Imagine a hero on a mission, riding through the African wilderness, fighting a silent killer. This is the story of Andrew Ochieng, a man with a unique past and an even more remarkable present.
A Survivor's Story: Battling a Deadly Parasite
Ochieng's journey began as a child, when he survived the world's second deadliest parasite - visceral leishmaniasis. This little-known disease, often referred to as Kala-azar, has devastating effects, yet few outside of impoverished communities are aware of its existence.
Recalling his experience, Ochieng describes a prolonged fever, a feeling akin to being run over by a truck. He was just 12 years old. His parents and neighbors were clueless, turning to traditional healers who performed rituals involving razor blades and animal dung. It was only later that he received proper medical attention, but the scars, both physical and emotional, remain.
A Mission to Prevent Suffering
Driven by the desire to spare others from his ordeal, Ochieng now works as a community mobilizer for the Drugs for Neglected Diseases Initiative (DNDi), a nonprofit organization. His work takes him across the Kenya-Uganda border region, a vast rural landscape where visceral leishmaniasis thrives.
The statistics are alarming: over 600 million people globally are at risk, with the majority of cases concentrated in East Africa. This parasitic disease kills more people than any other parasite, except for malaria. Yet, only a fraction of cases are reported, with an estimated 50,000 to 90,000 new cases worldwide each year.
Visceral leishmaniasis has a 95% fatality rate if left untreated, and it disproportionately affects children. According to the World Health Organization, half of the cases in 2022 occurred in children under 15.
The Challenge of Treatment
Current treatments for visceral leishmaniasis are invasive and toxic, similar to chemotherapy. Patients endure multiple daily injections over an extended period, often in a hospital setting. Scientists are searching for less drastic solutions and ways to educate communities, hoping to reduce infection rates.
Ochieng is a key player in this effort. He sets up his workstation beneath an acacia tree in Akorikeya village, a short drive from Amudat in northeastern Uganda. Here, he assesses the villagers, paying close attention to the children, checking for symptoms like joint pain, fevers, and nosebleeds. He uses rapid tests to diagnose, including the rK39 test, which provides results within minutes.
He also carries rapid tests for HIV, as those with compromised immune systems are more susceptible to visceral leishmaniasis. An HIV patient is 100 times more likely to develop the disease.
Understanding the Disease's Spread
While sandfly bites are the primary mode of transmission, socioeconomic factors also play a significant role. Joy Malongo, an access manager at DNDi, explains that visceral leishmaniasis affects only the poorest, those who are malnourished and sleep in inadequate housing. Lack of access to healthcare, nutrition, and proper sanitation, as well as population displacement, all contribute to the spread and impact of the disease.
Environmental factors, such as irrigation, deforestation, and climate change, also play a part by creating favorable conditions for sandfly breeding and resting sites.
The Search for Better Solutions
When Ochieng finds someone suffering from visceral leishmaniasis, he often transports them to Amudat Hospital in northern Uganda, near the Kenyan border. Here, the need for improved interventions is evident. Many young patients are accompanied by their mothers, some of whom are barely adolescents themselves. The youngest patients cry out in pain as nurses administer injections.
Patrick Sagaki, a doctor and medical superintendent from Jinja, has treated visceral leishmaniasis patients since 2007. He believes that while cases are identified and treated, many more go untreated due to the remoteness of the regions and the difficulty of active searches.
Sagaki highlights the challenges of accessing certain treatments, such as Liposomal amphotericin B (L-AmB), which is the first-line treatment in India but logistically difficult to administer in East Africa due to refrigeration requirements. The current standard treatment in Kenya and Uganda is a combination of SSG and paromomycin (PM), which, while an improvement over the older 30-day SSG treatment, still carries risks of side effects.
The Future of Treatment and Prevention
DNDi launched an open-label clinical trial in 2018, testing a new treatment combination of miltefosine (MF) and paromomycin (PM). The trial, which included many children, found both treatments to be highly effective, but the MF and PM option was considered more patient-friendly, with fewer injections and a shorter treatment course.
However, reinfections remain a concern, according to Malongo. She emphasizes that improvements in living conditions are necessary to break the cycle of infection.
Sagaki, too, sees the potential for elimination, citing the example of Bangladesh, where rapid case identification and easy access to treatment have led to greater awareness and control of the disease.
A Community's Perspective
Among those Ochieng encounters is Chemket Selina, a young mother of four. Selina had malaria and typhoid as a child, but it was Ochieng who diagnosed her with visceral leishmaniasis. He transported her to Amudat Hospital, a 20km journey, for treatment.
Selina worries about her children's health, as the risk of visceral leishmaniasis and other health issues exacerbated by poverty is ever-present. Her family eats just once a day, a simple meal of tea, ugali, and sokoria leaves. She believes that the painful injections she received were the most effective form of medication, a common belief in her community.
Ochieng's work continues, as he rides through the African bush, fighting a deadly disease and bringing hope to those in need.
