The treatment of parasitic skin disease Leishmaniasis in Suriname

Almost twelve million people world-wide are infected by Leishmaniasis. This disease can cause large, open wounds all over the body. However, not many people go – in time – to the doctor, while it is important to be treated at an early stage. Sahienshadebie Ramdas has examined which treatments patients in Suriname choose and what holds them to seek timely medical attention. Ramdas defended her PhD thesis on 15 January at the University of Amsterdam. A symposium on the subject was organised a day prior to her defense.

Patients often try to cure themselves at first with all kinds of aggressive methods. The belief that a horrific disease also need a horrific treatment plays an important role when choosing a 'suitable' drug, resulting in the most aggressive treatments. Also ignoring the wounds is a big problem. The result is often that the wounds get worse. It is therefore important to understand why people in the Inlands initially barely turn to professional medical help, even if this is available free of charge.

Self medication versus medical treatment

Ramdas examined why patients prefer uncertain self-medication to proper medical care. For instance, due to lack of medical facilities, self-medication appeared to be a way to survive in the Inlands for ages. Another concern is a shortage of medicines in the Inlands. Distances from the Inlands to the Dermatological Service in Paramaribo are often long, while travelling to and accommodation in the city is expensive. Besides, an important reason why people rather opt for self-medication is their fear of injections (the regular biomedical treatment) and their side effects.

The research also indicates that patients in the Inlands of Suriname are often capable of diagnosing the disease, but do not know whether or not it is contagious. Above all they have no clue about the way they were affected, while the disease is spread by infected sand flies that occur especially in the Inlands according to scientists.

The severity of the wounds depends on the type of parasite. Patients are also worried that their limbs must be amputated if the wounds do not heal. This can also prevent them to visit a doctor initially. If their skin is affected, patients might feel uncomfortable in their interaction with others. Since the Surinamese the variant of Leishmaniasis has less impact on the skin of the face, there is – in contrast to various other countries – hardly any stigma or discrimination against people with the disease.

Information and education

It is clear that information and education about this disease are urgently needed, at the national level, but especially for domestic communities and specific professional groups, such as gold miners, loggers, hunters, and others who live and work in the Inlands. This also applies to groups that live in the city, but who visits the Inlands for recreational purposes, such as hunters and tourists. The medical mission (a private, nonprofit organisation that provides health care in the remote Inlands of Suriname) can play a crucial role, along with the Dermatological Service and the Office for public health care in Suriname. Local traditional health experts should also be involved in providing information in the Inlands.