Utilization of empiric treatment for leishmaniasis in endemic communities of Peru

LEARNING LOCAL
E.E. Freeman MD PhD



I do speak Spanish. Or so I thought, until I tried explaining my purpose here in Peru to my taxi driver on the tortous drive between Lima's airport and my apartment. "I work with leishmaniasis," I explained in my best Peruvian Spanish accent, "from the bite of a sand fly." He stared at me blankly. Perhaps I was not pronouncing leishmaniasis correctly. "LeishmanIASIS?" Nothing. "LEISHmaniasis?" Still nothing. "LeishMANiasis?" Nope. "Well, it's a parasite transmitted by the bite of a sand fly. We don't have it here in Lima. It's at higher altitudes." That would have to do. Perhaps he'd never heard of it? I found that slightly hard to believe, given the high prevalence rates of Leishmaniasis in Peru, and given that most Limenos travelled into the sierra (mountains) or selva (jungle) at least at some point, whether to visit family or at least touristically. There was, of course, the more likely possibility that in common parlance Leishmaniasis had another name. I would have to wait until clinic tomorrow to figure that one out.



"Uta," as I later discovered, was my missing word. Uta, derived from the phrase "the bite of the rat," presumably because the ulcers can look like animal bites, comes in two forms. Wet uta is an ulcer from leishmaniasis, whereas dry uta is a flat lesion from an inject bite without parasitic involvement. Now, when people ask why I'm here, I explain that my research is on La Uta. This is followed by an instant flash of recognition, and stories about family members or friends who have had uta, and what they did to treat these notoriously difficult ulcers.



Tomorrow I head into the field, to visit endemic communities affected by uta. I'll be visiting patients in one of the Leishmaniasis Research Group's phase II clinical trials, as well as gathering background information for future investigations on empiric treatment of Leishmaniasis with battery acid, hot chili peppers, and the like (an unfortunately common practice). The plan is to sleep on the health center floors in these remote communities, visiting our patients during the day when the sand flies themselves are at their least active, trying to minimize our own risk.



I'm in charge of packing for the expedition, which includes our driver, a Peruvian physician, a Peruvian biology student, and myself. The medical supplies didn't worry me. I already had our Leishmansis smear slides, lancets, and gloves packed up. "There's no where to buy food up there," warned my Peruvian physician friend. "So make sure you pack enough food for everyone for several days. You never know when you'll get trapped by a river. Our driver likes coffee and eggs, otherwise he'll get grumpy. Oh, and don't forget a small food token of appreciation for the nurses in the rural health posts that will be hosting us." My confusion must have been obvious. "Marshmallows!" she chuckled. "They love marshmallows!"



Local knowledge triumphs again. Off I go, several bags of marshmallows tucked into my backpack, to study "the bite of the rat."