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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.
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Black Salve is applied to a girls infected ear;
she also has another sore on her cheek.
Discovering a Treatment
A U.S. RN, Dee Braden, now living in Panamá, began helping local village people with their general medical needs. Introduced to Black Salve and cutaneous leishmaniasis at about the same time, coupled with her concern over the possible effects of the heavy-metal shots (Glucantime) which the government administers—the only treatment available—she experimented applying Black Salve to cutaneous leishmaniasis wounds. The results were encouraging.
Mrs. Braden (shown at right applying Black Salve to a young girl's leg) soon devised a treatment that, when followed, removed the parasite and promoted healing, positive results seen in as little as two to three weeks. Briefly, the Black Salve is applied, covering the entire area of the wound. Next, a layer of petroleum jelly is smeared over the Black Salve to prevent it from drying out. The wound is then covered. Patients are told to leave the dressing on and to keep it dry until they return a week later. At that time, the bandages are removed, the wound inspected and cleansed, and if needed, more Black Salve applied before a new dressing is put in place. It is not unusual for the parasite and the affected flesh around it to stick to the gauze and come out in a clump when the dressing is removed for the first time (see Case 9 to the right).
Depending on the size and severity of the wounds, new skin can be seen as early as two weeks following the initial application of Black Salve. More serious wounds take longer, but results are observed, even in severe cases, within two or three weeks. NOTE: In patients who have already received the heavy-metal shots, similar results take three to four times longer!
The news of a treatment traveled quickly in a country desperately in need of help and, after hearing of this American woman's success, the mayor of Cacao requested Mrs. Braden come to his village to treat its outbreak of an estimated 500 cases of cutaneous leishmaniasis. When she agreed, he picked her and her two helpers up one Wednesday and drove them the hour and a half to Cacao's small school. Relying only on word of mouth, forty patients were seen that first visit, but that number grew to nearly 200 patients after only four weeks. A larger space for the clinic was needed almost immediately, so the mayor offered his home. As of this writing in June 2006, hundreds of sufferers have found relief.
Health Ministers of Panamá have verified Mrs. Braden's credentials, attended her clinic and observed her techniques; they said they planned to run scientific analysis on the Black Salve and investigate the feasibility of producing it themselves. In the meantime, the need for help is great; the costs of the free clinic growing exponentially with the number of patients seen. The U.S. supplier of Black Salve, hearing of the clinic's need, now discounts shipments to Mrs. Braden, but the quantity still makes it expensive. So far she has paid for nearly everything out of pocket, only receiving a few donations, mostly in the form of supplies.
Meanwhile, distressed villagers, many carrying their infected children and walking two to three hours to get there, begin to line-up outside the mayor's residence as early as 5:30 am—the number of patients consistently over a hundred. Helpers organize the lines and take the patients names, but it's a long day for patients and care-givers alike.
The immediate concern, besides cost, is to train others, especially locals from isolated villages where the need for treatment is the greatest. One woman came to the Cacao clinic specifically to ask Mrs. Braden to help people in the woman's remote village, a village so remote that it entails two different cab rides (one 4x4 only), then another two hours by horseback to reach. Mrs. Braden is going to pay the woman's cab fare for two months, so she can attend the clinic and receive instruction herself. That way, with help obtaining supplies, she'll be able to treat the victims in her village.
Patients waiting in the mayor of Cacoa's front yard to be seen.
Website: © 2007 McVey Design
Case 3:
Female, 55-years old.
Case 8:
Female, 47-years old.
Case 9:
Boy, 13-years old.
Case 10:
Man, 28-years old.