Supplemental Project Information

For those of you who don’t know where Ecuador is, well, shame on you:) Situated in the upper northeastern corner of South America inbetween Colombia (north) and Peru (South). The country is split by the Andes mountains into three distinct regions, coast, sierra, and “oriente” or amazon rainforest. It is in this last area where we are planning our project, in the far reaches of Pastaza province. See below:


(Map of Ecuador. Project planned in the far reaches of Pastaza Province)


Huge tracts of pristine rainforest make this area very difficult to access, indeed, a number of communities can only be accessed by days of walking or via small planes termed avionetas in Spanish.




(Rain-forest shot from Pastaza.)


A typical house from Arajuno, the second largest town in the province. Our project aims at communities further inside the province.




(House.)


Two main ethnic indigenous groups inhabit the area we plan to visit, the Shuar and the Achuar, each with a distinct language and myriad customs.


(Girl from Arajuno holding a local mammal.)


The medication most commonly used to treat leishmaniasis is called glucantime. It comes in a small liquid filled vial and the recommended treatment regimen for maximum results is 4 vials/day for a total of 2 weeks. At $5-6/vial this comes out to around $300/patient! The good news is the government has glucantime on their “free drug list” but the bad news is they will normally only provide ¼ the recommended dose per patient saying more is overkill. I work with the top leishmaniasis expert in Ecuador (Manuel Calvopiña) and according to him treating with a ¼ dose is more about saving bureaucrats money than with helping patients.

The disease normally starts off as skin lesions, some self-healing in a matter of months, but that can leave horrific scars even if they do heal. The real danger is that the cutaneous form can progress to the severe mucocutaneous version (this progression noted in 2-10% of all cases but only in the Amazon-side rain forests of Ecuador. MCL not found in the mountains or along the coast).

We have a great deal of evidence to suggest there is a significant amount of leishmaniasis in the area we will enter and thus the more money we can raise the more people we can treat. Please see pictures below:




(Mucocutaneous leishmaniasis (MCL) case from Amazon lowlands of Ecuador. Note complete destruction of nasal septum. MCL attacks the mouth and nose of sufferers, and while rarely fatal can disfigure a person leading to ostracization and other social problems. Image from M. Calvopina)




(Advanced MCL patient from the Napo province of Ecuador. Napo is similar to Pastaza in both geography and populace, bordering Pastaza to the north. Image from M. Calvopina)


For more information concerning leishmaniasis please see: http://www.who.int/tdr/diseases/leish/lifecycle.htm


In comparison with leishmaniasis, Chagas disease is a much more subtle affliction but decidedly more lethal. The disease usually presents symptoms decades after the initial infection, destroying heart and gastrointestinal tissues and resulting in high levels of morbidity and mortality among infected individuals. Treatment in the late stage chronic condition has debatable results but for those people more recently infected Rochagan (benznidazol) has been proven a very effective chemotherapeutic agent. It is thus imperative to diagnose this disease as early as possible as well as educating those living in endemic areas in order to help prevent transmission. Rochagan is a cheaper drug and we are not as worried about paying for it as with glucantime. Several studies (one listed at the end of the letter) have pointed to Chagas being a problem in the Ecuadorian amazon but no one has of yet conducted testing in the area we plan to visit.




(Youth infected with T. cruzi via the mucosal membrane of the eye. Image from http://www.vif.se/Mallar/publicent.aspx?SidID=10123)




(Electron micrograph image of trypanosoma cruzi next to red blood cells. Image from: http://www.rsc.org/Publishing/Journals/OB/News/B707772F_Hot.asp)


For information concerning Chagas disease please see: http://www.who.int/tdr/diseases/chagas/default.htm

In summary, our plan is to enter the two communities via plane, diagnose leishmaniasis on site and provide instructions and medicine for its treatment, while also taking venous blood samples (from all who will participate) to be analyzed at the lab using a proven commercial ELISA kit to look for the presence of T. cruzi infection (in brief, we look for antibodies produced by the body’s immune system which are present if the person has ever encountered the parasite). Education on these two afflictions will be imparted to both communities through their respective community health promoters. If we encounter individuals positive for Chagas disease they will be given a clinical screening and, if this confirms the lab results, treated with Rochagan.

If you read all this congratulations! And don’t hesitate to email me with more questions: wautersm@gmail.com

Best,

Mike