In rural Gong Dong, China, New York
doctor Ed Chai is training local health workers in western
medical techniques that will complement their background in
traditional Chinese medicine...
Name: Edward N. Chai
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Episode: "A Long Way From Home"
Project Update: Cutaneous Leishmaniasis in
In this episode, Dr. Milena Rosales and Biologist
Eugenia Alvarez are treating people who have contracted a disease
known as cutaneous leishmaniasis in the rural region of Satipo,
Peru. The drug they are using, sodium stibogluconate, or SSG, was
created more than 70 years ago. It is administered through a drip
and is painful and toxic, with occasionally dangerous side effects.
Because there is no research and development being done into new
drugs for leishmaniasis, it is all MSF has.
MSF opened the project in Satipo in February, 2001,
in response to indications that cutaneous leishmaniasis was endemic
to the isolated region, which is populated primarily by impoverished,
ethnically marginalized groups with very little access to health
care. For the first year, MSF concentrated on identifying people
with the disease and assessing the need for an intervention.
After MSF identified two-and-a-half times as many
cases as expected, the team’s objective became the creation
of a sustainable local response to cutaneous leishmaniasis in Satipo;
MSF aid workers began training local health workers to treat the
disease while lobbying the Peruvian government to take over the
burden of providing funding for treatment. By March, 2003, MSF had
treated hundreds of people with cutaneous leishmaniasis in the region
and had trained four district doctors and the staff of San Martin
de Pagoa hospital in recognizing and treating the disease.
More importantly, the Peruvian Ministry of Health
now provides a generic form of SSG which is 20 times cheaper than
the branded alternative. Its mission accomplished, MSF closed the
Satipo project. But the story of Satipo is one battle in a much
larger war – in many countries across the globe, a deadlier
form of leishmaniasis takes a terrible toll, and lack of a better
treatment than SSG has led to drug-resistant strains of the disease.
A Lethal Cousin: Lack of Research and Development
for Visceral Leishmaniasis Treatment
Leishmaniasis is spread by the bite of a sand fly.
Although never fatal on its own, cutaneous leishmaniasis can be
disfiguring if left untreated, and in some rare cases people have
been killed by bacterial infections that result from the disease.
Cutaneous leishmaniasis has a lethal cousin, however,
which affects the internal organs instead of the skin. This version
of the disease, visceral leishmaniasis, or kala azar (translation,
black fever), is endemic in 88 countries, but most cases of the
disease occur in the Indian subcontinent (India, Bangladesh and
Nepal), Sudan, and Brazil. Although most Westerners have never heard
of Kala Azar, one person dies from the disease every ten minutes.
Moreover, in large parts of India, the drug has become
ineffective because of parasite resistance. Miltefosine, an anti-cancer
drug discovered in the mid-1990s, is the first oral drug to treat
the disease, but treatment takes 4 weeks and is not indicated for
women in childbearing age. It has only been registered in India.
The real miracle drug is Ambisome® - it is simple to use (max.
10 days), revives patients within hours of getting the first shot,
and has virtually no side effects. The drawback is that there is
only one producer and it is astronomically expensive – the
best current price offer is US$1,500-2,400 per treatment, well beyond
the reach of most patients.
There is very little investment in development of
new drugs for kala-azar, since there is little possibility of financial
return. Veterinary research may provide some hope, since the disease
also affects dogs in wealthy countries. Safer, simpler, and cheaper
drugs and diagnostic tools are urgently needed, particularly for
patients in Africa.
read more about the crisis in research and development of treatment
for visceral leishmaniasis, click here.