"The situation of sleeping sickness (trypanosomiasis) in Congo-Brazzaville is undefined but the possibilities are daunting", says MSF country manager Cathy Huser, speaking from from Congo-Brazzaville. "The disease is suspected to be at epidemic proportions, but the National Trypanosomiasis Program of the Ministry of Health (MoH) totally collapsed in 1995, due to a series of civil wars."

Trypanosomiasis is transmitted by the tsetse fly and is always fatal when left untreated. From infection to death the disease takes some three to five years. "The MSF teams are working towards determining the prevalence-rate, as there is a total lack of accurate data in-country", says Huser. "We have heard anecdotal recounts of complete villages disappearing due to trypanosomiasis".

As of May, the MSF team will begin active screening for trypanosomiasis in the region, targeting some 30,000 people near the Congo river. Clear recommendations for a longer-term intervention will be made in three to five months, once the prevalence is understood.

MSF started treating trypanosomiasis patients from the beginning of April. The disease progresses in two phases. "First-phase patients are treated as out-patients with a series of ten injections of pentamidine. Phase two patients need hospitalisation since they have to be treated with the very toxic drug melarsopol. "In the Republic of Congo, there are an additional three historically known hot-spots for sleeping sickness, and it is feared that the disease could have an effect well beyond these sites, due to the large displacement caused by the wars."