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Yemeni poor suffer "neglected" disease (Health).

The rural farming family spent about YR 70,000 in Marib, but the baby just got sicker.

So, about a week and a half ago, Zaid Ahmed and his sister Nadia packed her 1 year-old son, Sayf Nasser, and his big brother, Salem, into a pickup truck and headed for Sana'a.

At the Al-Saba'een Hospital in Sana'a, Sayf was diagnosed with leishmaniasis, a disease that is curable with treatment, but according to the World Health Organization, fatal without.

It is one of about 14 diseases the WHO calls "neglected" because they are found only in the world's poorest and most remote areas. And in the Yemeni countryside, it is difficult to find a doctor who can diagnose or treat leishmaniasis.

"They gave us this treatment," said Ahmed, indicating a discarded box of medicine on the bed. "But he didn't get better there."

Sayf's family's decision to travel from Marib to Sana'a for treatment could have saved his life. But even in the capital, according to doctors, the treatment is sub-standard.

According to some doctors, the best medicine is no longer available in Yemen, and patients cannot afford to import it on their own.

Others agree, but say that the available medicine, which is imported from India and Pakistan, just doesn't work.

Dr. Afrah Al-Jowfi said the medicine Al-Saba'een Hospital gets for free from the Ministry of Health does cure her patients. But, she said, it takes twice as long to work as a British-made medicine called Pentostam.

Because many leishmaniasis patients travel long distances for treatment, lengthening their stay burdens the already-taxed families.

Longer hospital stays increase the costs of hotel rooms, missed work, and travel, Al-Jowfi said.

According to Dr. Haikal Abdualwareth at the Al-Kuwait Hospital, the medicine available to his patients through the government is not effective at all, and the good medicine, the Pentostam, is often not available to Yemeni patients at any price.

"Before, it was available, but nowC*" he said in an office in the hospital pediatric ward.

The children with leishmaniasis currently in his care have access to Pentostam, because doctors from Sa'ada donated a few bottles during a recent visit to Al-Kuwait hospital.

Abdualwareth said he stretches the medicine as far as he can, but he presently has a small amount, and he does not know what he will do when it is no longer available.

And, he said, although the disease is curable, it is not entirely preventable in some areas.

The disease is spread by sand flies, which are tiny bugs, about a third the size of mosquitoes, he said. They fly silently and they usually bite at night. Often, he said, the bites are painless.

"It is impossible to prevent the sand fly," he added.

Causes and symptoms

Sometimes the bites cause skin wounds that look like volcanoes with ulcerous craters, a disease known as cutaneous leishmaniasis. This is the most common form of the disease, and it affects about 1.5 million people worldwide yearly, according to the US Center for Disease Control and Prevention.

Sometime they cause a far more dangerous, but less common disease known as visceral leishmaniasis. The symptoms include an enlarged spleen or liver, weight loss, low blood count and a high fever. This disease affects about 500,000 people worldwide, according to the CDC.

Sometimes the former disease also leads to the latter, Abdualwareth said, and both diseases can take weeks, months, or even years to show symptoms.

Abdualwareth said he did not know how many people in Yemen have leishmaniasis. But, he said, Al-Kuwait Hospital has a small but steady stream of people who travel from other parts of the country to be treated for the disease.

He recommends that people put mosquito nets over beds and windows, and drain standing water. And despite his frustration with the medicine, he said people who show signs of symptoms should seek professional treatment.

The disease is not wide-spread in Yemen, but according to WHO maps, it can be found in the far western regions of the country.

It can also travel, according to the CDC, and evidenced by Sayf- who came from a rural area about four hours west of Sana'a.

Neglected Diseases

According to Integrated Regional Information Networks, a UN news agency, it is hard to diagnose leishmaniasis at the rural hospitals that serve the communities the disease effects.

Also known as "black fever" or "kala azar," the WHO calls leishmaniasis a Neglected Tropical Disease.

NTDs thrive in the most remote and poorest parts of the world, but barely exist elsewhere.

They are characterized by the lack of interest they command from the public.

Diseases like HIV and Tuberculosis cause outbreaks and large-scale deaths, which catch the attention of the media, and the international community, according to the WHO. But diseases like yaws, leprosy or leishmaniasis affect only the poorest people, and are far from the public eye.

About 80 percent of the people infected with NTDs live on less than USD 2 a day.

Also, NTDs tend to be found in areas with limited access to clean drinking water, basic sanitation and healthcare. And many people infected with one NTD are at risk of contracting another. This further complicates treatment because patients are often sick with more than one disease at a time.

"These diseases persist exclusively in the poorest and the most marginalized communities and have been largely eliminated elsewhere," reads the WHO Web site, "and thus are often forgotten."

At a 2007 conference on NTDs, Dr. Margaret Chan, the WHO director general said that leishmaniasis is among diseases that require better research, and better health care access in rural areas, before they can be addressed effectively.

It "cannot be treated under a tree," she said, according to the conference report. "Dramatic steps forward must await the development of better diagnostics and drugs."

And while leishmaniasis is present in Yemen, especially after floods, it is not found often enough to be considered a public health crisis, according to Dr. Adel Nasser Al-Jasari, of the Ministry of Public Health and Population.

Al-Jasari also said that government-imported medicines undergo strict scrutiny and meet the standards of several international monitoring organizations, including the WHO and the US Food and Drug Administration.

But, he said the ministry authority on the matter was Dr. Abdul Hakeem Al-Kuhlani, director of combating diseases and epidemic observation at the Ministry of Health.

Al-Kuhlani could not be reached for comment....

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Publication:Yemen Times (Sana'a, Yemen)
Geographic Code:7YEME
Date:Jul 29, 2009
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