PESHAWAR: Medicines Sans Frontieres (doctors without borders) has started treating of cutaneous leishmaniasis patients already on waiting list as the medical charity has acquired injections but the province-wide infected people have to wait for their medication as the drugs pledged by the World Health Organisation are yet to arrive in Pakistan.

“A batch of drugs has arrived and we have started taking patients from waiting list. There are over 400 patients on the waiting list,” a senior official of MSF told Dawn. The drugs would be provided to patients registered at cutaneous leishmaniasis centre established by MSF in collaboration with health department at Naseerullah Khan Memorial Teaching Hospital, Peshawar.

Glucantime injection, the only drug of choice for treatment of the skin disease, is not available in Pakistan and patients are totally dependent on MSF, which is importing the injections from its headquarters in Paris.

Most of infected people have to wait as drugs pledged by WHO still awaited

More than 1,400 patients have been treated at the centre since its establishment in May 2018.

Officials say that they don’t know that these injections will be enough for how many people because patients require medication from one to four weeks depending on the intensity of their wounds caused by bites of infected sand fly. They add that a total of 9,000 vials have been received.

The MSF, which runs three cutaneous leishmaniasis centres, two in Balochistan and one Peshawar, has also applied for No Objection Certificate (NOC) to the government for import of 15,600 more vials keeping in view the load of patients. The MSF hopes to receive the shipment by end of March after which it would start taking new patients.

The provincial health department has asked the WHO for supply of the injections for more than 21,000 patients recorded in the province but the process of import is complicated due to which people have to wait for their treatment.

Experts say that the skin ailment is not fatal but it causes gruesome and lifelong scarring that leads to disfigurement of faces and limbs and the infected people, especially women, face social rejection. They add that most of the infected women have to cover their faces to stay safe from being ridiculed in the community.

The infection aggravates in the absence of treatment and creates painful ulcers. In early 80s, the disease was prevalent in the areas located near the border of Afghanistan but now it is found in all districts of Khyber Pakhtunkhwa and former Fata.

Experts point out that early treatment helps the patients as the deforming lesion continues to grow bigger and spreads when left untreated and the scars remain forever.

The health department has no option but to wait for WHO’s consignment to be able to treat the patients because the injection is not registered locally.

“On the request of health department, the WHO is importing 11,500 vials of injections with the help of MSF for procurement process, which is lengthy and take longer to get custom clearance in Pakistan,” sources said.

The humanitarian groups, including WHO, have been asking the government to soften the procedure of import so that the patients can get timely treatment.

The world health agency has been asking Pakistan to register the drug so its production can begin locally, according to sources. To cope with the present number of cases, Pakistan requires at least 27,000 injections and it is unlikely to be made available by the MSF and WHO in near future.

Our correspondent from Upper Dir adds: Hundreds of leishmaniasis patients have demanded of the provincial government to provide the relevant medicines to district headquarters hospital and other health facilities in the district.

The patients said that they could not afford the expensive and lengthy treatment of the skin disease because most of them belonged to poor families.

Dr Abdullah Shah, focal person of a project working to eradicate leishmaniasis, said that cases of the disease were reported in 2004 for the first time in Upper Dir when several people were affected in Jilaar area. However, he claimed that later a non-governmental organisation run a campaign to uproot the disease.

Dr Shah said that Wari tehsil was the most affected area in the district. He said that many patients in Khal, Akhgram, Jilaar, Kass Chapar and other areas were brought to hospitals for treatment. Darora, an area in Dir tehsil, has also reported many cases of the disease. Several cases of leishmaniasis have also been reported from other areas of the tehsil.

Akbar Zada, a resident of Kass Chapar, said that he himself, his three children and close relatives were affected by the disease. He said that he was a poor man and couldn’t afford the expenses of the treatment.

Dr Arshad Ahmad Khan, the director general health, told this correspondent during his recent visit to Dir that up to 2,100 cases had so far been registered across the province.

He said that he recommended precautionary measures like keeping the environment clean to stay safe from the disease. He said the first batch of injections for treatment of the disease would soon reach from abroad.

Dr Imtiaz Ahmad, the medical superintendent of the district headquarters hospital, said that one or two leishmaniasis patients came to the hospital in a week. He said that the injunction was not available in the market because it was imported from abroad. The capsules were also costly due to which treatment of the disease was very expensive, he added.

Published in Dawn, February 11th, 2019