Fieldset
In the shade of the Kala azar tree

One of my favorite places here in Lankien is under the Kala Azar tree. The Kala Azar tree is a large spreading tree in the hospital compound, near the Kala Azar tukul, of course.

One of my favorite places here in Lankien is under the Kala Azar tree. The Kala Azar tree is a large spreading tree in the hospital compound, near the Kala Azar tukul, of course. It is the place where I sit, with one of MSF's national staff, to admit new patients to the Kala Azar treatment program. We usually do this in the afternoon between 4 and 7 pm, when the air is starting to cool down and light changes.

Kala Azar's official medical name is Visceral Leishmaniasis. Kala Azar (KA) is actually a Hindi word that means "black fever". In India, another hot spot for KA, patients with the disease develop darkened skin, ergo the name.

The word Kala Azar has stuck and it is used commonly in the medical literature and in spoken language. Everyone here calls in Kala Azar, and everyone knows about it.

Kala Azar is a tremendously satisfying disease to treat. Without treatment it is fatal in 95% of cases; with treatment, most people recover completely.

KA is transmitted by a tiny, hairy, sand fly, which lives in the black cotton soil of southern Sudan. During the dry season the ground is hard and the cracked; the sand flies live in the cool cracks. We are in the 'Kala Azar Belt' that stretches along the eastern part of Sudan and northwest Ethiopia. Pockets also exist in Uganda and Kenya. There is KA in other parts of the world, South America, the Mediterranean and particularly India, but the species of parasite, sand fly and reservoir animal varies. I have yet to figure out what the reservoir animal here, perhaps cattle.

The parasite that causes KA in southern Sudan is Leishmania donovani. It lives in the gut of the sand fly and is transmitted when the sand fly bites a susceptible victim. The parasite invades the liver, spleen, lymph nodes and bone marrow.

The patient has fever, wasting, and an enlarged spleen. She has been sick for several weeks and has walked a long way for treatment. She has several risk factors for death from KA: severe weakness, anemia, malnutrition and advanced age (she is only in her late 40's). Because of her fragile state she will receive a second line drug called Ambisome, more expensive that the standard treatment, but with fewer side effects.

Enough about Leishmaniasis for now.