Disfiguring skin disease plagues Afghanistan*

06 May 2007 23:03:38 GMT
Source: Reuters

KABUL, May 7 (Reuters) - The 10-year-old Afghan girl has big eyes, a shy
smile and a dark lesion speckled with blood on her right cheek.

The girl has leishmaniasis, a disease caused by a parasite transmitted
by a tiny sandfly that can lead to severe scarring, often on the face.

The girl, Sahima, wearing a purple tunic and trousers and pale blue
shoes, answers "no" softly when asked if the sore hurts.

But her father is worried about the lesion, the size of a big coin.

"Of course, this doesn't look good," the father, Najibullah, said at a
leishmaniasis clinic crowded with children with sores in the Afghan
capital, Kabul.

Najibullah said he first noticed a mark on his daughter's face two
months ago. "It was a very small dot but it grew and grew. If it grows
any more it will cover her whole face."

Leishmaniasis isn't a priority for the government and its aid donors,
grappling with shocking rates of infant mortality, tuberculosis, malaria
and trauma.

The most common form of the disease is not fatal but it causes untold
misery. Victims with scarring on their faces are stigmatised: children
are excluded at school and girls often won't be able to find husbands.

Long-neglected by the rich world, the disease is attracting a bit more
attention in the West, if not more funds.

Some foreign troops in Afghanistan and Iraq have also been bitten by the
sandflies and have developed the disease. NATO saw about 150 cases in
Afghanistan in 2005 and about 12 last year, a force spokeswoman said.

NATO camps have been fortified to try to stop the sandflies and soldiers
are warned to keep sleeves rolled down, to use insect repellant and to
watch for bites.

"DISEASE OF DESTRUCTION"

But it's Afghanistan's poor who are most vulnerable.

Kabul, battered and neglected for years, has the world's worst outbreak
of leishmaniasis, health experts say.

"It's out of control, absolutely out of control," said Reto Steiner, a
medic with the German Medical Service which helps run the Kabul clinic.

"You won't control it until the sanitation has recovered."

The deep ulcers caused by the parasites will heal if left untreated, but
that invariably involves disfigurement and can take many months. That
has given rise to one of the diseases many nicknames: saldana, or
one-year sore.

Though present in all Afghan cities, it is in Kabul's crowded
neighbourhoods that the disease has exploded and spread to hundreds of
thousands of people.

"When we have one case in a family, of course, it's not only one case:
it will be all the family and even the neighbours," said Health Ministry
official Abdullah Fahim.

The sandflies that spread the parasites are carried by animals including
dogs and a species of gerbil, as well as people. The insects often breed
on waste land and in rubbish.

Although they don't fly well, the insects infest the cracks and crevices
in people's homes from where they emerge to bite exposed parts of the
body -- noses, chins, cheeks and hands -- as people sleep, from late
spring to autumn.

"It's a disease of destruction," said Toby Leslie, a researcher from the
London School of Hygiene and Tropical Medicine. "It will thrive in
post-war areas and areas where there's poor sanitation, poor community
services."

Cutaneous leishmaniasis is not fatal although a less-common form,
visceral leishmaniasis, can cause organ failure and death.

"Leishmaniasis is one of the top neglected diseases, certainly outside
Africa, and it just doesn't attract the funding that's needed," Leslie said.

TREATMENT, PREVENTION

Doctor Faquir Amin says he's been treating leishmaniasis since the
1960s. Refugees returning from abroad are particularly susceptible as
they have no resistance, he said.

"No one's taking care of it. The people are coming, it's crowded, the
people are susceptible and the disease is increasing," Amin said at his
Kabul clinic. "It is not a killer disease but mentally people suffer. We
have to deal with it."

The sores are treated with a course of injections, or cauterized to kill
the parasites. Amin's clinic has the only laser cauterizing machine in
Afghanistan. Electric cauterizing machines are also effective and much
cheaper.

Prevention is also key, experts say.

Bed nets impregnated with insecticide are being distributed to stop
malaria and they will also stop sandflies spreading leishmaniasis. But
only a few nets are being distributed compared with the number needed.

"The ministry is battling to get funds and no one's interested. It's
impossible to get funds," said Health Ministry adviser Kathy Fiekert.

"This is an issue that needs to be addressed."