THE BATTLE OF KALA AZAR

PS Kenya got invited to attend the annual World Health Day commemoration event organized jointly by the World Health Organization and the Health Promotion Unit and its partners. The theme for this (2014) year’s WHD is “Small bite, big threat”. The organizing committee brought on board KEMRI and its partner DNDi – who together are battling to control the little know but extremely devastating disease - Leishmaniasis, better known as Kala Azar. Baringo County has been chosen as the venue of the 2014 commemoration of the WorlWill alth Day and we must make attendance.

We leave Nairobi on a lazy Sunday afternoon and head down to the Rift at a leisurely pace. The rainy season has just begun and the green rustic countryside is utterly enthralling. Down from Limuru, through Kijabe, Kanale and down to Naivasha, the crisp air is therapeutic to these urban lungs which only know the smog and exhaust fumes of dense city traffic.  

The Rift Valley lakes of Naivasha, Elementaita and Nakuru are now full to the brim. The graceful flamingoes have since taken leave from the lakes due to of lack of food. The fresh water does not support robust growth of the blue-green algae which is the main diet of the Lesser and Greater flamingos found in the Rift Valley lakes.

Our plan is to sleep in Nakuru and head for Baringo the next morning. We drop off the boss at good old Cathy Hotel, which I hear, has seen better days. I am spending the night at Hill Court Hotel, a nice little hotel on the Nakuru – Nairobi highway with great fresh food, new working facilities and great service.

We’re up and off to Baringo at 6.30am on Monday morning. Surprisingly, most of Nakuru town is still asleep. At this hour, Nairobi would already be in the throes of the maddening morning rush hour.  I grew up in Nakuru and the drive through town brings wistful childhood memories. As we pass by the ASK show grounds, I reminisce the days when we looked forward to a day’s visit at the famed ASK show. Back then, Agriculture was on default setting, not some elective subject. I mourn for today’s kids, how can they not appreciate fat cows? Do they even know where milk comes from?

The compact homesteads of the now affluent neighborhood of Kiamumbi, soon give way to the open expanse of neatly plowed wheat farms that stretch all the way to Kabarak. Kabarak is the retirement home of former president Moi. A devout farmer and former teacher, education and agriculture are his passion. He set up a great education complex that is Kabarak. It has a primary school, a secondary school, and a university all set on prime acres of pristine grounds surrounding the old man’s home. Reminds me, what happened to the court case where some mzungu wanted back some 100 acres of land he alleges the former president grabbed while in power?

We drive past Kabarak and gradually the plantations fade into small-holding farms (shambas). It keeps getting drier and poorer and the shambas eventually give in to the harsh savannah scrubland. The fat dairy cows have by now been replaced by herds of goat and tortoise. They was a story a while back in the press of a jolly good conservationist who would pick up the ungainly reptiles and carry them across the road. In this part of Kenya, speed guns do not exist. They wouldn’t make economic sense (to the cops); what, with just an occasional government SUV dashing past. Even the goats will not give way on the road. Over the years he has saved thousands from being crashed by speeding vehicles. Now that the locals have turned crocodiles into a delicacy, I wonder how the tortoise would taste? Like fish, I would presume. Anyway, that’s not up to me to experiment, some son of Mumbi will come along pretty soon and cook some big yummy strange-tasting samosas that will probably land a few greedy mouths in hospital.

There is a small market town called Kampi ya moto some distance past Kabarak. I am thinking – “Kampi” is the Tugen version of “Kambi” which means “camp” in Swahili. So what happened for the town to be christened “Kampi ya moto” (camp of fire)? They must have been burning witches at the stake here…

A little past Kampi ya moto, you abruptly bump into the Mogotio Sisal Estate. Sisal, sisal, sisal - in all four directions, as far as the eye can see. We are welcomed to Mogotio town by the stench of rotting sisal. There is this hulking rusting mabati sheet structure that is the factory for processing the sisal. It has seen better days; still, it strives on with the unabated heartbeat of an old horse.  This is the heart of the town. Everything in this disorganized town revolves around sisal. What do they eat here, sisal?

We get to the Lake Bogoria junction and I can’t help but envy the recce Ministry of Health team from Nairobi. They stayed overnight at the Lake Bogoria Spa and Resort. From their long tales, I gather that the Lake Bogoria Spa and Resort is quite a great retreat. I have also noticed that the resort’s signage has Chinese subtitles. I hope we don’t sell this inheritance to the orient for a song. This is the cradle of mankind, the home of Homo Erectus. The lake is surrounded by hot water springs that can boil an egg in minutes. I think that’s how Mr. Erectus cooked his meals, no? I long to see the Njemps, a lost clan of the Masaai, who eat fish and some romour, crocodiles. This place does warrant a place on my bucket list.

A Njemp man fishing on Lake Baringo

We get to the Marigat/Kabarnet junction and turn left into Kabarnet road. Kimalel Health Center is five kilometers up the hill. This is the same Kimalel that hosted the famous annual Kimalel Goat auctions in days of Moi, now revived under his protégé. The Ministry of Health officials are already on site, clad in blazing white and blue t-shirts, ready to welcome their Principal Secretary.

                                                            Waiting for the Principal Secretary of Health

Kimalel Health Center is home to the KEMRI/DNDi supported research facility on Leishmaniasis. The disease in common in semi-arid districts of Kenya especially Baringo, Wes Pokot, Samburu, Turkana, Isiolo, Wajir, and Kitui counties where the vector, the diminutive sand fly, abounds. A small bite from the tiny sand fly and it could infect you with protozoan parasites that will infest your system. The parasites will then migrate to your internal organs - liver and spleen and even the bone marrow. If left untreated, it will most certainly lead to your death. Kala Azar or black fever is the second-largest parasitic killer after malaria. 

                            The female sandfly is the vector responsible for the transmission of Kala Azar

                                                                Abandoned anthills - habitat to the sand fly

The signs and symptoms include fever, weight loss, mucosal ulcers, fatigue, anemia, and substantial swelling of the liver and spleen. Of particular concern, according to WHO, is the emerging problem of HIV/VL co-infection. There are many cases of Kala Azar misdiagnosed as malaria. Diagnosis of the disease is invasive, difficult, and dangerous. To make matters worse, the treatment is expensive and takes at least 30 days. KEMRI and DNDi have developed a 17-day treatment course that has led to significant savings in the cost of treatment

A boy affected infected with Kala Azar

Kala Azar can be prevented by wearing long-sleeved shirts/ blouses and trousers, using insect repellents, spraying living/sleeping areas with an insecticide to kill sand flies, clearing of bushes around the homesteads, repair of cracks on walls to minimize entry of sand flies and sleeping under a treated mosquito net. Destruction of the sand fly habitats, in-active termite hills, and animal burrows around homesteads is also an important control measure.

                                                           A mother laying her baby to sleep under a treated mosquito net

The Principal Secretary of Health arrives at Kimalel a little past ten o'clock. He then takes a tour of the facility, talking to staff and consoling Kala Azar patients before leaving for Marigat town - the venue of the World Health Day commemoration activities. Before embarking on the serious business of speeches, the PS leads his delegation in destroying an anthill at Marigat High School.

Destroying the typical sand fly habitat - the anthill

PS Kenya has set up a booth to display its products at the Marigat High School. Among the displays, there is the Long Lasting Treated Net that is distributed by PS Kenya and is an effective control measure against the sand fly that is very active from dusk to dawn. After the gallery walk through the display booths, the PS is treated to a medley of traditional dances by a local Tugen Women choir troupe and Njemps Morans and a comedy by a local comedian who does a great impersonation of former President Moi (Walter Mungare/Nyambane style) with a fresh authentic Tugen twist.

 Morans from the Njemps tribe performing during the World Health Day commemoration event

The Governor for Baringo, Hon. Benjamin Cheboi (formerly, the CEO of the Higher Education Loans Board - HELB) arrives at about 11am and it's time to get down to the serious business of speeches.  The PS and the Governor in their speeches reiterate the magnitude of the Kala Azar problem and especially as concerns the complicated invasive diagnostic procedures and the expensive treatment. The PS pledges that the National government will support the research efforts into the disease and also the purchase of drugs for the infected. He also underscores the need to take preventive measures.

PS Kenya is at hand to make a donation of 1200 LLTNs to the county government of Baringo to help in the prevention effort of Kala Azar and Malaria.

PS Kenya CEO Mr. Anthony Okoth hands over the net donation to the Governor of Baringo Hon. Cheboi. Also in the picture, Prof. Segor 

The day’s program ends a little past one o’clock and it is time to head back to our busy urban life.

  

I filed this story after a trip down the Rift Valley to attend the World Health Day event in Marigat. Nice trip it was. ©vince316 – April 2014