MSF takes an innovative approach to eliminating sleeping sickness, taking mobile clinics by Land Rover and boat to far-flung parts of sub-Saharan Africa.
Apart from MSF, there are few organisations in the field dealing with sleeping sickness, a disease of the nervous system that is spread by the tsetse fly, causing severe neurological disorders or even death.
Dr Andreas Lindner is a member of MSF’s team, working to combat this neglected disease in Chad, Central African Republic, South Sudan, Republic of the Congo and Democratic Republic of Congo.
He shares his insight and experience on combating sleeping sickness:
Finger prick screening for sleeping sicknes, DRC. If this test is positive further more complex tests are needed to confirm sleeping sickness.
© Robin Meldrum
Opportunity to eliminate sleeping sickness
“We’ve been presented with a unique opportunity to help eliminate sleeping sickness.
Over the past few years, the disease has slowly been coming under control and, with a concerted effort, it’s feasible that the next few decades will see the elimination of this disease.
It’s in sight, but everything depends on what we do now, and our willingness to really focus and invest resources and manpower into tackling the disease.
I’ve spent the past few months working in areas affected by this disease in Chad, Central African Republic and Republic of the Congo, and what I’ve seen has convinced me that, although this disease is still a problem, the opportunity is there to deal with it.
Elimination is our aim but, in order to achieve that, we need a sustained effort to overcome some serious obstacles.
Ready-to-use tests
Firstly, we need new diagnostic tools in order to identify the disease, as the current tools aren’t up to the task.
Right now, if we want to diagnose patients with sleeping sickness, we have to use a lot of complicated equipment, including centrifuges and microscopes, which are cumbersome and difficult to use in remote areas.
If you’re out in the middle of Central African Republic, travelling by boat up a river, it’s not efficient or practical to be using such complex equipment.
What we need are ready-to-use tests that can be used by local health staff in rural health posts. Like the malaria test, it should be a simple finger-prick test, where small drops of blood are put on a test and you quickly get the result.
Time for action
These tests are in the development pipeline, but we can’t afford to wait several years for them to come online.
There are people suffering and dying now, and there has to be a concerted effort to move things along. Now is the time for action.
Along with research and development, more effort needs to be put into control of the disease in the here and now. It means we have to go to remote areas which are often politically unstable and have weak health systems. We have to go and find patients in their villages, with systematic screening.
There are large areas in endemic countries without surveillance, where we just don´t know what is going on. Apart from MSF, there are few organisations in the field dealing with sleeping sickness.
MSF innovation
MSF team conducts a lumbar puncture test for sleeping sickness, required to determine the appropriate course of treatment. DRC, February 2011
© Robin Meldrum
We also need more innovative approaches to control, which is why, at MSF, we came up with the idea of creating an international mobile sleeping sickness team.
In some of these remote areas where the disease is prevalent, we can’t justify setting up a full and permanent project.
But what we can do is establish a small mobile unit made up of a lab technician, a medical doctor and a few others, who can travel across regions in a number of countries screening people and treating the disease.
I was in the first team that set out in August last year, and we started working in areas where the national control programmes struggle, and where political instability or remoteness make disease surveillance and management difficult.
Reaching the sick
There were a lot of lessons learned. In southern Chad, we screened a little village of about 2,000 people over two-and-a-half days. There was a good response and we didn’t find a single patient.
But after the screening was finished and we had moved 50km on into Central African Republic, people from the same village caught up with us, with a young woman who was suffering from the disease.
The woman was unable to walk, or even to feed herself. We asked her why she hadn’t come to the screening, and she told us she had felt too sick to come.
That was a real wake-up call for us, because it showed us how difficult it can be in remote environments to really get to the people who need help. We need to visit the most far-flung villages and look into people’s huts to find those who are too sick or too ashamed to come for help.
We learned a similar lesson with fishermen, who are exposed during their working day to the tsetse fly. In order to reach these people, we quickly realised we had to be up at dawn, before they headed out on their boats, otherwise we would miss our chance.
National programmes needed
However, all the smart approaches in the world will not make a difference to this disease unless we put our full support behind national control programmes and national health systems in countries where the disease is endemic.
With health services already fighting other epidemics such as HIV, it’s easy for sleeping sickness to become even more of a neglected disease.
In many of these countries, the national programmes are poorly equipped and don’t have the capacity to deal properly with the disease.
We have to realise that, ultimately, it is the national control programmes – and not MSF, or any other organisation – that will get this disease under control, and they need all the support and cooperation they can get.
We’ve talked about a ‘final push’ to eliminate sleeping sickness, but in reality that makes it sound too quick, easy and short.
What we really need is a firm commitment over the coming decade – or more – to tackle this disease. I’m optimistic that it can be done.”