About a year ago, Serafín Moreno – a 40-year old miner born and raised in Chocó, in the Colombian Pacific Coast – believed he was about to die. The first lesion appeared on his forehead, and the second on his arm. After a month, the lesions had grown and multiplied, taking over his entire body.
“I counted 98 ulcers in total at a certain point, the worst was the one on my forehead, very deep, I could no longer hide it and could not find work anymore,” he recounts in a faded voice. In Chocó, the waiting period for the medicine was about two months, but it never arrived. So Mr. Moreno decided to spend the little money he had, leave his wife and children, and go to Medellin, about 180 kilometers away. There, he was told, treatment could be found.
At the University of Antioquia in Medellin, the clinical site of the Programme of Study and Control of Tropical Diseases (PECET, for the acronym in Spanish) attracts patients like Serafín Moreno from all over the country. In Colombia, cutaneous leishmaniasis is an endemic disease in most of the country. Over 128,000 cases were reported in ten years, from 2001 to 2011, according to the Pan American Health Organization. “While not fatal, the cutaneous form of the disease is surrounded by social, economic and psychological stigma,” says Byron Arana, Head of the cutaneous leishmaniasis disease program at DNDi. It is estimated that 10 million people are at risk in Colombia, with transmission occurring especially in rural areas. Worldwide, 350 million people are threatened by all forms of the disease. Cutaneous leishmaniasis is the most common, causing approximately 50-75% of all new cases.”
Leaving from Medellín to Bogota, passing between the mountains on a windy road, we reach the Rio Claro, situated between the central and the eastern Andes. On the outskirts of Rio Claro is Jerusalem, a village of around 100 houses, which seems to be inhabited only by women and children. Men are at the marble mines. In the surrounding area, the native vegetation is home to the Lutzomyia mosquitos. The area is endemic for cutaneous leishmaniasis, and it is rare to find a child who has not already been a victim of the disease. Traditional treatments are homemade, such as boiled lemon juice or caustic soda. The consequences of these treatments are skin burns that leave scars for life. The only alternative are the painful daily injections also used to treat the visceral form of the disease, it is fatal sometimes but that remains as the only option for the cutaneous form of the disease at the time. “We cannot accept that a treatment of a non-fatal disease can kill a patient,” says Carolina Batista, medical director of DNDi Latin America.
DNDi’s cutaneous leishmaniasis programme in Latin America started in 2012. A study in Colombia is currently investigating whether a topical formulation containing amphotericin B is safe and efficacious for the treatment of cutaneous leishmaniasis. The project is part of a wider strategic alliance between DNDi and Ruta-N – City of Medellín – for the development of health innovation for neglected populations such as those who suffer of leishmaniasis and Chagas disease.
Images: Fabio Nascimento