GONDAR, Ethiopia (Thomson Reuters Foundation) – When increasingly erratic weather ruined his crops of maize, wheat and barley in highland Maksegni, the middle-aged farmer migrated to Metemma, in northwest Ethiopia, to look for work in the lowland area’s commercial sesame and cotton plantations.
There he picked up more than work. Today the 39-year-old is infected with visceral leishmaniasis – a disease commonly called kalaazar – and with HIV.
The father of two, who is being treated at the University of Gondar, is among an estimated 300,000 Ethiopians who migrate to the plantations near the Sudan border every year, looking for new sources of income as their farms struggle.
But as they flee from hunger, they enter into sandfly territory, and bites by the insects spread kalaazar, a parasitic disease that is usually fatal if untreated. The loneliness of being away from family also leaves them vulnerable to HIV, researchers say.
“It is a kalaazar endemic area,” explained Ermias Diro, a researcher at the university’s clinic. “A lot of people travel there to look for work and in the process they get bitten by the sandfly.”
“After working throughout the day in the farmland they rest under a tree where there is shade,” he added. “It is a very hot place and they may not be dressed fully, so they get bitten.”
FAILING CROPS, RISING MIGRATION
Experts have linked more irregular rainfall and crop failures to a rise in migrant workers in Ethiopia. Meteorologists said Maksegnit, in the highlands, should record as much as 1,059 millimeters of rainfall during the peak season, but in the last few years rainfall has been as low as 317 millimeters.
That has led to a decline in staple crop farming, while cash crop farming in the lowlands pulls the struggling poor from the highlands, and toward new health threats.
Changing climatic conditions also are changing the range of the sandflies, said Daniel Argaw Dagne, of the leishmaniasis control programme at the World Health Organization.
“Kalaazar is a vector borne disease that can be influenced by climate change,” he said. “Global warming affects the distribution and growth of vectors.”
Fabiana Alves, the clinical project manager at the Drugs for Neglected Diseases Initiative, said double infection by migrants with HIV and kalaazar “is a disease burden that we do not see in other countries even in East Africa.” More worryingly, “treatment with the available drugs is becoming difficult,” she said.
At Gondar University more than 15 percent of patients are “co-infected”, and studies are underway to look for new treatments. But testing and treatment in remote villages is needed as well, the experts say, and will be difficult.
NEED FOR RURAL TREATMENT CENTRES
Hasrat Hailu Mekuria of Addis Ababa University said the long distances and geographical isolation mean health care workers cannot reach some villages, while others lack basic facilities.
“Lack of water, hygiene and energy sources in rural healthcare is a big problem because kalaazar requires refrigeration or cold storage for some of the diagnostics,” Mekuria said.
Experts say establishment of mobile clinics and positioning of health extension workers in the communities could help migrating populations.
Kenya, meanwhile, is suffering similar problems treating its own kalaazar cases, said Anderson Chelugo, a clinical officer at a treatment centre in Kimalel, where the road, energy and communication network is poor.
Power blackouts at the facility that hospitalizes kalaazar patients for close observation occur for full days as often as three times a week, he said.
The facility, in one of the most arid parts of the country, has yet to be fitted with alternative energy sources, such as solar. Even the standby generator has not been functioning for the last two months, Chelugo said.
“The patients we are unable to reach in the villages prefer traditional treatment like the use of herbal medicine and spiritual cleansing,” he said. “Many die because of lack of, or late treatment.”
Medics say that governments must invest in renewable energy if communities hardest hit by climate change and migration are to get their disease burden under control.
Kagondu Njagi is a freelance contributor for the Thomson Reuters Foundation, based in Nairobi and writing on climate change issues.