Fieldworker Friday: https://www.msf.org.

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Ren Kabera: Treating kala azar in South Sudan
The second-largest parasitic killer in the world, after malaria, kala azar
remains one of the worlds most neglected diseases

Deep in the Sudd swampland of South Sudan is the remote town of Old Fangak. It
is isolated, totally cut from the rest of the region due to a lack of roads. The only
way to get there is by boat along the Bahr-ez-Zeraf river, or by air.
When Rwandan Dr Ren Kabera arrived there in June to take up the post of
Medical Team Leader at the Doctors Without Borders (MSF) hospital in town, he
found the needs much greater than he expected.
There was just one doctor at the hospital when I arrived, so instead of just doing
my office work, I went to join the team at the hospital, did rounds and handled
emergencies and everything including usual team leader responsibilities, he
says.
In this almost forgotten part of South Sudan, MSF has since 2014 supported the
meagre local health system with secondary level healthcare, including inpatient
and outpatient care, an emergency room, ante-natal services and a boat
ambulance to reach people isolated in surrounding villages.
We cant just be at the hospital waiting for the patients to get sick. We have to
get a team in the community to go to find the patients, Ren explains.
Especially to treat those with kala azar. This disease is spreading and these
areas dont have roads.
Second-largest parasitic killer
Kala azar is a tropical, parasitic disease transmitted through bites from certain
types of sandfly. It is endemic to 76 countries around the world, with 90% of
cases occurring in Bangladesh, India, Brazil, Ethiopia, Sudan and South Sudan.
The disease, although preventable, is deadly if left untreated. It is the secondlargest parasitic killer in the world, after malaria, resulting in some 200,000400,000 deaths annually. But most people still dont know it exists.
Kala azar is a huge killer. But we dont have the kind of awareness or advocacy
around it as we do around malaria, Ren says. We dont see people doing
research or publications, or putting in extra funds all these things that we see
around HIV and malaria. For me this is a sign that it really is a forgotten disease.
A family physician from Rwanda, Ren has worked with MSF since 2014, seeing
many patients with malaria and malnutrition. Working in Fangak was his first
experience with treating kala azar, when the county faced an outbreak in August.
Alarming situation
MSF doctors saw more than 60 kala azar patients in the hospital per week. This
situation was alarming, Ren says.

The worst-affected were children under-five years old.

The kids were coming in with complications. I had one patient who was just 8
months old. She came in with severe acute malnutrition, but we found out she
also had malaria and severe kala azar. Everyone was saying this child will die.
But we put a lot of effort in with medicines and treatment. Eventually, after
almost 15 days we saw an improvement, and she was discharged after a month.
Ren gained a lot during his time treating kala azar patients in South Sudan. But
he feels there is much more that needs to be done to combat this disease,
especially in Africa where the best available treatment is still a combination of
pentavalent antimonials and paromomycin, which is toxic and requires a number
of painful injections.
As a health professional, I learnt a lot from treating kala azar. It is a very
demanding disease, and a huge disease to deal with. It includes long treatment,
and severe cases, so you have to be passionate about the work, he says.
But it is a preventable disease, he adds. Because we know how it is
disseminated and the species of flies causing the disease. So there are things
that can be done. The drugs are very complicated now we use injections. They
need to research this and move forward, to find more suitable treatment,
especially for remote areas.