Neglected kala-azar disease hits poor Turkana boys hard

Sylvester Esekon, a 12-year-old orphan, could have died of kala-azar disease were it not for his teacher Margaret Esinyen who took him for specialised treatment in the nick of time before it reached a fatal stage.

The tropical disease unknown to many and transmitted by a female sand fly has haunted Turkana children for years, especially boys who take care of livestock and play near ant hills.

For the children suffering from kala-azar, medicines and doctors are hard to come by. The poor transport network and warring communities — the Pokot and Turkana — have made it difficult for medical care providers and aid agencies to reach the far-flung villages.

Esekon lost his father to banditry four years ago, hardly 12 months after losing his mother to sickness. His neighbours — also poor — are taking care of him.

‘‘Once in a while I am called for a boiled maize meal. The neighbours have few goats that produce milk after most were stolen. So the milk is only enough for the babies,’’ he says.

For his daily meals, Esekon relies on the free primary school feeding programme just like eight of his friends.

It is at school that his teacher, Ms Esinyen, discovered that kala-azar was slowly emaciating Esekon, who he describes bright, hardworking and disciplined pupil.

Esekon started by nose bleeding frequently until his teacher decided to host him. The nose bleeding became frequent, he lost weight and started experiencing bouts of fever.

“I accommodated him after realising that he did not have responsible relatives or guardian to take care of him,” the teacher said.

The pupil was taken to a dispensary where, after diagnosis, he was found to have a swollen spleen — a common symptom for kala-azar. He was later referred for specialised treatment at a facility in West Pokot — 60 kilometres away.

Medicins Sans Frontieres (MSF) runs and manages the Kacheliba kala-azar clinic, which has doctors trained in treating the disease.

However, few patients seek treatment at the facility despite the many boys who suffer from the disease in Turkana.

Ethnic mistrust between the Turkana and Pokot communities prevents most of the affected residents from seeking specialised medical treatment at the clinic.

Cattle rustling and border disputes between Turkana and West Pokot have fuelled the mistrust among the residents over the years.

Treating kala-azar costs Sh200,000 per patient for 30 days. Esekon was lucky. He was treated at the clinic free of charge and survived a disease that silently kills many Turkana boys.

“The doctor told me never to play near an ant hill again,” he says. Ant hills in Turkana have been nicknamed ‘Turkana eucalyptus’ because they are taller than most houses and trees in the vicinity. Children play hide-and-seek, among other games, around the ant hills, which host the sand flies — vectors of the disease.

Dr Gilchrist Lokoel, the Lodwar County and Referral Hospital chief executive, says about 4,000 kala-azar cases are reported in Kenya annually, especially among the poor. Many cases, he says, go undetected killing many young people.

Dr Lokoel says the majority of the victims are aged between 12–15 and that 98 per cent of them are herders. Worldwide about 500,000 cases of kala-azar are detected annually.

Twenty-two counties in the Rift Valley and north eastern Kenya are most prone to the disease. Turkana and neighbouring counties of Baringo, West Pokot and Samburu record the highest number of reported cases.

James Kisike is another affected boy in Lokiriama, Loima sub-county. He found out that he had the disease when his family migrated to Moroto in Uganda in search of pasture and water in 2013.

He says most herders use the ant hills as shelter due to the persistent drought and dry trees.

‘‘We even sleep under the ant hills in shifts as the others watch out for cattle rustlers, especially from 11am to 3pm when the sun is too hot,’’ he says.

Amudat Kala-azar Treatment Centre in Uganda attends to patients testing positive of the disease along the Kenya and South Sudan border.

Awareness campaigns

But the facility is underutilised because most residents are ignorant about the disease. A majority only go to hospitals due to gunshot wounds and child birth complications.

Turkana health officials now walk from one manyatta to another holding barazas urging residents to desist from sleeping next to their animals. The awareness campaigns target schools, churches, health facilities, local administrators, village committees, herders and women groups.

Most pastoralists share sleeping areas with their cows, goats, sheep and chicken to protect the livestock from raiders.

Residents are also encouraged to sleep under treated mosquito nets — seen as luxury item in Turkana — as sand flies stick on the animals that share sleeping space with humans.

Another challenge in war against the neglected topical disease is that most residents live in mud-and-grass thatched houses — conducive habitat for sand flies.

Sylvester Eoko, Turkana coordinator of neglected tropical diseases, says the county allocated Sh4.5 million for identifying all the tropical diseases including Guinea worm and kala-azar.

“The disease is among the 17 listed neglected tropical diseases identified by World Health Organisation and it is time all citizens are protected against through access to better health care and awareness,” says Mr Eoko.

As kala-azar continues to stalk herders, hope lies in devolution. The county has pledged to improve roads, stock health facilities with adequate drugs and deploy more than 300 medical workers in its healthcare plans.

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