Saisuru (the real name is not being used to protect the patient’s identity) is a seven-year-old girl, living in the remote Sosak village 60km from Amudat Hospital - one of the research and treatment centres for the DNDi LEAP paromomycin project, overseen by Makerere University.

Two years ago, when Saisuru first became severely ill, she was carried on her grandmother’s back to seek treatment at Amudat Hospital Kala-Azar treatment centre, then run by MSF. She was found to have VL and received 30 painful injections of glucantime and was subsequently discharged. She was well and walked back home, the entire 60 kilometres. One year later she became sick again and was carried to Kacheliba MSF centre, 120 km away. She was again diagnosed with VL, treated with 15 infusions of amphotericin B - each one administered every second day over 30 days – and then discharged. This time, her parents were advised by the grandmother that she should not go back to her village for fear that she would contract the disease again. She therefore went to live with some relatives and family friends in Natiniri village.

Five months later she became ill again. This time, she was taken to local herbalists and traditional healers who treated her skin with cow dung and rubbed ‘healing ash’ into incisions they made. An animal was sacrificed and libations poured to the gods. Saisuru’s condition deteriorated, however, and in December 2008 she was brought to Amudat hospital, DNDi ’s LEAP paromomycin project, as a second relapse occurred. By this time she was severely ill and weakened by the disease. She was not considered for the trial but put on liposomal amphotericin B - AmBisome^®. She responded quite well to treatment. Her nose bleeding has stopped; fever went down and overall she also responded well to nutritional therapy.