'Black Death' sparking fear as peace looms

January 24 2006 at 03:07PM

By Michelle Faul

Lankien - Intravenous drips hang from the branches of a big shade tree. A child screams in pain as a nurse injects the thick liquid that - given daily for two and a half weeks - will save his life.

The child has been suffering from a rare contagious disease called kala azar - a Hindi word meaning "Black Death" - that erupted during Sudan's 21-year civil war and killed more people than bullets and bombs.

Doctors fear a precarious peace brokered a year ago this month could cause even more deaths, with tens of thousands of returning refugees traversing the forests that provided safety from marauding soldiers and guerrillas in wartime - but also harbour sandflies carrying the parasite that causes kala azar.


"We still have fatalities, but we now have a cure rate of up to 95 percent," said Tom Roth, the Sudan mission chief for Medecins Sans Frontieres, or Doctors Without Borders, which has become the largest provider of medical care in southern Sudan since the organisation diagnosed the disease here in 1989.

Back then, tens of thousands were succumbing to kala azar, which kills within six months if left untreated.

Victims were unable to reach treatment because of fighting that also forced the doctors to evacuate repeatedly.

Also called visceral leishmaniasis, the disease causes high fever, swelling of the spleen and massive weight loss. Survivors can be badly scarred.

Around 500 000 new cases appear every year in the world, with a sharp increase in the last decade, according to the World Health Organisation. Most occur in Sudan, Bangladesh, India, Nepal and Brazil.

MSF says that in Sudan, war enabled the disease to "spread with remarkable rapidity and destructiveness," and estimates it killed one third of the population in Sudan's Western Upper Nile region between 1990 and 1994 - 100 000 of 300 000 people, most of them children.

The organisation says it is a tragedy comparable only to such scourges as the bubonic plague of medieval times.

Sudan, according to the UN Children's Fund, has the worst life indicators in the world, with the highest malnutrition and infant mortality rates.

In the south, most people live without roads, health care or schools, a neglect blamed on increasingly Islamist Arab governments in the north repressing southerners who are mainly black Christians and animists.

Centuries-old animosities were compounded when the government began exploiting oil in the south.

Last year's peace agreement promised an equal share of oil wealth to an autonomous southern government.

But delays, which some blame on bureaucracy and others on deliberate northern tactics, mean that while most fighting has ended, little has changed on the ground.

Roth says his organisation has saved the lives of up to 40 000 kala azar patients but has no estimate for how many others have died.

Clinics were not excluded from Sudanese government air raids and ground attacks by government and rebel forces during the war.

Hundreds of thousands of civilians were forced from their homes as troops torched villages and crops, worsening already pitiful nutritional levels and making people ever more susceptible to diseases like kala azar - the leading killer in several areas.

"The strange thing about this war is that most people weren't dying from being shot; they killed the population by clearing out what little health care there was," said Roth, an Australian hospital administrator.

Because there's no road, vehicles or even bicycles, patients walk for up to four hours to the clinic at Lankien, the latest epicentre of the disease.

It takes longer if relatives carry a patient too sick to walk. The doctors fly in everything by expensive charter plane.

One recent morning, more than 100 people lined up at what nurses jokingly call their "outpatients" clinic.

Medical assistant Francis Gatluak hung a pair of scales from a branch and put a child into a crudely fashioned sling below.

His skin was wrinkled from malnutrition, and burning up with fever.

The six-year-old boy, Yany Both Biel, weighed just 16kg - a weight more likely in a two-year-old.

Gatluak popped a test stick under the child's tongue and, within minutes, gave a positive diagnosis.

"But we'll make him well soon," he assured the anxious mother, explaining that he himself had nearly died of the disease.

Gatluak contracted it in 1989 and lived only because MSF identified kala azar that year.

"I was lucky," he said.

"Kala azar killed my brother, his wife, four of their children, two of my sisters and one of my father's wives and her daughter and two boys before it was identified."

Despite progress fighting the disease, doctors still face problems. The main clinic, at Lankien, had to be evacuated for more than a year after rival clans clashed about its location and looted it.

The medical team returned in June, after the clans begged them to and agreed to return looted goods.

Now doctors fear the flood of returning refugees - the World Food Program anticipates more than a half million this year - will bring more victims as people traverse the forests that harbour the pestilential flies.

This month, they identified five returnees who tested positive for kala azar.

"You catch it like malaria and it wastes you like Aids," said Dr Erwin de Vries, the head of MSF's Lanien clinic. - Sapa-AP

Leishmaniasis is a very nasty disease.

What, if any, are the preventions for traveling hunters?