trol­ling the sit­u­a­tion,” says Dr. Des­jeux, for­mer head of WHO Leish­ma­ni­a­sis Con­trol Pro­gramme.

Afghanistan is en­tan­gled in sundry com­plex­i­ties and finds it dif­fi­cult to cope with the out­break of the epi­demic which can be cured by em­ploy­ing var­i­ous meth­ods. A se­ries of in­jec­tions of sodium sti­boglu­conate to the le­sions helps in treat­ing the dis­ease. Sim­i­larly, nets and win­dow screens can be used to avoid ex­po­sure to the in­sects. All this ap­pears a pain­less job, but it is eas­ier said than done, es­pe­cially when a coun­try ne­glects the very ex­is­tence of the men­ac­ing prob­lem. Afghanistan lacks the fa­cil­i­ties to re­strain the growth of the dis­ease.

There are a few leish­ma­ni­a­sis treat­ment cen­tres in the coun­try for the swelling num­ber of pa­tients. These are far-flung and lack the ca­pa­bil­ity to ad­min­is­ter in­jec­tions. Dr. Sami Nazhat, Di­rec­tor of the Na­tional Malaria and Leish­ma­ni­a­sis Con­trol Pro­gramme, de­scribed the sit­u­a­tion: “Leish­ma­ni­a­sis is a neglected dis­ease. We don’t have enough treat­ment cen­tres in Afghanistan. Drugs are of­ten not avail­able at the pri­mary health­care level and health­care staff lacks the ca­pac­ity to di­ag­nose and treat pa­tients.”

The flesh-eat­ing dis­ease has put the lives of 33 mil­lion Afghans at risk. The dis­ease is not fatal in most of the cases but it does bring hor­ri­ble con­se­quences. Scar­ring of the ex­posed part of the body of the vic­tim makes his life mis­er­able as the pa­tient re­ceives ig­no­min­ious treat­ment from fel­low be­ings who out­cast him on the premise of be­ing con­ta­gious. Women and young girls tend to ex­pe­ri­ence so­cial os­tracism more of­ten. To counter the mis­con­cep­tion, the mind­set needs to be changed as in­di­cated by Dr. Warusavithana, a WHO co­or­di­na­tor: “We need to fight the stigma as­so­ci­ated with the dis­ease by rais­ing peo­ple’s aware­ness, im­prov­ing early treat­ment and chang­ing harm­ful at­ti­tudes, es­pe­cially against women and girls. High oc­cur­rence of the dis­ease re­flects lack of se­ri­ous­ness on the part of gov­ern­ment au­thor­i­ties who have failed to pre­empt and de­ter­mine the men­ace in the first place.”

The writer is a mem­ber of the staff.

Newspapers in English

Newspapers from Pakistan

© PressReader. All rights reserved.