This spring, pharmaceutical giants GSK and Pfizer Inc forged a new partnership. They committed to sending two of their employees to work together to address one of South Asia’s most deadly but infrequently discussed health challenges, visceral leishmaniasis or “black fever.”
When it comes to insect-borne infectious diseases, health experts often reference the world’s deadliest insect-borne disease, malaria. Visceral leishmaniasis, also known as “black fever,” or by its Hindi name, Kala azar (KA), is similarly deadly but less well known. Each year the world’s second-largest parasitic killer, KA, infects an estimated 500,000 people. It is especially prevalent in India and South Asia, as it is transmitted by small sand flies.
To assist CARE India in researching ways to eliminate KA, Pfizer Inc and GSK developed a new and unique partnership through their corporate volunteering programs. The collaboration brought together a GSK PULSE Fellow, Clara Marr, and a Pfizer Global Health Fellow, Matt Azzara.
Clara is a clinical research and infectious disease specialist from England and Matt is a market researcher and oncology strategist from the United States. Given the competitive nature of the pharmaceutical industry, Clara and Matt are an unlikely duo, but Matt’s experience in strategy development and market research complements Clara’s deep clinical research and infectious disease expertise. Together, they make an exceptionally skilled and knowledgeable pair.
Matt and Clara came into this project with no prior experience with KA and no experience working in rural India. With the help of CARE India program leads, Dr. Raj Mohan Singh and Dr. Indranath Banerjee, Matt and Clara embarked on the journey with clear goals and a strong commitment.
Their objective is to better understand the role of private medical providers, especially Unqualified Medical Practitioners (UMPs) in rural India, in regards to identifying, diagnosing, and treating KA patients. UMPs far outnumber qualified doctors in India, and a high proportion (estimated to be over 80%) of rural villagers rely on UMPs as first-line providers for their basic health needs. However, as UMPs operate outside of any public system, they receive no formal training, there is no tracking or regulation of their activities, and no reporting of patients, which would help the Government of India understand where to direct their resources to combat KA. Most importantly, UMPs’ knowledge and awareness of proper diagnostic and treatment techniques for KA has been demonstrated to be quite poor, leading to patients becoming very ill or dying of the disease instead of being cured.
Clara and Matt are designing a research study to investigate how these UMPs (as well as some qualified doctors with private practices) interact and manage suspected and confirmed KA patients, and to help determine a way for these practitioners to be included in the effort to eliminate KA.
Meeting a patient
In 2011, in the Indian state of Bihar alone, over 30,000 cases of KA were reported, with many more cases unreported. Clara and Matt visited Bihar several times to meet with local stakeholders and patients to better understand the dynamics of the disease. They saw first-hand the devastating effects that the disease can have on patients.
While at the hospital in Bihar, Clara and Matt spoke with a KA patient, a young man named Prasanth*. Prasanth had been sick for ten days with a fever and an upset stomach when he first sought medical help from an unqualified medical practitioner. He was treated for jaundice for two months. His skin turned black as often happens with KA patients and he went through several additional months of treatment before being sent to a public health facility. Finally, he was admitted to the emergency room and was diagnosed with KA, seven months after falling ill.
While Prasanth was expected to fully recover from KA, he had not received any information on how to prevent it in the future. “While it may not have been representative of all cases, we were left with a vivid portrait of a family who had limited control over their own health needs in a complicated health care system,” said Matt.
Hope for Elimination
Although the volunteers found local physicians knowledgeable about the disease, the doctors were not always aware of the latest protocols and new, more effective treatments. Matt and Clara’s field trips and meetings with relevant stakeholders enabled them to design their research protocol, establish goals, and determine how best to monitor and evaluate progress of their work over time. “Reporting and tracking new KA patients in order to identify KA hotspots and measure progress against the elimination goal is critically important,” said Clara.
While travelling to villages and health centers throughout the region, Matt remarked “In some places, it seemed like a lot of progress had been made to combat the spread of KA, including prevention activities like spraying homes with insecticide to reduce the number of disease-carrying sandflies, and awareness of the disease was high among villagers. In others areas, KA still seems to be relatively unknown.”
By the end of Matt and Clara’s six month project in India, they will have completed a pilot study and also designed a robust research protocol to further assess the role of the private sector in the management of KA. The research study is planned to be conducted next year; the evidence generated from the study will enable CARE India to facilitate changes to public policy for a new approach to both treating and raising public awareness of KA.
Clara and Matt have come a long way in the three months—visiting patients, UMPs, private doctors, public health facilities, social health activists, and research institutions in Bihar. They have worked together, capitalising on their diverse backgrounds to build their survey and a comprehensive research protocol to implement it. To ensure the project’s sustainability, they will train the CARE India team to conduct next year’s broader study. Matt and Clara have also committed to be available to provide support after their assignment if needed.
GSK’s and Pfizer’s commitment to working together with CARE India to eliminate KA speaks to a growing willingness among corporations to look past their competitive differences and to collaborate to solve big problems. The potential success of innovative teamwork, like that of Matt and Clara, encourages the need for collaborative approaches to address global health challenges, one patient at a time.
Hopefully, GSK’s and Pfizer’s willingness to collaborate will inspire other corporations to adopt the same impactful approach towards solving tough global problems.
*Name has been changed.
Gavin Cepelak is the Director of International Corporate Volunteer Programs at CDC Development Solutions where he plays a lead role in developing, facilitating, and implementing global citizenship and volunteerism programs throughout the world.