African Sleeping Sickness

Mobile Intervention Teams – On a Journey to Bandundu

African sleeping sickness is caused by a parasite which is transmitted by the bite of the tsetse fly. The result is this disease, which threatens millions of people in many countries south of the Sahara. Bayer supports mobile intervention teams of the World Health Organization in their efforts to control this infection in the remote focal disease areas. The teams are based in the country most affected: the Democratic Republic of Congo, where more than eighty percent of the cases occur.

“According to estimates of the World Health Organization (WHO), African sleeping sickness is a threat to 57 million inhabitants of the continent's tropical belt, 36 million in the Congo alone,“ explains Dr. Ulrich Madeja, while on the horizon the glowing red sun sinks into the glittering Congo River. Dr. Madeja, Global Head of Access to Medicines with Pharmaceuticals at Bayer, is on the landing approach to Kinshasa, the capital of the Democratic Republic of Congo (DRC), where he will meet Dr. Crispin Lumbala, Head of the Program for Control of Human African Trypanosomiasis (HAT) of the country. HAT is better known as African sleeping sickness.

 

Joining Forces

On January 30, 2012, Bayer and other pharmaceutical companies, together with representatives of WHO, the World Bank, the Bill & Melinda Gates Foundation, governmental and non-governmental organizations such as USAID (United States Agency for International Development) and DNDi (Drugs for Neglected Diseases initiative), along with several governments, signed the London Declaration on neglected tropical diseases (NTDs). Its objective is to completely eliminate – or at least bring under control – ten of the most devastating NTDs by 2020, including HAT. This is an engagement that Bayer takes very seriously.

“With nifurtimox, we produce one of the two important medicines for treatment of HAT used in the highly effective Nifurtimox-Eflornithine Combination Therapy since 2009,“ says Dr. Madeja, “and we do it exclusively for distribution by WHO. But providing medicines to WHO is not enough. Since 2013, our support is focused on DRC as country with the highest disease burden. We financially support mobile intervention teams reaching out to remote focal disease areas where they actively screen people for HAT patients and refer them to treatment centers.”

 


While seeing hospital patients in Kinshasa, Dr. Ulrich Madeja and Dr. Crispin Lumbala are joined by Sylvain Baloji Kanga, National Supervisor of PLNTHA, a program that fights African sleeping sickness (HAT), as well as a local nurse (right to left). 

Dr. Lumbala (l.) and Dr. Madeja (r.) on the journey to Mushie, a small city 60 kilometers northwest of Bandundu, which is best reached by boat and provides one of the rare opportunities to make phone calls.

A visit to the hospital pharmacy in Mushie: Dr. Madeja (l.) shows the content of the individually packed Patient Treatment Kits provided by the World Health Organization. Beside medicines for the combination therapy (NECT), they contain instructions and all supplements necessary for the treatment of one patient and can be used independent from what is available locally.

 

The next morning, Dr. Madeja, accompanied by Dr. Lumbala, leaves Kinshasa to get a personal impression of the work of these mobile teams. On the eight-hour jeep journey to Bandundu, the province most seriously affected by HAT, Dr. Lumbala explains: “It's important to actively search for the patients and to find them during the early stage of the disease when they are not yet showing specific symptoms, when they can be completely cured and the spread of the disease is low. This is why the mobile teams visit village after village, screening all of the people. Not only those who are unwell, but also people who feel nothing at all and don't appear to be sick.“

 


 

Too Few to Cover so Many
In Bandundu Ville, the two doctors meet with Dr. Florent Mbo, their colleague who coordinates the program's activities. 13 mobile intervention teams systematically examine the entire population of all villages in the province at regular intervals. "Each of our teams checks a certain number of endemic villages every year," Dr. Mbo explains. "Last year, it was about 500. However, the proportion of the population that is endangered is very high compared to the number of mobile teams. We really need a lot more staff."

 


The bite of the blood sucking tsetse fly transmits African sleeping sickness. This insidious infection is caused by single-celled Trypanosoma parasites, which, after initially long periods of not highly specific symptoms, at later stages of the disease attack the human brain and mostly cause disabling symptoms.


 

 

Drs. Madeja, Lumbala and Mbo continue their travel, now going to Mushie, which is 60 kilometers northwest of Bandundu Ville, and is best reached by water. In their next three hours on the river, the only other people they see are some paddlers standing in their dugouts, some women washing clothes on the river banks in front of a few huts made of palm fronds, and fishermen wading up to their waists in water – all of them right in the middle of the tsetse fly's hunting grounds, where the vector infects its unsuspecting victims with a sore sting.

 

 

Marked by the Disease
This is exactly how Nsole Bompina caught the disease. He is currently the only HAT patient in Mushie´s hospital, which was built by the Belgians during their colonial rule, and makes an extremely neat impression for the region. In the well-swept courtyards hang the freshly washed clothes of patients and their families, who pass the time sitting in front of the light green-painted wards. Among them is the fisherman Nsole, his brother Lokua and their sister Isumu. Nsole is visibly marked by the disease; he can't stand or walk on his own and has difficulty talking. His brother and sister wash and feed him every day, putting a total of three of the family's breadwinners out of action.

 

Nsole Bompina (center) is a fisherman infected with African sleeping sickness (HAT). His sister Isumu (l.) and brother Lokua (r.) accompanied him during a fourteen-hour journey to the hospital.

 

Nsole´s brother paddled him to Mushie with his dugout canoe in a 14-hour tour de force. "When I came to him, he could neither sleep, nor speak, nor eat," emphasizes Lokua. "His skin was flaking, and he was terribly choleric toward his wife. But people where we live know these symptoms. If a person strikes someone for no reason, and also has fever and a headache, like with malaria, they know that this man is suffering from sleeping sickness."

In their search for the intervention teams, who cannot be reached by telephone or otherwise during their mission in the hinterland, Drs. Madeja, Lumbala and Mbo continue their travel to Ngantoko the next day. The small village, 80 kilometers northeast of Mushie, is only accessible by boat. No sooner do they approach the landing stage than Dr. Madeja, the first visitor from Europe for years in this area, is greeted by hordes of frolicking children. Women in hitched-up skirts pause in their task of washing clothes in the shallow waters near the shore for a discreet look, and fishermen shyly offer their fresh catch. 

 

The mobile intervention team, with their equipment ready, examines villagers at wooden tables that have been set-up under large, shady trees on the central square of the village. As Dr. Madeja and his colleagues walk through the village, their entourage and the volume level grow continuously. The latter is surpassed only by the megaphone announcements of the village’s speaker, who explains the team's purpose to the population and calls on them to participate in the screening.

 

The children in Ngantoko welcome Dr. Madeja with curiosity and fun since he is the first European visiting their village in the last five years.
Alexandre Mbukatoto, medical director of the mobile intervention team in Kutumpay, is firmly convinced that their work is crucial to screen patients in potential disease areas and refer them for treatment at the next hospital.
Dr. Ulrich Madeja, Sylvain Baloji Kanga (from left) and Dr. Florent Mbo (right) together with staff of the Centre de Santé de Bemu, review examination protocols for CATT, a blood test which can detect African sleeping sickness.

 

Control of Vectors and Carriers

The long queue in front of the intervention team's tables is evidence of how successfully he has done his job. While doing a blood test, the Card Agglutination Test for Trypanosomiasis (CATT), which determines whether a person has come into contact with trypanosomes and has developed antibodies, the teams’ chief physician Dr. Alexandre Mbukatoto affirms: "We bring the techniques for fighting the disease and early detection to places where there are no clinics, and the population is very poor. The fight against African Trypanosomiasis would be impossible without the mobile intervention teams.”

 

Many hours later, the doctors begin their journey back to Kinshasa on the mighty Congo River. After the hearty farewell by the people in Ngantoko, Dr. Lumbala depicts a problem that is arising because of the undeniable success of the teams: “In Bandundu, five mobile teams only found 18 patients last year. That's no longer cost-effective, but we must maintain monitoring in the field. Otherwise, there will be an increased risk that the number of cases will start rising again." 

 

Dr. Mbo shares his worries by pointing to another serious aspect in the battle against HAT: “We must also focus on vector control and destroy the carriers of disease because if the vectors remain in our environment, there will always be people who will fall ill.“ He refers to the fact that the traps used against the tsetse flies could be significantly more effective if they were impregnated with pest control agents. He continues, “We see how the disease repeatedly flares up again in the villages where we have examined the entire population. In other words, we must combine the screening, the treatment and the fight against the vector.”

 

 

 

 

 

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