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"What is it?"
Cutaneous Leishmaniasis (cue-TAY-knee-us LEASH-ma-NIGH-a-sis) is a parasitic disease spread by the bite of infected sand flies. The Leishmania is a single-celled parasitic protozoan that spends part of its life cycle in the gut of a sand fly and part in the blood and other tissues of a vertebrate.
Leishmania's period of incubation is not certain; sores can appear in the first week or not for months after the initial bite of an infected female sand fly. The sores develop into ulcers often looking somewhat like a volcano, with a raised edge and central crater. The sores can scab or not scab, be painful or not painful, and can cause similar cutaneous lesions to those produced by other diseases such as cutaneous tuberculosis, syphilis, leprosy and skin cancer, among others.
Leishmaniasis is found in parts of over 80 countries. Most of those countries are in the tropics or subtropics, but the settings in which leishmaniasis is found range from rain forests in Central and South America to the deserts of West Asia. For instance, leishmaniasis is present in Iraq and was contracted by a number of the troops involved in the 2003 invasion of that country and its subsequent occupation. The soldiers nicknamed the disease the Baghdad boil.
Cutaneous leishmaniasis is the most common form of the disease, causing numerous sores on the body which will self-heal in from several months to a few years, but leave unsightly, even deforming scars. If not treated, the cutaneous disease can also result in mucocutaneous leishmaniasis where skin ulcers spread causing tissue damage to (particularly) nose and mouth.
Two common therapies, both containing antimony—a potentially toxic heavy metal—are: meglumine antimoniate (Glucantim®) and sodium stibogluconate (Pentostam®). (Antimony, Atomic number 51, is a trivalent and pentavalent metalloid element used especially in alloys and semiconductors, but also in medicine as a constituent of some antiprotozoal agents.) It is not understood how this metal acts against the parasite; it may disrupt its energy production or trypanothione metabolism. In many cases the drugs don't work or become progressively ineffective with repeated use—patients are known to have received over a hundred of these shots, yet still exhibit the sores.
(Follow the links above to discover more about Leishmaniasis, Black Salve, etc.)
That's Dr. José treating the infected ear of a man who lives in Mata Ahogado.
MATA AHOGADO CLINIC
(report by TC McVey)
It was during the Arenosa clinic that Dr. José, from the Department of Health, called Dee to say he needed supplies for another clinic he was starting in Mata Ahogado, a tiny mountain community outside El Valle.
As some of you might remember, Dr. José had leishmaniasis and came to the Cacao clinic for treatment. He was so pleased with the results that he came every Wednesday for several months to learn and to help treat the patients we saw there. Since that time, he has spread the word amongst his peers, and now doctors at the Health Clinics in Bejuco and Santa Clara refer their leishmaniasis patients to him—he will either meet them at the clinic or make house calls.
It turned out that the representative for the Mata Ahogado district contacted Dr. José because the representative's sons had leishmaniasis; he had heard about "La Gringa" (Panamanians' name for Dee) and the positive results at the clinics.
As of now, our friend and trainee, Janeth, has volunteered to travel with Dr. José every Monday to Mata Ahogado to bring needed supplies, and to help with treatments. Already, they have helped over twenty victims of leishmaniasis.
[click images for larger versions]
So, as you can see, and without any concerted effort or planning, a network of clinics is springing up. Here is a list of the people we have trained and now supply, along with the towns and villages where they hold their clinics:
[click image for larger version]
As to where we start the next Wednesday clinic, we are waiting to hear from Representative Lucio Molina of Sora. He made the arrangements for the first clinic in Cacao, and now he is searching for another area in need of help. Meantime, we get a short break from our weekly travels, and the fact it coincides with the holidays doesn't hurt at all!
Donations
We wish to thank all of you who made donations in cash and supplies this past year. Your support, plus your confidence in us and our work is very encouraging. With your help the clinics will continue to srpead and victims of leishmaniasis will find relief.
"Thank You and Happy New Year!"
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