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On the African continent, in the narrow band between the 15th parallels that bookend the equator, a tiny fly is jeopardizing the lives of 55 million people and could be responsible for one of the largest epidemics of this century.

The narrow arc along the equator ventures through 36 sub-Saharan nations, 22 of which are among the most underdeveloped in the world. In every land, the tsetse fly thrives.

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The tsetse fly feeds on the blood of animals and humans. Its bite can carry a parasite that will work its way through your body and, if left untreated, put you on course for a slow, agonizing and certain death.

It's called the sleeping sickness.

The World Health Organization says if the entire at-risk population were put under medical surveillance, the number of diagnosed cases would reach 250,000 to 300,000.

But accurate medical surveillance is difficult in a region wracked by civil wars, economic turmoil, environmental changes and displaced populations. WHO estimates that one-tenth of the at-risk population is under surveillance, which has allowed about 25,000 new cases of sleeping sickness to be diagnosed each year.
Medical catastrophe

Dr. Michaleen Richer of the International Medical Corps said the prevalence of sleeping sickness has risen by more than 15 percent.

"This is an epidemic of really catastrophic proportions," Michaleen added.

The IMC, U.S. Centers for Disease Control and Prevention, CARE and other organizations are in the midst of a major effort, which began last year, to identify people infected with sleeping sickness and contain the epidemic.

But the organizations say their efforts could take years. Meanwhile, WHO estimates that every year some 250,000 to 300,000 men, women and children are left to suffer and die because their illness is going undiagnosed and untreated.

And every untreated, undiagnosed human creates a new host for each uninfected tsetse fly, which means the disease spreads exponentially.

Perhaps the saddest commentary on the lives lost is that the illness is relatively easy to treat. But medicine is expensive. It can cost more than $1,000 to cure a sleeping sickness victim.

"One hundred percent of these people will die if they don't receive medication," said Dr. Sandra Clark of the IMC. "These people have virtually nothing, and they are dependent on the outside world for help."

WHO estimates it costs $27 million a year to fight the disease in the 36 endemic countries, and another $1.5 million a year to coordinate field efforts, technical support and operational research.

Some pharmaceutical companies have donated medicine to the cause.
A horrible death

Much has been reported about the gruesome deaths associated with hemorrhagic fevers, like Ebola, which can bring a quick death.

But imagine having your body slowly destroyed by a parasite that will literally drive you insane.

That death is what the bite of the tsetse fly can bring.

In the beginning, you may think you have the flu. You can run a high fever, have headaches, joint aches, even itching.

As the parasite spreads throughout your bloodstream, it takes its toll on your organs. You can develop anemia or endocrine disorders. You can develop heart and kidney problems. And pregnant women can lose their fetuses.

By the time the parasite reaches the central nervous system, you are vulnerable to unpredictable mood changes, and you are so weak that it wears you out to eat or even open your eyes.

You are a danger to yourself and others because you can suffer from sudden bouts of aggressiveness. In some villages, the people tie sleeping-sickness victims to huts or poles to keep them from harming others.

Eventually wasted and destroyed, sleeping-sickness victims slip into a deep coma and die.
An old threat

Records indicate that Africans have fought against the sleeping sickness as far back as the 14th century.

In 1906, an outbreak of sleeping sickness killed 4 million people in Uganda.

Health officials say at that time, sleeping sickness was considered the No. 1 public health threat in the tropics.

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