Last week I focused on malnutrition, and how that affects so many people in developing countries – often as the primary cause for the secondary disease they end up in hospital for. This week I am looking at Human African trypanosomiasis, or sleeping sickness. The World Health Organisation estimates that there are between 50,000 and 70,000 people with sleeping sickness in Africa, and that millions more are at risk.
Lots of Work the World students have come across the disease during their electives, giving them firsthand experience that they could never have received at home. And if MSF are to be believed, this is going to be vital in our understanding of how to approach and overcome the problem. “Nearly eliminated in the 1960s, sleeping sickness has made a comeback of epidemic proportions due to war, population movements, and the collapse of health systems over the past two decades.”
WHO outline the disease and its progression:
“In the first stage, the trypanosomes multiply in subcutaneous tissues, blood and lymph. This is known as a haemolymphatic phase, which entails bouts of fever, headaches, joint pains and itching.
In the second stage the parasites cross the blood-brain barrier to infect the central nervous system. This is known as the neurological phase. In general this is when more obvious signs and symptoms of the disease appear: changes of behaviour, confusion, sensory disturbances and poor coordination. Disturbance of the sleep cycle, which gives the disease its name, is an important feature of the second stage of the disease. Without treatment, sleeping sickness is considered fatal”.
Diagnosis must be made as early as possible as once patients enter the neurological stage the damage is irreversible. Depending on how patients present, this can be simple or more complex – for example parasites can trigger enormous swelling of the lymph nodes that are an obvious warning sign, but in some cases the damage spreads internally, exhibiting itself via anaemia, endocrine, cardiac, and kidney dysfunctions.
Who does it affect?
This vector-borne parasitic disease occurs in only 36 sub-Saharan Africa countries and is caused by tsete flies. There is still a lot to understand about why people are affected by the disease – although it seems to mostly affect rural areas, and can take out whole villages at a time, Confusingly, there are many regions where tsetse flies are found, but sleeping sickness is not.
The Guardian reports that “in Sub-Saharan Africa, the chances are you will not receive safe, effective drugs, and you will die from the disease or its treatment. Even if a person isn't infected with the disease it still devastates lives, because it infects and kills livestock, too.
Currently, the drug most commonly used to treat sleeping sickness is melarsoprol. A derivative of arsenic developed more than 50 years ago. Treatment from this drug is excruciatingly painful and potentially fatal. Often described by patients as “fire in the veins,” between 5 and 20 percent of those treated die of complications from the injected drug".
What experience have our students gained?
“A reason for choosing Ghana was for me to see medicine in a completely different setting, in a deprived area where diagnoses had to be made and treatment had to be given without the simple equipment that we take for granted in the UK. This meant that diagnosis was much more challenging as you had to rely more on clinical judgement and medical knowledge. I also wanted to go to a place where the spectrum of disease would be very different from what I was used to, and it certainly was. I saw a child with sleeping sickness, another with tetanus and many with malaria, diseases I would be unlikely to come across in a lifetime in the UK”.
Rachel Stafford, University of Manchester
“I spent a day of my recent trip to Tanzania in Mwanza's Government referral hospital. It serves a population of over 8 million people living in the Lake Zone and patients from all walks of life are referred here for tertiary healthcare services that are not readily available at regional or district level hospitals.
I joined one of the students on the Paediatric ward, where there were two children suffering from sleeping sickness – the student explained to me that unfortunately both had delayed diagnosis and were in the neurological phase of the disease. It was incredibly sad to think they would never fully recover”.
Susie Anthony, Work the World Operations Manager for Tanzania