More than 400 million people are at risk for the neglected tropical diseases (NTDs) visceral leishmaniasis (kala azar), sleeping sickness, Chagas disease, and Buruli ulcer. The first three are the deadliest of all the NTDs, and all four have been highlighted by the World Health Organization (WHO) as especially troublesome due to treatment and diagnostic tools that are old, ineffective, or worst, simply non-existent, and patient populations stuck in remote or insecure areas with little or no access to already limited available treatments.

Even worse, research and development (R&D) of new medicines and diagnostics has ground nearly to a halt.

According to the 2009 G-FINDER report, US$2.96 billion was spent on R&D for "neglected diseases" in 2008, but less than 5 percent combined was devoted to these four diseases. The recently announced US Global Health Initiative (GHI) focuses on some neglected diseases, but does not currently include these four diseases, threatening further neglect of diseases that impact the world's most impoverished and marginalized people.

Unless there is a substantial increase in resources for diagnosis, treatment, and prevention, as well as dedicated R&D, these diseases will continue to take a heavy toll.

In the outskirts of Cochabamba, Bolivia, MSF provides medical assistance to patients up to 50 years old, promoting the inclusion of adult patients in the treatment of Chagas disease. This is a step forward in the fight against Chagas; until recently, it was thought that the treatment was only effective on very young children. [Bolivia 2009 ? Anna Surinyach/MSF]

Patients with sleeping sickness usually develop inflamed lymph nodes in the neck area where the parasite is hosted. Diagnosis for this disease can be done by puncturing the ganglion in order to extract a sample of lymph, and looking for the trypanosome parasite under the microscope, or it can be detected in blood tests. [Sudan 2006 ? Juan Carlos Tomasi/MSF]