PESHAWAR: Lack of glucantime injections, the only choice of treatment for cutaneous leishmaniasis, has been hampering the treatment of the disfiguring skin ailment in the province.

Health Secretary Dr Syed Farooq Jameel told Dawn that some cases of the disease had been reported in parts of Karak district for which teams were deputed.

“We have declared Sunday as working day to inform and educate people in Karak regarding safety measures, which include use of repellent and nets besides provision of injection glucantime,” he said.

Firm supplying injections to Pakistan has diverted its attention towards African countries

The health secretary said that people would also be educated about the treatment of lesions through radiothermy, locally called Garam Takor, till availability of proper radiothermy. However, there is no drug available with the government, nor with World Health Organisation, which used to supply medicines in the past, to treat the patients.

Medicines Sans Frontiers, which has launched a CL Centre at Naseerullah Khan Babar Memorial Teaching Hospital in Peshawar, is likely to run out of stock as it has already stopped taking new patients and wants to provide the injections to the 1,400 patients, it has already been treating.

Experts said that a multinational pharmaceutical company, which was supplying injections to Pakistan, had stopped the supply as it had diverted its attention towards some African countries where the disease was endemic.

A local pharmaceutical firm has requested the government for registration so it can begin producing the medicine locally but it is yet to be accorded approval. As a result, the people are getting infected with the disease, which is not fatal but causes gruesome and lifelong scarring that leads to disfigurement of faces and limbs.

Sources in the health department said that WHO provided 25,000 vials in 2017-18 for free provision to the patients in Khyber Pakhtunkhwa and tribal districts but there was no record about the utilisation of the drugs. The WHO had been asking the health department to give details about the consumption of those injections but to no avail.

In present situation, the patients are totally dependent on the MSF-run centre at NBMTH, which receives patients from KP and tribal districts but recently it has only been registering new patients as it wants to allow the old patients to complete their treatment course.

The government requested the manufacturing firm for supply of the injections one year ago but there was no response. The new patients are being asked to wait for the arrival of new injections to be able to get treated.

A health department press release on Sunday said that awareness campaign was launched in the areas where CL cases were reported in Karak.

Experts said that advocacy like asking people to stay safe from sand fly bites was correct strategy, but the infected people required injections, which were not available in the government’s stock as well as in the market.

The disease is caused by low-flying hairy sand fly, which bites the exposed parts of the body like hands, face, feet, etc and the only way to reduce scars is administration of injections.

The infection aggravates in the absence of treatment and creates painful ulcers. It is prevalent in the area located near the border of Afghanistan. The deforming lesion continues to grow bigger and spreads when left untreated.

Initially, the people feel little itching which they mistake for common mosquito bite but later it blossoms into big wounds and they seek treatment locally that’s of no help, according to doctors associated with treatment of CL’s patients.

Khyber Pakhtunkhwa is the only province to have declared the disease notifiable but people still await treatment.

The main disadvantage of this disease is psychological, especially for females with lesions on their face due to which they face social rejection.

Experts said that it was poor-specific disease as people stricken by it travelled from all corners to seek free medication in Peshawar. The MSF has planned to open a second CL centre in Nowshera and in southern areas in near future but those are only planning now till availability of injections in the country.

Published in Dawn, January 21st, 2019