Heath experts, policymakers, scientists and other stakeholders were in Kigali to explore how certain tropical diseases can be done away with.
For the best part of a week, what on the face it seems like a paradoxical exercise, played out under the domed roof of Rwanda’s Kigali Convention Centre (KCC). The world’s healthcare community came together to give their full, undivided attention to Neglected Tropical Diseases.
For an area that is regarded as neglected, it drew some impressive interest. The Rwanda Biomedical Centre (RBC), in partnership with the African Research Network on Neglected Tropical Diseases (ARNTD), and the Coalition for Operational Research on Neglected Tropical Diseases (COR-NTD), came together, for an international conference on Neglected Diseases (NTDs) in Africa, and the second International Podoconiosis, Conference.
The conference or conferences, as Podoconiosis had an entire day all of its own, brought together around 500 participants from all parts of Africa, Europe and North America. They included researchers, scientists in healthcare, policy makers, regulators, representatives for foundations who support health programmes, campaigning organisations, representatives from the World Health Organisation (WHO), of course, representatives from the private sector, and innovators, who design and engineer tools on which healthcare workers rely.
An awe inspiring caring army, to combat a challenging range of debilitating diseases. And how such an army is needed. Podoconiosis, Schistosomiasis, Visceral Leishmaniasis, to name but a few, diseases that continue to devastate lives, primarily though not exclusively, on the African continent.
Participants discussed how diseases like Podoconiosis, Schistosomiasis, Visceral Leishmaniasis, to name but a few, can be eliminated for good.
Many of these diseases are preventable and can be eradicated, although there would be no guarantee against their re-emergence. One such disease is guinea worm, which is caused by a waterborne parasite.
The conference paid tribute to the late former American President, Jimmy Carter, who after leaving office, dedicated the remainder of his life to campaigning for a more peaceful world, and combating neglected diseases. Through the eponymous Carter Centre, established with his wife, Rosalynn, Carter worked to see the eradication of guinea worm, while he lived. In an emotional celebration of his life, a director at the centre, Kelly Callahan, pledged to fulfill Carter’s wish.
The fulfilment of the pledge is well in sight, thanks to the centre’s founder. Although he did not live to see its eradication, by the time of his death, with only a handful of cases recorded, Carter was able to see that for guinea worm, the end was indeed nigh.
Schistosomiasis is another waterborne parasite. The larvae enter the body, and develop into adult worms, which live in the body’s blood vessels, where the parasite then continues to produce eggs. The parasite’s cycle is continued through urine and faeces of the infected people. Children are particularly vulnerable, when they swim and play in infected water, as are adults, mostly women, who have no access to clean water.
Prevention includes greater awareness of proper hygiene, sanitation and provision of safe, clean water. Podoconiosis on the other hand can be prevented simply with footwear. The disease commonly known as elephantiasis, causes lower limbs to swell, leading to acute pain and discomfort to the sufferer. Unusually, there is no parasitical culprit. Naturally occuring minerals in the soil are to blame. The disease is contracted through long term exposure to soil, especially volcanic soil, rich in silica and aluminum silicates.
Podoconiosis has been found in seventeen countries, in Africa, Latin America and Asia, but primarily in Africa, with twelve of the seventeen countries. Rwanda is among the East African nations where the disease is endemic. While anyone exposed to prolonged direct contact with the soil is at risk, some people have been found to be more genetically susceptible to contracting the disease, and women are more likely than men to be sufferers.
As many of these NTDs, Podoconiosis “disproportionately affects individuals in low income communities, perpetuating cycles of poverty, stigma, and limited opportunities” said RBC Senior Researcher in NTDs, Ladislas Nshimiyimana, “yet, what distinguishes this disease is its preventability. With simple, cost-effective interventions such as proper footwear, hygiene education, and early treatment, we have the means to eliminate podoconiosis as a public health problem.”
According to Nshimiyimana, mapping of the disease in Rwanda, found around 6,000 sufferers, of whom 1,311 are receiving treatment. Thirteen treatment centres have been established, in collaboration with Heart and Sole Africa/Action (HASA), and more are planned.
“Rwanda is steadfast in its commitment to eliminating neglected tropical diseases (NTDs), as a public health concern, by 2030, in line wth the Kigali Declaration on NTDs (2022) and the WHO roadmap on NTDs (2030).”
It is precisely that kind of commitment that all the participants hope could be adopted by other governments. Perhaps the most repeated words throughout the conference were “integration” “scaling up” “raising awareness.” All words that are a call to the type of action that cannot be achieved without the full commitment of governments.
Speakers highlighted some of the actions that can be taken to eliminate NTDs.
For NTDs to get the attention needed, they have to be integrated into healthcare systems. In Rwanda, this integration has resulted in training healthcare workers in the treatment of Podoconiosis. Without the awareness, prevention becomes difficult, if not impossible, and to reach everyone, “leaving no one behind” as Rwanda puts it, services have to be scaled up.
And the greater the awareness, the easier it is to educate the community not to ostracise sufferers of these neglected NTDs. The exclusion from society not only shuts out sufferers from all opportunities, including economic opportunities, it also leads to deterioration of their mental health. The conference considered how to treat sufferers not just physically, but how they can be supported mentally and emotionally.
Lack of awareness can also mean misdiagnosis, because the diseases’ neglect can mean little education and training about these diseases, for healthcare professionals. Schistosomiasis for instance, can be mistaken for a sexually transmitted disease, in women, especially.
The conference told a good news and bad news story. On the one hand, the hundreds of dedicated health professionals, researchers, scientists, who gathered in Rwanda, joined by campaigners, health promoting foundations, even the private sector, were only a small fraction of a larger community, worldwide, which is dedicated to see NTDs if not a thing of the past, but at least more manageable than they are now. It is difficult not to bet on their commitment.
“This conference offers us a unique opportunity to delve into the groundbreaking research, innovative prevention and care approaches, and scalable strategies for community engagement…a reminder of our shared responsibility to ensure that no one is left behind in our pursuit of health equity…” said Nshimiyimana.
On other hand, the sheer number of the diseases and sufferers demand concerted, unremitting focus and action, if ending NTDs is not to remain just a dream. Can governments match the researchers’ and scientists’ dedication?
In holding the conference in Rwanda, the organisers inadvertently or consciously, chose a place that shows a glimpse of how, in the war of disease versus people, the balance might be tipped in favour of people.
If with its meagre resources, Rwanda can be confident of winning against Podoconiosis and other NTDs, then surely, with the right will, bigger, better resourced nations can do at least as well.
