ANGOLA: Progress on sleeping sickness brings new challenges

[ This report does not necessarily reflect the views of the United Nations]

CAXITO, 30 Jan 2006 (IRIN) - International medical NGO Medecins Sans Frontieres (MSF) handed over its final sleeping sickness project in Angola to the Health Ministry last week, having successfully contained and stabilised the disease.

But medical staff from both MSF and the national Institute to Combat and Control Trypanosomiasis (ICCT), which will assume responsibility for the sleeping sickness project in Caxito, in the northern province of Bengo, fear the illness could again spiral out of control if the Angolan authorities fail to manage it tightly.

MSF, in collaboration with the ICCT, has been working in three of Angola's six endemic provinces - Bengo, Kwanza Norte and Zaire - sending teams out into areas close to forests and rivers which provide an ideal climate for the tsetse fly, whose infected bites transmit the sickness.

These teams have actively sought out people with advanced symptoms of the disease - typically zombie-like expressions and lethargy. The patients were tested, treated, and the infection monitored for up to two years after the symptoms disappeared.

Coupled with public information campaigns and a scheme to trap and kill the flies, this programme resulted in a reduction in the infection rate in super-endemic areas to around 0.7 percent from 2.5 percent in 2002.

"When we started in 2002, we had an epidemic on our hands, but now the prevalence of the disease is low. The situation has stabilised," Dr Claude Kiangala Tukila, MSF's field coordinator in Caxito, told IRIN.

Two years ago MSF-Belgium's sleeping sickness centre in Caxito was full, and the busy staff were seriously concerned that Human African Trypanosomiasis (HAT) could run rampant. Now, all but three of the beds are empty and the situation has been downgraded to endemic.

With six endemic northern provinces, including Malanje, Uige and Kwanza Sul, it was feared that as many as four million Angolans could potentially be at risk if the reservoir of the disease, or infected people, was not reduced. Sleeping sickness is fatal if left untreated, but difficult to detect in its early stages because first symptoms such as headache, fever and muscle pains are often confused with other ailments.

"We have managed to contain this reservoir. The fewer people there are with the infection, the more difficult it is for the disease to spread," Tukila said.

The key task is to continue surveying vulnerable populations to keep the disease under control. Angola knows from experience how important this is, having all but eradicated sleeping sickness in 1975, before three decades of civil war took their toll on the country's health system and allowed the disease to return with a vengeance.

"The disease has not been eradicated. If sleeping sickness sufferers are not controlled afterwards, if active screening does not continue, if there are no programmes to get rid of the flies, then the cycle will start again," Tukila warned.

Yet there are niggling fears that the ICCT, which will take over the project next week, will be tempted to let surveillance slip, as other, seemingly more urgent health priorities, divert attention and resources.

"The ICCT has all the right qualifications to do this, but does it have the will?" Tukila asked. "At this moment, sleeping sickness is no longer a big problem, but there must be mechanisms in place to detect patients in the community. When we talk to ICCT staff, they say they are ready to take over, but we just don't know. We can only hope," he added.

Even some ICCT staff lament the fact that MSF is pulling out. There are aspects of the programme which may not continue, such as MSF's practice of giving patients money, sometimes as much as 4,000 kwanzas (US $50), for the bus fare back to Bengo for follow-up surveillance.

"We are worried about MSF leaving because they supplied us with materials, equipment and drugs. When MSF leaves, there will be problems for sure, but we are confident that we will control the level of the disease," said Luis Antonio, ICCT's laboratory head at the Caxito centre.

"The biggest headaches for us will be the lack of transport to do the active screening, and money for drugs," he said. "It is a little bit like having to start from scratch again, although MSF has made our job less difficult."

There is no question mark over the timing of MSF's pullout. With just three patients in Caxito requiring treatment, it is evident that the expertise and resources of the NGO, whose mandate is to provide medical care in emergency situations, could be better employed elsewhere.

"Clearly, the situation with sleeping sickness has stabilised, and the national institute has the necessary resources - both in terms of staff and financial resources - and skills to tackle this issue," said Joachim Delville, head of the Belgian branch of MSF in Angola. "It will take more effort to totally eradicate sleeping sickness, but that challenge is in the hands of the ICCT."

There is also a growing sense that after almost four years of peace, it is time the government of this oil-rich country started shouldering responsibility for its own problems. "All handovers are a bit tricky. We cross our fingers that it will go well," Delville commented. "It depends on the motivation [of the authorities], because the resources are there."

[ENDS]