The search for Bilyaminu and understanding sleeping sickness

Precisely 40 years ago, when I was much younger and growing up in Jos, my parents hired a young man named Bilyaminu (not real name. Bilya for short) as a house help. He was between 25 and 30 years old and, despite his frail appearance, promised my parents they wouldn’t regret employing him. Unfortunately, Bilya […]

Precisely 40 years ago, when I was much younger and growing up in Jos, my parents hired a young man named Bilyaminu (not real name. Bilya for short) as a house help. He was between 25 and 30 years old and, despite his frail appearance, promised my parents they wouldn’t regret employing him. Unfortunately, Bilya turned out to be a disappointment.

He struggled to complete tasks as expected, often complaining of headaches, lethargy, and sometimes seemed confused and disoriented. Simple tasks like sweeping and mopping the living room became a chore for him. Amazingly, he would often fall asleep on the floor, leaving cleaning tools scattered around. Sometimes he would even fall asleep under a tree while sweeping the compound, leaving the broom behind. When given clothes to wash, he would dump them in the laundry and take a nap in the coolest area or on top of the dirty clothes.

My parents grew concerned about Bilya’s excessive sleeping, having heard about “sleeping sickness” on a radio health programme. To my parents’ surprise, when they decided to take Bilya to the hospital, he was nowhere to be found. He had packed his belongings and left. My parents were disturbed but concluded that Bilya must have preferred alternative treatment.

I vividly remember that day; as a child, I asked my mom to explain what was happening, and she told me they suspected Bilya had “sleeping sickness.” I naively replied, “Bilya zai yi bacci ya huta” (Bilya will get enough sleep and rest).

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As I grew older, my curiosity deepens  about  sleeping  sickness and  often wondered if Bilya could have survived what my parents suspected. Hence, in the process of writing this article, I decided to search for Bilya to put my mind at ease.

Thanks to GSM (mobile phones), with the help of my parents, after numerous phone calls, I was able to connect with an elderly person Hajja, (not real name) who knew Bilya and finally got the news I had been searching for. Hajja, told me that Bilya, who hails from Dass in Bauchi state, is alive, well, and happily married with children. I also learned that Bilya had left my parents’ house abruptly because he was terrified of death and had rushed back home. 

I asked Hajja, about Bilya’s health 40 years back, and my worst fears were confirmed: he had contracted sleeping sickness. I was relieved to hear that he received conventional treatment. And overjoyed that Bilya had survived, though all efforts to get through to him proved abortive. 

To this end, amazingly, I found myself working with the Nigerian Institute for Trypanosomiasis Research (NITR), an organisation dedicated to researching and controlling African trypanosomiasis, a disease that affects both humans and animals. In humans, it is known as human African trypanosomiasis (HAT) or “sleeping sickness,” while in animals, particularly cattle, it is called animal African trypanosomiasis (AAT), or “Nagana” and “Surra” in camels.

Interestingly, my curiosity on sleeping sickness was cleared. I now understand, sleeping sickness is not about, ‘Bacci ko Hutu’ (sleeping or resting.) As an information officer, I learned that HAT or “sleeping sickness” is caused by protozoan parasites called trypanosomes – Trypanosoma brucei gambiense in West and Central Africa, and Trypanosoma brucei rhodesiense in East and Southern Africa – that are transmitted by the tsetse fly (called “kudan tsando” in Hausa). These flies are found in savannah forests, mangrove forests, or along riverine vegetation.

Rural dwellers who engaged in socio-economic activities like farming, fishing, and hunting near tsetse fly habitats are at higher risk of contracting the disease. 

To minimise exposure are advised to: 

Wear thick protective clothing, including jeans, socks and long-sleeved shirts.

Avoid dark and bright colours that attract tsetse flies.

Disinfect vehicles before use.

Avoid bushy areas during hot periods of the day when tsetse flies rest and may bite if disturbed.

Once bitten by an infected tsetse fly, the disease develops slowly over a period of two years, culminating in disrupted and altered sleeping patterns, thus the name “sleeping sickness,” and   if left untreated, the disease ultimately results in death.

Symptoms 

Early-stage symptoms of sleeping sickness include intermittent fever, skin lesions, headaches, malaise, exhaustion, anorexia, extreme thirst, muscle and joint pains, anaemia, and early signs of neurological and endocrine disorders such as daytime somnolence, insomnia, changes in personality, coldness, lack of appetite, polydipsia, impotence, amenorrhea, and infertility. The late stage is accompanied by worsening early-stage symptoms and the appearance of more severe and complex symptoms, including sleep-wake cycle disturbance (sleep by day and restless night, as the name “sleeping sickness” suggests), psychiatric disorders, confusion, tremor, dementia, epileptic fits, and eventually death.

Treatment 

 Treatment with drugs has been the main approach for managing “sleeping sickness” patients. This approach has been unsatisfactory due to numerous problems, including high toxicity, poor efficacy, undesirable routes of administration, and drug resistance. Additionally, the drugs are very old, such as suramin, melarsoprol, eflornithine, pentamidine, and nifurtimox.

However, there is good news now as a new drug called fexinidazole has just been developed and introduced as an oral and effective treatment for “sleeping sickness.” Parafuramidine and acozaborole are two candidate drugs currently in clinical trials with promising results so far.

Prevention 

For prevention, there is no vaccine yet near the clinical trials stage, though NITR has recently developed DNA-based vaccine constructs that have shown promising results in experimental models. Control Vector remains the best option for controlling both the human and animal trypanosomiasis. 

NITR, as the desk office of the Pan African Tsetse and Trypanosomiasis Control (PATTEC-Nigeria) project, has worked diligently over the decades to suppress the tsetse fly population in many parts of the country, and has covered areas such as National Parks and Game Reserves. This has significantly reduced the risk of the disease and the emergence of new cases.

 In retrospect, the last diagnosed case was from Delta State in 2012, and this has paved the way for target elimination in 2030 by the World Health Organisation (WHO.)

However, it’s crucial to remain vigilant. If you or someone you know exhibits symptoms of sleeping sickness, please report immediately to any NITR laboratory for medical test in either, Kaduna, Ibadan, Suleja, Boko or Vom. Sleeping Sickness is curable, especially when detected early. 

Let’s stay alert and ensure that the gains made in tsetse fly and “sleeping sickness” control are not reversed.

Lastly, Bilyaminu, this is for you, and to good health.

 

Hafsat is with Public Relations Unit, Nigeria Institute for Trypanosomiasis Research, Kaduna