Dr Florent Mbo Kuikumbi, Provincial coordinating physician of North Bandundu for the National Human African Trypanosomiasis Control Programme (DRC)
Sleeping sickness has several facets. We have to cover all of the endemic areas with surveillance efforts, otherwise there will always be pockets than can later lead to epidemics. Today, for example, in Bandundu Province in the DRC, we can only say we are controlling the disease, not eliminating it. We have to be able to cover all of the disease pockets and follow them for some time.
We can treat the patients at the level of the community, but the vector – the tse tse fly – that transmits the parasites from an infected person to a healthy one is still out there and will continue to transmit the disease as long as people are carrying the parasite. We have noticed in certain areas where we have treated all the patients we found, the disease re-emerges within a year or two. We have to cover all the pockets with screening – active and passive screening. We have to diagnose and treat all those with the disease.
Today we are hearing alarm bells as the Belgian Technical Cooperation project – which currently finances up to 75% of the control programme – is coming to a close in June of the 2013. If the majority of the activities of the mobile teams and the programme stop, we are looking at a situation that we have already seen in the past: surveillance decreases, and the disease re-emerges even to epidemic proportions. You go to a village and people everywhere are sick, entire villages in a slumber. That is the risk.
Here in Bandundu Province, we will clearly go beyond the entire number of reported cases for the year 2011, and this before the close of year. In 2011 over the entire year, we recorded 1437 new cases only in the northern section of the province, but in the first semester 2012 we are already at 1025 cases so we may see double the amount of cases by the end of the year. So if, in the month of June 2013, the control programme activities cease due to lack of financing, there will be zones that are not visited, vector control will cease, active screening will cease. As the disease touches the poorest of the poor, the victims do not and can not come to health centres on their own. We see them in the villages, and the mobile teams are their only means to accessing healthcare. By the time they do come to the health centres, the disease is often already at the advanced stage. This is a real problem.
Advocacy must continue so that we can ensure a transition period in which we engage with new partners to avoid reverting to situations of stark re-emergence of the disease. We have already begun to integrate the HAT programme activities into the health system more ‘horizontally’, but much more needs to be done for before we get there and cover all the needs. Better diagnostics, an oral treatment for both stages of the disease, continued surveillance, and sustainable financing are all part of what it will take to truly tackle the disease. We are clearly not at the brink of elimination.
Dr Florent Mbo Kuikumbi
Provincial coordinating physician of North Bandundu for the National Human African Trypanosomiasis Control Programme (DRC)
Click here to access MSF Press Release on sustainable funding for HAT national control activities.