Coping with disease and drought in Upper Nile

Medical staff said the child was suffering from Kala Azar - a severe
parasitic infection transmitted by the female sand fly, which mainly lives
in Acacia and Balamites woodland. Left untreated, it is fatal in 95
percent of the cases.

"Most Kala Azar patients arrive in the hospital unable to walk and have
other co-infections, such as TB or malaria, because the disease destroys
the body's immune system," George Mbaluto, a nurse working for the medical
charity MSF-Holland which runs the hospital, told IRIN.

"They are usually severely malnourished and are often carried here by
relatives," he added.

The temperature in the intensive care unit was 48 degrees Celsius, as the
heat of the dry season simmered over Malakal. It was so hot that before
taking the child's temperature, the nurse had to dip her thermometer in a
bowl of cold water to cool it down.

According to the medical personnel at the hospital, the Kala Azar season
in Upper Nile coincides with the dry season. It lasts from
September-October until January-February. During this season there is also
an increase in dust-induced pneumonia, as well as bloody diarrhoea.

"The water-level of the River Nile is very low around this time of the
year and people drink directly from the river, while they also use it to
bathe and wash their clothes," Samuel Nyitwel, the supervisor of the
hospital's in-patient department, told IRIN.

Widespread in Few Countries

According to the World Health Organization, there are 500,000 new cases of
Kala Azar per year in 88 countries around the world. However, 90 percent
of all the cases occur in only five countries: Bangladesh, Brazil, China,
Nepal and Sudan.

In Sudan, it is found in a belt that runs from Unity State, through Upper
Nile, Blue Nile, Sennar, and Gedaref, up to Kassala in eastern Sudan. It
is also found in some parts of Ethiopia, Kenya, Somalia and Eritrea.

Mbaluto said new Kala Azar patients usually had to spend 30-45 days in the
intensive care unit to stabilise the disease and treat complications. On
average, Kala Azar patients remain in the hospital for one to three months
before they are discharged.

Most patients who receive treatment recover, but some die. Recently, a
small girl died of co-infections in the hospital. Mbaluto said she had
Kala Azar, TB and meningitis.

Peter Garmaac Chol, a 37 year-old blind man from a village near the town
of Ayod, showed up at the hospital in January suffering from Kala Azar. He
travelled on his own for over two days, making his way to the hospital
despite his lack of sight.

Chol, who was 1.91 mt tall, but weighed only 53 kg, was discharged on 21
February, but he was still too weak to make the entire journey back to his
village by himself.

"We are trying to track down his relatives so that they can pick him up,
but so far we have been unsuccessful," Mbaluto said.

Other Diseases Widespread

Diseases such as TB, malaria, diarrhoea, pneumonia and severe
malnutrition, have also taken a heavy toll on the population of Upper
Nile. During the last week of February, the Malakal hospital had 170 TB
patients on treatment.

"TB is endemic all year round and, as the first phase of the disease is
highly infectious, new patients have to be isolated for up to 2 months,"
Moussa Hamadan, a national TB doctor, told IRIN.

To complete the treatment, patients have to stay on combined TB drugs
treatment for six to nine months. Those who live far away stay in the
hospital during the entire time. Patients from nearby villages only stay
in quarantine during the initial phase, then come to the hospital to get
their medication every day.

MSF is training medical staff from the Sudanese Ministry of Health to
eventually take over the Kala Azar and TB programmes. However, it costs
almost US $1000 to treat a TB patient, which is a substantial financial
constraint for the ministry.