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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Historical Perspective
Kala-azar first came to the attention of Western doctors in 1824 in Jessore, India, where it was initially thought to be a form of malaria. India gave kala-azar its common name, which is the Hindi for “black fever”, so called for the darkening of the skin on the extremities and abdomen that is a symptom of the Indian form of the disease. The agent of the disease was also first isolated in India — by Scottish doctor William Leishman and Irish physician Charles Donovan, working independently of each other. As they published their discovery almost simultaneously, the species was named for both of them — Leishmania donovani.
Today, the name kala-azar is used interchangeably with the scientific name visceral leishmaniasis for the most acute form of the disease caused by L. donovani. Contemporary life has made itself felt even here, however — not as “progress” but in the form of the many small wars of Africa’s post-colonial era. In the Sudan, where civil war has been continuous since 1983, the violence has been concentrated in the more populated south, and kala-azar was concentrated there too. But the wars have driven a steady stream of refugees out of the region, and these traveled either across the southern border or into the remoter western part of the country called the Upper Nile, where both war and the disease that went with it had not yet penetrated.[1]
These refugees, moving at foot-speed, carried the disease with them, and when it arrived it hit the Upper Nile with a force comparable to smallpox hitting the American Indians. The isolated people of the Upper Nile had no access to medicine or education about the new disease among them. Worse, their immune systems were defenseless against this new pathogen, foreign to them though it came only from another part of their own country. One village at the center of the epidemic, Duar, was left with four survivors out of a population of a thousand, and from the late eighties to the mid-nineties a total of 100,000 succumbed to the sickness in that region alone. In the words of Jill Seaman, the doctor who led relief efforts in the Upper Nile for the French organization Medicins Sans Frontieres, “Where else in the world could 50% of a population die without anyone knowing?”[2]
The world’s failure to notice the epidemic was not due solely to its primitive setting, but also to the realities of politics. When, in 1991, a group of Sudanese researchers with the World Health Organization warned of a coming kala-azar epidemic and proposed the construction of a treatment center, the Sudanese government stepped in and denied the existence of any epidemic. At war with its own people, the government in Khartoum did not wish to have foreigners aiding the population, and preferred to use limitations on foreign aid as a means of political control. The WHO, a non-governmental organization, could do nothing in the face of opposition from its host government, and so nothing was done. For much of the nineties, Medecins Sans Frontieres battled the disease essentially alone, working not only without borders but without hospitals or visas.[1]
See also History of leishmaniasis