August 2004 saw MSF start up a sleeping sickness project in the Eastern Province of the Democratic Republic of Congo (DRC). Based in Isangi, the objective is to reduce the number of sleeping sickness carriers in the local population from the current 6.8% to under 0.l% over the next two years. Additionally, the project will include a clinical trial on a new treatment, which if successful could result in dramatically improved care for sufferers worldwide.

Sleeping sickness, also known as African Human Trypanosomiasis, is a parasite transmitted by infected tse-tse flies. If left untreated, it is fatal.

"The incubation period lasts for up to 21 days, and it can take up to two years before the parasite enters into the brain," explained MSF Medical Co-ordinator Mieke Steenssens. "The classic symptom is that the patient is manic at night and sleepy through the day, hence the name of the disease. Eventually he will fall into a coma and die."

The extent of the disease in the Isangi region was discovered during an emergency intervention carried out in 2003. Out of 3,044 people tested, 207 were found to be positive. The team also left fly traps in villages as a vector control. So far, over 33,000 flies have been caught.

The aim of new project will be to screen 100,000 people across two health zones around Isangi. If the predictions about the infection level turn out to be correct, this will mean 5,000 people require treatment.

The project, run in partnership with the Congolese Ministry of Health, will also provide an important opportunity to improve treatment for the severe cases of the disease (when the parasite has reached the brain). The principal objective will be the clinical trial of a treatment which is more effective and significantly less dangerous for the patient.

"This will mean that the current drug, an arsenic-based compound, which has a potential mortality rate of 10% and was developed over 50 years ago, will no longer be in use," explained Steenssens.

A further difficulty is the remoteness of the project, which is only reachable by a five-hour boat ride along the River Congo from Kisangani.

"There are a lot of challenges ahead in the next two years," said Steenssens, "But the potential for this project is enormous, not only in Isangi, but for sufferers of sleeping sickness in other areas of the DRC and beyond."