May 20, 2015

We walked across a narrow bridge made of old boards corroded by time and salt water, surrounded by humble, austere houses. This is Tumaco, a city in the southwest of the department of Nariño, Colombia, where the general state of abandonment is plainly seen. People receive us with interest, wanting to know about this Chikungunya disease, whose exotic name comes from the African language Makonde—it was first detected in Tanzania in 1952—and means "bent over with pain," in reference to sufferers’ stooped appearance caused by joint pain.

This little-known virus is spread by infected mosquitoes, causing high fever and severe joint pain. In Colombia, it has already affected 208,044 people this year, according to the National Institutes of Health. The first cases were recorded in September last year.

The Doctors Without Borders/Médecins Sans Frontières (MSF) team and the Nariño Departmental Institute of Health continue their tour of this impoverished neighborhood to raise awareness of the disease. They go from house to house, instructing inhabitants to cover food and drinking water, and to spray their houses, clearing away items that might suffer some type of damage.

In a humble abode, an elderly lady who is lying in bed alone and distressed, tells us that she has been suffering for a month. “Since last month I have been dragging my feet when I walk around the house, as if they were made of iron, and every day I wake up with a new and intense pain,” she tells them. “In all this time there has not been a day when I don’t have a fever, my head doesn’t hurt or I don’t wake up with swollen hands and ankles. I also suffer from sore shoulders, knees and neck, and itching all over my body. But what makes me panic most is the flaking I have on the soles of my feet and my elbows, as if I was a fish.”

These are the symptoms of Chikungunya. There have been 930 cases in Nariño since 2014, although the number is probably much higher since most sufferers are not diagnosed.

Manual spraying for vector control in the most vulnerable neighborhoods—where the houses are built on stilts over water—has been carried out in 10,000 homes, protecting about 50,000 people. In addition to the spraying, MSF has trained emergency medical personnel in several hospitals for clinical diagnosis, treatment, and epidemiological reports.  The MSF team has also explained to pharmacists the complications of mismanagement and the need to refer the sick to health centers.

In Colombian culture, the pharmacist plays a key role in medical care. Whereas the doctor is perceived as being an unapproachable and distant figure, the pharmacist is the person that patients trust and feel close to and that they can call on. This situation is more pronounced in Tumaco, partly because of the difficulties in getting health care. In local pharmacies, people find an immediate and effective response to a large percentage of their minor ailments.

With the Chikungunya epidemic, people have felt that the suffering through long waits in the emergency department only to return home with a dose of acetaminophen (paracetamol) cannot be justified. They look for alternative remedies to their severe pain from pharmacies. Unfortunately, this is a new disease in our country, and pharmacists and health workers have little knowledge on how to treat it. Moreover, most population attributes the pains to “God punishing us” or “the seven plagues” or other superstitions.

Due the large number of cases, the sometimes long-term inability to work, the adverse effects from inappropriate medicines, and the consequences of inaccurate diagnoses, the disease has a high social impact. Therefore, another element of the organization’s response has been the donation of 600 tests to help diagnose this emergent disease and help sufferers get the proper treatment.

Chikungunya is a viral disease transmitted to humans by infected mosquitoes. It causes fever and severe joint pain. Other symptoms include muscle pain, headache, nausea, fatigue, and rash.

Joint pain is often debilitating and can vary in duration. Most patients recover fully, but in some cases joint pain may persist for several months, or even years.

The disease shares some clinical signs with dengue, and can be misdiagnosed in areas where dengue is common.

There is no specific antiviral drug treatment for Chikungunya. Treatment is directed primarily at relieving the symptoms. There is no commercial Chikungunya vaccine.

The proximity of mosquito breeding sites to human habitation is a significant risk factor for Chikungunya.

Chikungunya has been identified in over 60 countries in Asia, Africa, Europe, and the Americas.

The disease occurs in Africa, Asia and the Indian subcontinent. In recent decades, mosquito vectors of Chikungunya have spread to Europe and the Americas. In 2007, disease transmission was reported for the first time in a localized outbreak in northeastern Italy. Outbreaks have since been recorded in France and Croatia.

 

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