Bechaini Debi Chaudhari is frightened she may die from Kala-azar, a deadly fly-borne disease, which is fatal if left untreated. She has been undergoing treatment for the last 45 days and is still not cured.
“We have spent so much money and now we cannot afford any more,” her son, Rameswar Chaudhari, told IRIN. The family owns only a small plot of agricultural land, which they mortgaged to take out a loan of US$500 to pay for Chaudhari’s treatment.
Kala-azar, also known as visceral leishmaniasis, is an infectious disease common in many tropical countries. It is characterised by lesions of the liver and spleen and is often fatal. It's transmitted to man through the bite of an infected female sand-fly and the incubation period is generally two to six months Children are generally more susceptible than adults.
Bechani and her son traveled over 175 km for treatment from their home in Mohatarri district to the town of Dharan in Koshi province in eastern Nepal. Although Bechani’s family is sceptical whether she will survive, her doctors have reassured them that she will live.
But many are not as lucky as Bechani. Despite an alarming number of people infected with Kala -azar, the level of awareness of the disease is still very low. Experts say that though it is a major public health problem, there is no national commitment to tackling it. The reason may be that the disease is mainly concentrated in only one region of the country, the southern plains of Nepal and affects the most poverty-stricken.
“Kala-azar affects the poorest of the poor and drives them further down the spiral of poverty from which they are unable to recover,” Samlee Plianbangchang, Regional Director for the World Health Organisation (WHO) South-East Asia Region said last week when Nepal, India and Bangladesh signed a regional agreement to collaborate on eradication of the disease. According to the WHO, Kala-azar affects 100,000 people each year in the countries where it is endemic and puts 147 million people at risk.
In Nepal alone, around 6 million people on the plains are vulnerable to Kala-azar, said a government report recently, indicating that the disease has now become a major health crisis for the country.
In a poor country like Nepal, where malnutrition and low immune function are major problems, the disease is regarded as 100 percent fatal if not treated on time. Bangladesh and India have made inroads into tackling it but cases are reportedly increasing in Nepal.
The Nepali government has introduced Kala-azar control programmes focusing on early diagnosis and prompt treatment, as well as establishing laboratory diagnostic facilities. It has also introduced indoor residual spraying. But patients and some health experts complain that the government has not done enough. Many affected families have accused the government of not spraying enough places to control the disease.
The disease is most prevalent in Nepal’s drought areas and densely populated villages where there is poor sanitation and unhygienic living conditions. This is evident in Dharan’s dirty slum areas where unsanitary pig farms are seen as massive breeding grounds for the sand-flies that carry the disease.
With less than 33 beds in Dharan hospital’s Kala-azar ward, the medical facility has to host patients from all over the eastern region. Nearly 100 people have been admitted since January. At least 90 have left the hospital following treatment but two patients, a 4-year old child and 27-year old woman have died from Kala-azar.
Until last year, the treatment was free at the hospital but now patients have to foot all the medical bills. Many sufferers who cannot afford treatment are now turning to faith and traditional healers.
“Several have died in the last few years due to their blind faith in the healers,” explained Prahlad Karki, head of BP Koirala Hospital, one of the biggest tropical disease facilities in the country.
Meanwhile, WHO is working hard to reduce the prevalence of the disease.
“Our goal of eliminating Kala-azar from Nepal will also contribute to improving the health of vulnerable groups,” said WHO’s Plianbangchang. “This [agreement] signals greater political will and commitment to collaborate in reducing the annual incidence of Kala-azar to less than one per 10,000 population, at the district or sub-district level, by 2015,” he added.