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By Shabbir Hussain
PESHAWAR, Dec 31 (Alliance News): Covering herself from head to toe in a traditional dark brown coloured burqa (veil), Aasia, a young lady in early thirties, exhibited hesitance in exposing her disfigured cheek to medics for examination at dermatology ward of Ghalania Headquarters Hospital of Mohmand District of Khyber Pakhtunkwa.
Her reluctance to compliance of medical staff requests reflected emotional agony and perturbance she felt after appearance of a deep skin scar on face, impairing her look.
After brief dithering in uncovering her blemished face, the medical team succeeded in proper examination of the lesion with a diagnosis of Cutaneous Leishmaniasis (CL), a neglected tropical disease (NTD) registering constant surge in northwestern region of the country during the last several years.
Leishmaniasis is a parasitic disease caused by a Leishmania parasite and exists in three forms including Cutaneous Leishmaniasis (CL), Visceral Leishmaniasis (VL) and Mucocutaneous Leishmaniasis (MCL).
According to WHO, an estimated 700,000 to one million new CL cases occur annually around the globe while the disease affects some of the world’s poorest people and is associated with malnutrition, displacement, poor housing, weak immune system, climate change and lack of financial resources.
“The disquiet exhibited by Aasia is not rare but normal for us as a reaction of psychological trauma being felt by patients of CL, especially female,” says Fazle Rahim, Focal Person for Leishmaniasis in Ghalania Headquarters Hospital.
Apart from badly damaging skin, Leishmaniasis also serves as a source of distress and inflicts psychological stigmatization on patients by causing disfigurement on exposed body parts mostly face, he added.
Disfigurement due to infection, especially among young women, put them in a poking grief and mental trauma owning to societal norm of giving preference to beauty as a first requisite for a decent marriage, Rahim explains.
“Majority of the female patients experience mental stress after appearance of lesion and feel embarrassment, depression, anxiety and self-contempt,” he went on to say.
“The infection leaves patients with mental strain and also shatters their confidence, especially of young girls who are much concerned about their appearance,” elaborates Dr Rafiq Hayat Malezai, District Health Officer (DHO) Mohmand District, a hotspot of Leishmaniasis registering more than 4,099 cases till June 2023.
The emotional toll of the disease is also witnessed among male patients, mostly youngsters, especially when the skin ulcer appears on uncovered body parts like face, affecting appearance of the infected persons.
“Noticing psychosocial trauma of Leishmaniasis on patients’ minds, preference is being given on youngsters over elders in treatment,” Dr. Rafiq continued.
While among youngsters, girls get priority over boys in utilization of the limited stock of Glucantime injections, a commercial name of Meglumine antimoniate, the first-choice drug against cutaneous leishmaniasis and is being imported through World Health Organization (WHO), he continued.
Similarly, school going children are given preference in provision of treatment over out of school children to save them from disruption of studies due to stigmatization they face from classmates.
A research study conducted by a student, Bibi Sakina, for her M. Phil studies at Zoology Department of Peshawar University also found psychological stress on minds of patients.
The study considered as first ever in Pakistan over psychological and social impact of Leishmaniasis, made an observation that Cutaneous Leishmaniasis is not fatal, but unfortunate disfigurement due to this infection results into common stigmatization and adversely affects social and economic wellbeing of patients.
“One of the most pointed out stigmatization is that the affected young women face difficulties in securing jobs and getting married,” highlighted the study conducted at Kuwait Teaching Hospital of Peshawar by interviewing 130 patients.
It was found in the survey that patients have negative consequences on their family, profession, personal, and social life and they believe that the illness has considerably changed their natural beauty.
During interviews of 130 patients, about 37.69 percent shared that they always had negative feelings of despair, a blue mood and anxiety.
The study also made a startling disclosure that there is growing evidence that leishmania infection in school age children in endemic areas leads to absenteeism from schools.
“Majority of patients are found much keen in removal of scar instead of treatment, reflecting psychological stress due to cosmetic deformity,” comments Dr. Hafsa Usman, a dermatologist serving in Peshawar.
She warned over increase in number of CL patients in KP as people from adjacent districts like Khyber, Mohmand, Bajaur and Nowshera are coming in large number to Peshawar for treatment.
The epidemiological record of Public Health Department of KP is also reflecting consistent spike in number of Leishmaniasis cases during the last three years with 3,177 in 2021, 18,180 in 2022 and 19,458 till August month of 2023.
In the year 2018, the southern region of Khyber Pakhtunkhwa witnessed an abrupt outbreak of CL infecting more than 28,000 people, prompting Medecins Sans Frontieres (MSF), an international medical humanitarian organization, to expand its services from Balochistan province to Khyber Pakhtunkhwa in order to help thousands of patients by providing free medical care.
MSF’s support provided great respite to poverty stricken CL patients by getting free of cost treatment and medicine.
“Eight members of my family including aged mother and children are infected with CL and I cannot even afford to bring all of them to the hospital in Peshawar from Cherat (Nowshera) for continuation of their treatment on daily basis,” said Hafeez Ullah, a mason by profession.
Soothing his three-year old daughter crying after getting a Glucantime shot at Naseerullah Khan Babar Memorial Hospital, the major health facility providing CL treatment with support of MSF in Khyber Pakhtunkhwa, Hafizullah said he visited different health facilities in Nowshera but could not find injection on regular basis for proper treatment.
Finally he took a difficult decision of visiting Peshawar on daily basis to bring all the ailing family members turn-by-turn on motorbike to Naseerullah Khan Teaching hospital for treatment.
“A vial of Glucantime is available in open market at a cost of Rs 2,000 each and it is impossible for me to purchase eight doses on a daily basis for treatment of all the eight infected family members,” he added.
“We are receiving around eight to 10 new patients on daily basis and is also providing services to people traveling across a large area where CL is endemic,” says Faqir Hussain, Supervisor of Dermatology Ward at Naseerullah Babar Hospital.
“Almost all the patients are treated with Glucantime, which is given per body weight, a child of 20 kg requires 1 ampoule a day for 20 to 28 days, while someone from 80 kg needs four ampoules of 5ml per day,” Faqir apprised APP.
“MSF has so far treated around 12,000 CL patients in Khyber Pakhtunkhwa since 2018 and 37,927 in Balochistan since 2008, totaling 49,693 in its five diagnostic and treatment centers,” shared Dr Halima Khalid, member of medical staff of MSF in Peshawar.
“Taking notice of increase in number of patients, MSF is nevertheless planning to expand CL activities in Khyber District of Khyber Pakhtunkhwa,” Halima said.
“While observing symptoms of psychological stress among majority of patients and for providing them proper counselling, MSF is also planning to depute a phycologist at Naseerullah Khan Babar Memorial Hospital in Peshawar, Dr. Halima told APP.
“Apart from arranging treatment of Leishmaniasis infection from dermatologists, the government should also focus on emotional wellbeing of patients by arranging psychological counseling for them ,” opined Dr Asad Zahoor, Focal Person of Leishminiasis in Karak district where around 10,000 of CL cases are piled up till September 2023 around 5300 new and remaining as follow up.
“Being a doctor we say some words of solace to give hope to patients for early recovery but for proper counseling services of psychologists is necessary to lessen the burden on patient’s minds, Asad told Alliance News.
Asad also suggested arranging free of charge treatment of cosmetic deformity at public sector hospitals because majority of the patients are poor and cannot afford plastic surgeries.
“The hotspots of Leishmaniasis are mostly in Southern districts of Khyber Pakhtunkhwa especially the newly merged one where there is no entomologist and government should give serious consideration to filling these vacant posts for prevention of vectors responsible for spreading this infection,” suggested Amjal Khan, an Entomologist working with Integrated Vector Contral Programme.
It was also suggested to create awareness among people about preventive measures like use of nets, repellents, insecticide, fumigation, waste management to reduce sand fly breeding places and maintenance of proper hygiene.
Reporting for this story was supported by the MSF-DNDi Grant on Neglected Tropical Diseases as part of the Without Borders Media Fellowship. The fellowship encourages independent, impartial and neutral reporting on health and humanitarian crises.