By Glenda Boza Ibarra (El Toque)
HAVANA TIMES – Anabel didn’t tell almost anyone that she had scabies. “It’s a disease people with poor hygiene get,” she only told a group of close friends.
She is a lawyer in a collective law firm in Las Tunas and “scabies isn’t a disease for the university-educated.” When she asked colleagues for treatments for “someone she knows’ daughter”, you could still find Permethrin at some drugstores. That was back in January 2020.
“I bought six bottles of 1% permethrin at the drugstore. I washed our clothes and put it on both my son and I. We got it again in early March. Luckily, I didn’t give that medicine away to anyone. Almost nobody knew I had scabies… and they’ll never find out.”
According to the World Health Organization (WHO), human scabies is a parasitic infestation caused by Sarcoptes scabiei var hominis, that mostly affects people with poor access to hygiene.
“The highest rates of infestation occur in countries with hot, tropical climates, especially in communities where overcrowding and poverty coexist, and where there is limited access to treatment.”
Anabel believes “this disease” isn’t something worth talking about. Not even when she know’s that there are many Cubans who, just like her, have become infected with scabies in the past 14 months. While there are no official statistics available, the spread of scabies continues to be heard outside the media in Cuba.
Permethrin, benzyl benzoate and ivermectin (drugs in the basic list for scabies treatment) are the most highly sought-after in medicine exchange, donation and buying and selling groups. Posts and comments are testament to this. However, the government has said little or nothing about this “plague” that has the country itching all over.
“Globally, it is estimated to affect more than 200 million people at any time,” the WHO says. It is most common in warm tropical countries in resource-poor and densely-populated areas.
The National Program for Controlling and Preventing Scabies has existed in Cuba ever since 1995, which not only includes treatent for the disease, but also actively checking schools and daycare centers, training health professionals and localizing those who have been in contact with the sick.
However, this program’s implementation hasn’t stopped Cuba from seeing a surge in this parasite infestation, especially in recent years.
In November 2019, doctor Ailen Delgado, a leading expert in Dermatology and Comprehensive General Medicine at the Amalia Simoni Hospital in Camaguey, told the local newspaper that case numbers had risen in Cuba.
“We know that cases of the disease are growing both worldwide and in our country, because according to international data, there is a surge every 8-10 years, and that’s what is happening right now,” she said.
Lillisbet Leyva’s two sons had scabies in early 2020. She doesn’t know for sure whether her youngest son became infested at the daycare center or whether it was the other one at primary school. Children are the most vulnerable not only because they don’t uphold strict hygiene habits, but also because they are at greater risk of developing secondary complications of infestation.
According to the bibliography on epidemology and source control that Med students receive in Las Tunas, there is a Joint Instruction 1/86 between the ministeries of Education and Health, which covers managing and control of ectoparasites such as scabies. However, what manuals and prevention programs outline isn’t always implemented in reality.
According to a study carried out at a daycare center in Bayamo during 1994-1996, some of the factors for reinfestation of scabies in children include: inadequate cleaning; undiagnosed infested patients; contacts with the infested person not being treated; places without a bathroom; improper washing of towels, of nursing and older children’s clothes, cot covers, etc; improper treatment because of a lack of medicines such as: benzyl benzoate and lindane; shortages of soaps and detergents for domestic use; to name a few.
The economic crisis in the ‘90s made this one of the main causes of deaths linked to dermatological disorder and related complications during the Special Period.
The study published in 2014 shows how economic crises have an impact on demographic processes and health, and lead to a surge in infectious diseases such as scabies. The tense situation in Cuba, along with other factors, is the reason behind the current outbreak.
Medicine shortages have seriously affected scabies treatment in Cuba. On BioCubaFarma’s website, two users asked what the situation was with drugs to cure scabies. The response to one of the queries was that “permethrin production had been affected because of raw material shortages and import alternatives are being looked at to get a hold of these.”
According to statistics published by this Cuban body, 5% permethrin cream which is nationally produced, went from being missing in four provinces in January 2020, to being missing everywhere in the country in March of last year.
However, it was no longer included on the list of missing medicines, as of August. While records (which BioCubaFarma publishes monthly) go back to September 2020, many people have confirmed that permethrin has been entering drugstores on occasion.
In the medicine distribution report for the National Health System, August 2020, only 114,827 tubes of 5% permethrin cream had been delivered, when there is an annual demand for 395,955 tubes. Up until today, production of the 1% cream only reached 92,093 bottles out of a total of 3,069,783. Up until now, monthly demands haven’t been met in either case: permethrin cream production only covered 29% of estimates, and lotion production was only 3%.
According to the National Medicine Formulary, benzyl benzoate (produced by the Oral Liquids Pharmaceutical Laboratory Company, could also be used to treat scabies, but there is no official record of why it is missing from drugstores.
Ivermectin is an imported product that is used to treat scabies in immunosuppressed individuals, and it has been one of the products that Cubans regularly search for on social media. However, this medicine is exclusively for hospital use; and in April 2020, health authorities said that Cuba had this anti-parasitic drug if it were needed to treat COVID-19.
The Cuban government and Public Health Ministry officials have repeated that the US blockade is the main reason for current medicine shortages, which is a situation that has only been made worse by the pandemic, but actually dates back to 2016. According to recent information, the sector estimated losses at over 198 million USD, between April and December 2020.
Studies from 1994, 1998, 2006 and 2018 confirm that shortages and an unstable supply of drugs for scabies treatment allow this highly infectious disease to spread.
Spaced out periods between outbreaks, as well as very little dermatological attention in health services, have an impact on the inadequate training of Comprehensive General Medicine residents and, as a result, in them losing the habit of promptly diagnosing this parasitic infestation, especially of crusted scabies, which if treated late, can result in death.
Lillisbet Leyva hasn’t been able to find any medicine to treat scabies. She scoured every drugstore in Las Tunas for a week, but she didn’t find anything. She’s tried guava leaves, aloe vera, vinegar, but nothing has been able to stop her two children from itching.
“My step-father was told about DerNim, a natural medicine that is being sold in Labiofam. We’ve all been using it at home for a week,” she says.
DerNim is a Cuban bioproduct that is made with teetree oil from the Neem tree and it is used to treat scabies in humans and animals. In the case of the human version – DerNim U -, a 2005 study concluded that you can treat scabies in 3-5 days without any adverse reactions, by applying this natural antimite product.
However, DerNim U wasn’t the solution to Lillisbet’s children’s itching problem. It was DerNim P, which is used to treat scabies in animals.
“At the Labiofam retail point, the sales assistant herself explained to my step-father that many people are using this “cream” and it has proven effective. You put it on for a week and you adopt other hygiene measures, such as washing all of your clothes and bedsheets in hot water,” she says.
Lillisbet says that in addition to DerNim, she also used Labiomec, another veterinary medicine that is mixed with a skin cream or added to water, which is also effective in treating scabies.
“With medicine shortages, we had to “grab hold” of anything that showed up and many people recommended these two medicines. I was afraid, as you can imagine, but I trusted the people who told me it worked,” Lillisbet says. “I bought 2 cc for 30 pesos, I put three drops into the water at the end of the bath, and I didn’t dry it off. I did the same thing with my children, and the scabies went away.”
However, Yamilet Rodriguez, a nurse at one of the capital’s pediatric hospitals, warns that they have had many children arrive at A&E with complications linked to Labiomec use.
“I understand that drugstores don’t have medicines, but these are products for animal use only. People need to be careful with the things they give their children, especially if they are young,” she points out.
In spite of nurse Yamilet’s call of caution, many social media users without medical training are claiming that Labiomec is an effective medicine to treat scabies in humans.
“It’s the best thing out there for scabies. You put it on three nights with your skin cream and it’s a miracle. I had scabies and it was the only thing that got rid of it,” Celina Ramos says.
At the beginning of the pandemic, Mariela Muñagorri bought a 5 ml bottle of Simpiox in a Revolico group. She paid 50 CUP for this oral solution of 0.6% ivermectin. Ten months later, her family got scabies again and you couldn’t even find medicines brought over from abroad.
“As lots of people aren’t able to travel, you can’t even buy medicine on the illicit market. When we got it again in February, I asked for medicines at the international clinic, on different Facebook groups, at the candongas in Santa Clara, friends…
I finally got some because a neighbor still had half a bottle of permethrin and she gave it to us when she found out how desperate I was.”
Very few medicines brought over from abroad – especially for scabies treatment – can be found in buying and selling groups. The drop in international flights because of COVID-19 has reduced this illegal offer and remittances from relatives living in other countries. In the face of such a situation, many people have had to seek out alternatives.
White vinegar, baths with French candlebush leaves and sulfur with coconut butter or oil, are some of the natural alternatives that many readers have shared as part of their experience in treating scabies. In the case of the sulfur solution (6% sulfur vaseline), some people say that many drugstores in Havana are selling it with a medical prescription. Meanwhile, they say that demand exceeds supply.
Likewise, 10% propolis dye and propolis cream are also effective in treating this disease, according to a study by the Dr. Antonio Luaces Iraola Hospital in Ciego de Avila.
While almost nothing has been said about the new scabies outbreak, state media in Cuba have recommended the use of home remedies and keeping clean.
“We shouldn’t stop using soap, nor should we use very hot water for bathing,” doctor Ailen Delgado pointed out in Adelante newspaper. “This sometimes causes greater skin irritation. You have to disinfect clothes and bedsheets, which should be boiled and ironed, even if they dry in the sun. Everyone in the household needs to be treated, even if they don’t show symptoms.”