A frail 65-year-old woman sitting under the mango trees in a rural village in Chad suffers from a tropical disease that eats into the brain, and the locals blame on witchcraft.
"I've been suffering for more than two months now. I have headaches, fever, and I just feel very tired," said Lea Sadene, who has just been tested and diagnosed.
She has Human African trypanosomiasis, commonly known as sleeping sickness, which is transmitted by tsetse flies found in 36 sub-Saharan African countries.
Sadene is in the first phase of the often fatal illness. Without treatment in four months to a year, "the parasite penetrates into the brain, causing serious neurological symptoms, until death," said Doctor Benedict Blaynay, head of neglected tropical diseases at French pharmaceutical giant Sanofi.
"The symptoms can cause a change in personality, mental deterioration, leading to a long sleep or coma," which gives the illness its name, he said.
Chadian health officials say around 3,300 people were infected between 2001 and 2011 in several areas of the landlocked central African nation, one of the poorest in the world.
"With more than 100 cases per year Chad is considered an endemic country," said Doctor Peka Mallaye, who is in charge of the national programme to fight against sleeping sickness.
In Kobitoi in southern Chad recently, village women lined up with their children, many with swollen bellies, in the scorching sun as temperatures hit 43 degrees Celsius (109 degrees Fahrenheit) to undergo tests for the disease organised with Sanofi.
The team found 14 cases of sleeping sickness out of 120 people examined, Mallaye said.
"This village is located next to a forest where the tsetse flies live. During the rainy season, people pass through the forest to go fishing or hunting," he said.
Fighting the disease, however, takes more than testing and drugs. For the people living in Chad's rural communities, the strange symptoms of sleeping sickness have long been shrouded in superstition about witchcraft and demonic possession.
"Before we didn't know that it was the disease that was killing people. People died like flies, they blamed witches," said Alngar Legode, a village mother trying to comfort her eight-month child still crying after being pricked for the blood test for the disease.
"Witchcraft is seen as a real phenomenon in traditional societies," said sociologist Serferbe Charlot. "They think that a man or a woman suspected of witchcraft is eating away at a person's soul."
In the advanced stages of the disease the infected person experiences severe neurological problems.
"When this disease reaches the brain, the patient loses control of his life, he even becomes violent. That is when the villagers believe that the sick person is possessed by evil spirits," said Charlot.
"It is up to the health specialists to prove" to the population that it is not witchcraft, he said, adding: "The fight against sleeping sickness calls for raising awareness."
But the World Health Organisation says it is not a losing battle.
After continued control efforts, the most recent statistics available show the number of cases in 2009 dropped below 10,000 for the first time in 50 years, and the trend continued in 2010 with 7139 new cases reported, the WHO reported on its website.
WHO estimates the number of actual cases is currently 30,000. The most affected country has been the Democratic Republic of Congo, which declared 500 new cases in 2010.
The WHO has established public-private partnerships with Sanofi and also Bayer Healthcare to create a surveillance team and provide support to endemic countries in their control efforts as well as a free supply of drugs to treat the sick.
Diagnosis should be made as early as possible before the disease reaches the neurological stage, which calls for more complicated and risky treatment.
The chief executive of Sanofi, Christopher Viehbacher, said the main challenge ahead "is to keep up the expertise in diagnosis and treatment in the medical centres, so that the monitoring for sleeping sickness is maintained."
Sleeping sickness figures on the WHO's list of 10 neglected tropical diseases. In January in London, the UN health agency brought together the US, British and United Arab Emirates governments along with 13 pharmaceutical companies and international organisations like the World Bank and the Bill & Melinda Gates Foundation to make a new push to eliminate these diseases by the end of the decade.
"If we keep doing the right things better, and on a larger scale, some of these diseases could be eliminated by 2015, and others by 2020," WHO Director General Margaret Chan has said.
