Fieldset
Dear Friends,

This is my first blog entry as part of "Awakening in CAR" written from Toronto, Canada. This won't be eloquent by any means - forgive me now. I am about to travel to Maitikulu, a small excuse for a village in the Central African Republic in 3 days.

This is my first blog entry as part of "Awakening in CAR" written from Toronto, Canada. This won't be eloquent by any means - forgive me now. I am about to travel to Maitikulu, a small excuse for a village in the Central African Republic in 3 days. There I will join our MSF team treating human African trypanosomiasis (HAT). This terrible disease is also called "sleeping sickness".

Sleeping sickness is a disease most of us in Canada have probably never heard about. The diagnosis is made by an invasive, uncomfortable means. The treatment is pretty terrible too. Let me tell you a bit more.

Sleeping sickness is due to a parasite that mostly (almost exclusively) affects humans. It is thought to affect some domesticated animals like sheep and cattle as well. The infection is passed from human to human through the very aggressive tsetse fly which takes a piece out of you when it bites you. This disease is only found in Africa and MSF has been doing a lot of the research and treatment to advance the care of this disease.

The disease causes intermittant fevers and a flu-like illness initially. Then one develops, anemia, cardiac problems like electrical disturbances of the heart, but ultimately, the worst part of the disease is the neurological manifestations. A wide variety of neurological and psychiatric changes can occur in patients including difficulty sleeping, excessive daytime sleeping, clumsiness, confusion, mania, paranoia, depression and a change in personality. You can also develop many movement disorders where you involuntarily writhe around.

Needless to say, we don't see this in Canada. I think I have seen one case before when I was volunteering in Burundi with MSF, but I really can't be sure. This patient got the standard lumbar pucture that we do to diagnose sleeping sickness, but I'm not sure are lab staff were oriented to see the trypanosomes. Most of my physician friends and colleagues look at me a bit funny when I mention I'm going to help take care of sleeping sickness. Though a few have heard of it since it is related to a disease we see much more of here in Canada, called Chagas' disease.

Anyway, those are the disturbing manifestations which ultimately end in coma and death.

To make the diagnosis we have to aspirate from a lymph node and do a lumbar pucture. Lumbar punctures can actually be done pretty quick and without too much suffering - but let's face it - it does hurt anytime someone sticks a big needle in your back. When you turn out to have the disease you have to have such a spinal tap a total of 4 times. Having done many lumbar punctures in Canada and in Burundi with MSF, I can say I've never seen anytime someone totally comfortable with the procedure. Even with good local anesthesia (which is sometimes not possible in the field) it hurts.

Sigh. And then comes the treatment. Maybe I'll talk about that in another entry, but suffice to say, perhaps that is the most horrible part of this all (other than dying from the disease). There have not been new drugs developed to treat this disease for over 50 years. You can only imagine the side effects of such old medications (like melarsoprol, derived from arsenic). I'll keep you posted sadly enough.

Anyways, I'm excited again to go to the field to volunteer. I have a million things I tried to get done before going. Needless to say, not all of it got done. The most important thing on my list is to try and talk again with a German MSF doctor who just got back from our project about 3 weeks ago. We skyped the other day. I've got t-minus 2 days to extract every last pearl I can out of her, to try and carry on the good work of her and the rest of the team.

OK - over and out from my humble apartment in Toronto, Canada.

Raghu