Letters from Ann Evans, Old Fangak.

4th Kala-azar Letter from Old Fangak

The race against time continues in Old Fangak, no sign of a Thanksgiving holidaythe kala-azar epidemic slacking for a Thanksgiving holiday—not here, not now.   With the 30-day treatments completed, many are recovering; but I’ve lost count of deaths, each to a family that hoped against the odds, that mostly waited too long, arrived too late, the blood count dropping to nearly nothing.   Getting here is complicated—whether to pay the boat fare—if a boat is even an option, or money can be found; or to make the long trek on foot, carrying a sick child, perhaps bringing other children and family too.  One mother had had five live births, and all five of her children died.  Infant and maternal mortality are so high in Sudan that census takers don’t count breast-feeding babies at all; instead, mother and baby tally as one ‘person’.   Thanksgiving, in Old Fangak?  It won’t be like any I have known.

Kala-azar is called one of the ‘neglected’ tropical diseases, neglected because it hasn’t garnered the attention and resources of other diseases.  Is it ‘neglected’ because it occurs in some of the poorest regions of the world?—90% in Bangladesh, India, Nepal, Sudan and north-eastern Brazil?   Jill says research is being done and medicines to treat it are now available; attempts at developing a vaccine continue but haven’t been successful.  It’s a tough disease to prevent—how to stop the bite of a tiny sand fly, just a third the size of a mosquito.  Sand flies travel through mosquito nets with ease; only the no-see-em nets keep them out.   Insecticide treated bednets are an option, but come with other barriers—like the higher cost and short lifespan of the insecticide.  Personal insecticide sprays and insecticide-impregnated clothing are beyond the means of people in villages like Old Fangak, where children wear just a shirt or simple dress, and sometimes not even that.

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