Sleeping Sickness: Treating a Neglected Disease in Central African Republic

CAR 2012 © Sebastian Bolesch

Am MSF health worker checks a young boy for signs of sleeping sickness in Mboki, Central African Republic.

As 11-year-old Natacha Minissale tosses and turns in a hospital bed in a village in Central African Republic (CAR), her parents sit close by, their faces drawn with worry. A doctor and nurse from Doctors Without Borders/Médecins Sans Frontières (MSF) are preparing to treat Natacha for sleeping sickness (human African trypanosomiasis), a tropical disease that penetrates the liquid around the brain and that is fatal if it is not treated quickly enough.

Natacha first showed symptoms three months earlier, but armed groups were roaming the area in which she lives, making all travel risky and forcing her parents to delay seeking treatment. As her condition worsened, her parents heard through the village leader that MSF doctors were treating people with sleeping sickness in the nearby town of Mboki. “We decided to take the risk and make the trip,” says her father.

Sleeping sickness, which is transmitted by the tsetse fly, is mainly found in central Africa. During the first stage of the illness, people feel feverish and weak, but once the parasite enters their central nervous system, their symptoms change, and they become confused, lose their coordination, and suffer sleep disturbances and personality changes. Their mental faculties deteriorate until eventually they sink into a coma—the long sleep which gives the illness its name. 

This past July, MSF’s mobile sleeping sickness team spent 18 days screening and treating people for the disease in Mboki, in CAR’s Haut M'boumou region. In the week before screening started, community health workers, with the help of local authorities, traveled around the area raising awareness of the disease and passing on the message that free testing and treatment were available.

Since 2006, monitoring and controlling sleeping sickness in the remote and inaccessible southeast of CAR has been particularly difficult due to cross-border attacks by the Ugandan rebel group known as the Lord's Resistance Army.

During their 18 days in Mboki, MSF staff screened 4,534 people. Thirty were suspected of carrying the disease and six cases were confirmed. Currently, the most common treatment for the disease is nifurtimox-eflornithine combination therapy (NECT) which, while an improvement on previous treatments, is still complicated to administer, requiring multiple injections and close patient monitoring, which are frequently unavailable in sub-Saharan Africa. 

One of those diagnosed in Mboki was Marie Claire, a young woman in the early stages of pregnancy. To protect her unborn child from the toxic drugs, she will not start treatment until the second trimester of her pregnancy. In the meantime, MSF staff based permanently in Haut M'boumou will monitor her closely. "For now she is in good health, but sleeping sickness is a chronic disease and she will need to be evaluated weekly," says Brian d’Cruz, a doctor with the MSF mobile team.

Marie Claire is fortunate in that she was diagnosed before the disease did permanent damage. But for others, treatment comes too late. Tragically, 11-year-old Natacha died two days after arriving at Mboki hospital. 

MSF’s sleeping sickness specialists are determined that deaths like Natacha’s will soon be something of the past, and that incidence of the disease will be reduced in central Africa. Over the past decade, the number of reported sleeping sickness cases has dropped, while treatments have improved, and MSF teams in CAR have seen significant progress in the areas in which they have worked. 

One major obstacle to eliminating the disease is the lack of easy-to-use tests and oral medicines suitable for remote settings. Two oral drugs are currently being developed, but the national sleeping sickness programs that will one day need to deliver them to patients often lack staff and funds. 

Until sleeping sickness is finally banished, MSF will continue to work to improve access to quality care to people suffering from this neglected but devastating disease.