When Sonu was born eight years ago, his mother, like nearly all mothers in India, put a black cord around his wrist as a type of amulet.
She also painted a black dot on his forehead. She wanted to protect him from the evil eye and evil spirits. What she didn't know was that these evils lived within their own house, lurking between the cracks in the adobe bricks of its walls.
That is where the sandfly lives, a tiny creature, even smaller than a mosquito, which feeds at dusk and makes no sound in flight. It is the vector of a tropical disease known as leishmaniasis visceral which attacks the immune system. Sonu was infected when he was only four years old.
Sonu is a timid child, somewhat short and thin for his age. When he smiles he squints and looks at you of the corner of his eye. Today he didn't go to school. The Indian government, after the earthquake in Nepal on 25 April, decided to cancel classes for two days in Bihar state, the region of India which was most affected by the catastrophe and which shares its northern border with the poorest country in Asia.
Sonu lives with his parents and six brothers and sisters in the town of Mallickpur, a village in the Vaishali district. Three years ago he got very sick. He became very thin, lost his appetite, and had a fever for nearly four months until his parents managed to raise the 20,000 rupees (more than 250 euros) that a private doctor charged them to treat their son, and who in the end couldn't tell them what the child had.
© Irene Núñez
A family like Sonu's can earn about 9,000 rupees a month (125 euros). His father works as a labourer and earns between 200 and 300 rupees for a day’s work. If he doesn't work one day, he doesn't get paid.
"Some people in the village told me that Sonu might have kala azar, but I didn't know what they were talking about," explains his mother, Sakuntala Devi.
For this reason, Médecins Sans Frontières (MSF) teams are dispatched to different villages to detect cases which have not been diagnosed and to raise awareness of this illness among the population.
Their mission is to inform, educate, and communicate with people in the villages about kala azar. In each place they visit they conduct information sessions for the smallest children and their parents.
Kala azar is the name given to this illness in Hindi, meaning "black fever". The main symptoms of the illness are irregular bouts of fever, substantial weight loss, swelling of the spleen and liver, and anaemia (which may be serious). If not treated, it is fatal in almost 100% of cases.
"I took Sonu to the closest public health clinic. I thought that they would not be able to help me either, but there was an MSF team there giving support in the treatment of kala azar and they referred me to the hospital in Sadar for a blood test, which confirmed that the child was infected with the illness.”
But the strange thing in Sonu’s case was that his spleen could not be felt easily. And that is rare. When a person has kala azar their spleen becomes inflamed, a condition that is known as splenomegaly. They did more tests at the Rajendra Memorial Research Institute, where the results again came back positive, so they returned to the Sadar hospital, where MSF has set up a specific area to care for patients with this illness, and where Sonu received treatment for several days and all of his tests were completed.
A week later Sonu began to feel better. "I saw it in his eyes. They shone again. I know that without a proper diagnosis and treatment it is likely that my son would not be here now. To have him here with me is my greatest happiness," says his mother as she hugs him.
It was Médecins Sans Frontières that introduced Liposomal Amphotericin B (LaMB) as a treatment for kala azar, because it was a very safe medicine, with few side effects and can be given to pregnant women.
The dose has been regulated and adapted through various studies and tests to arrive at the current treatment, which allows for the treatment of a patient with a single dose of LaMB via an intravenous infusion for a period of two hours.
"This treatment is a success, a revolution. Now there is real hope," says Dr Deepak Kumar, a doctor who has worked at the Sadar hospital for nearly six years.
Médecins Sans Frontières is supporting the Indian government in the implementation of this new treatment protocol under the auspices of its National Vector Borne Disease Control Programme, which includes a special team dedicated to the elimination of kala azar. As of September 2014, all of the states affected by this illness have adapted this single dose treatment.
"This treatment is free and effective. With just one dose, a large number of patients affected by the illness can receive the complete treatment, which represents a positive step towards the elimination of kala azar in the region," explains Nines Lima, Médecins Sans Frontières’ tropical medicine specialist.