Advertisement

Leishmaniasis, the disfiguring parasitic disease infecting a million around the world each year

Darwesh Khan gets treated for Leishmaniasis at the Naseerullah Babar Memorial Hospital in Peshawar, Pakistan - Saiyna Bashir /The Telegraph
Darwesh Khan gets treated for Leishmaniasis at the Naseerullah Babar Memorial Hospital in Peshawar, Pakistan - Saiyna Bashir /The Telegraph

Darwesh Khan's trouble began with just a little itching in his hands and what he believed was a pimple on his cheek.

The labourer thought little of either until painful ulcers began to grow over his fingers making it difficult to move them. At the same time, another disfiguring lesion started to blossom and spread under his right eye.

Fearing he would be unable to work if they got worse, he sought medical advice. But in his home of Charsadda district in Pakistan's northern east, that treatment was of little use, even if it cost a large chunk of his meagre wages. After shelling out $100 for medicine from private doctors, the sores kept getting bigger.

“Four months ago it became very serious,” he explained. “I spent a lot of money with no improvement.”

The 41-year-old had caught cutaneous leishmaniasis, a parasitic disease spread by blood-sucking sandflies that causes skin lesions in up to a million people around the world each year.

Darwesh Khan gets treated for Leishmaniasis at the Naseerullah Babar Memorial Hospital on Nov 26, 2018 in Peshawar, Pakistan.  - Credit: Saiyna Bashir /The Telegraph
Darwesh Khan's Leishmaniasis infection began with a little itching in his hands and what he believed was a pimple on his cheek Credit: Saiyna Bashir /The Telegraph

While the disease is not fatal, it causes gruesome, lifelong scarring that can disfigure faces and limbs. Because it is not deadly, and because its victims are normally the rural poor, the disease is also neglected.

Many health workers in Pakistan do not know how to recognise it, or how to treat it, but that may soon have to change.

The disease has long been endemic in the remote districts of Khyber Pakhtunkhwa and Baluchistan, but it appears to be spreading and becoming more common, not just in Pakistan, but around the world.

“It is increasing,” said Suzette Kämink, who researches the disease for the Doctors Without Borders (MSF) aid agency. “Increasing in places where we did see them before, but also we see cases now in different areas where we have not seen them before.”

Exact numbers for cases and how they are rising are hard to come by in Pakistan. Doctors must notify local authorities of cases of cutaneous leishmaniasis, but reporting is patchy.

Reasons for the increase are also unclear. Afghan refugees have brought cases with them in the past, but these are not thought to be responsible for the recent increase, Ms Kämink said, because they have been crossing the border to flee the war for decades.

Climate change may be a factor. The sandfly which carries the protozoan Leishmania parasites is very susceptible to temperature. Small fluctuations can mean that the parasite spreads in areas it previously found inhospitable. Changes in rainfall or humidity can also alter the flies' range.

The weals start appearing three months after a patient is bitten. They will heal if left untreated, which gives rise to one of the conditions nicknames, saldana or one-year-blister. But that process takes months and leaves deep scarring.

Patients wait outside the Cutaneous Leishmaniasis Treatment Centre at Naseerullah Babar Memorial Hospital on Nov 26, 2018 in Peshawar, Pakistan.  - Credit: Saiyna Bashir /The Telegraph
Patients wait outside the Cutaneous Leishmaniasis Treatment Centre at Naseerullah Babar Memorial Hospital Credit: Saiyna Bashir /The Telegraph

“Somehow it is neglected because people don't die from this disease, but they are quite affected by the big scars or big wounds on their faces,” Ms Kämink said.

“The main disadvantage of this disease is psychological, especially for females with lesions on their face. They are rejected by society,” added Dr Parvez Khan, medical activity manager at the clinic.

Those struck with the disease also often fall prey to medical quacks, or at best are given incomplete or expired doses of medicine. The only effective drug has to be imported into Pakistan by the World Health Organisation and MSF.

The need for treatment is obvious at MSF's clinic in Peshawar's Naseerullah Babar Khan Memorial Hospital. Since opening in May, the numbers attending have climbed steadily each month. It has received more than 1,200 cases and is operating flat out.

Khandad Khan, a soldier in the military gets treated for Leishmaniasis at the Naseerullah Babar Memorial Hospital on Nov 26, 2018 in Peshawar, Pakistan  - Credit: Saiyna Bashir /The Telegraph
Khandad Khan, a soldier in the military, is treated for his Leishmaniasis infection Credit: Saiyna Bashir /The Telegraph

Many travel for hours to reach it and receive a course of 20 to 30 daily injections free of cost.

Khandad Khan, a lance corporal in the Frontier Constabulary, said between 60 and 70 of his colleagues stationed at Darazinda in Dera Ismail Khan had been struck with the parasite.

“It's very difficult to walk,” he told The Telegraph, wincing as a nurse changed the dressing on an open ulcer on a big toe. “The flies don't bite the locals, they just bite us.”

A 10-year-old named Mohammad from Bannu district was delighted that his ulcer on his nose was gradually receding when The Telegraph visited the clinic last month.

“I noticed a small pimple on my nose and I didn't know what it was. Then it gradually got bigger and bigger.

Muhammad, 10-year-old gets treated for Leishmaniasis at the Naseerullah Babar Memorial Hospital on Nov 26, 2018 in Peshawar, Pakistan.  - Credit: Saiyna Bashir /The Telegraph
Ten-year-old Muhammad said his infection is beginning to recede after treatment Credit: Saiyna Bashir /The Telegraph

“My friends told me my nose was increasing in size day by day and they teased me. My mother also has the same problem in her hands,” he explained.

Darwesh Khan's course of injections have reversed his own infection and he is happy to show off his ulcer-free fingers. But sparing the time to attend the clinic for dozens of injections can be a heavy burden for day labourers like him.

Health officials hope to set up smaller sub centres closer to patients, with the first in Nowshera.

“They cannot afford to spare the time to come here. I have had one patient who begged me to give him all the injections at once,” explained one hospital official.

 Protect yourself and your family by learning more about Global Health Security