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RACHEL MARTIN, HOST:

We're going to look now at a mysterious kind of illness. It's called nodding syndrome, because one of its first symptoms is just that - a bobbing of the head. It happens among children in parts of East Africa. Epidemiologists here in the U.S. have made dealing with the unexplained outbreak a top priority, but they still don't understand much about the disease. Matthew Kielty reports.

MATTHEW KIELTY, BYLINE: Nodding syndrome only hits children. It first was noticed in Southern Sudan in the mid-'90s. It's since spread to northern Uganda and currently affects nearly 3,000 children. The first sign of the disease usually is pathological nodding. Ultimately, the disease wrecks the child physically and mentally.

(SOUNDBITE OF DOOR OPENING)

KIELTY: This is the nodding syndrome ward at the Atanga Health Center in the northern district of Pader. It's one of the five that the ministry of health opened last summer in northern Uganda. And it is a bleak place. Even a nurse here, Nicole Nyeko, will admit as much.

NICOLE NYEKO: Because it's not really a ward. It's just somewhere that they have dumped these children. Because you look and...

KIELTY: It's just a squat cement building. It's not spacious. It couldn't handle much more than the 11 mattresses - mattresses with no bed frames - that run the length of the walls. On one of those mattresses sits Lamona Santiana who came here a week ago with her grandson.

LAMONA SANTIANA: (Foreign language spoken)

KIELTY: Denis. Denis lies next to Lamona.

SANTIANA: (Foreign language spoken)

KIELTY: She tells me he's 16 but you can only get a glimpse of his age in his face. He looks half the size you'd expect him to be. He rarely moves. He hardly speaks.

SANTIANA: (Foreign language spoken)

KIELTY: Lamona tells me if he wants water, he'll take a cup nearby and...

(SOUNDBITE OF TAPPING)

KIELTY: ...tap the cement floor with it. Most everything else is nonsense, hallucinations. This happens with children with nodding syndrome. They fall apart cognitively, but there are moments, like this one at the end of my conversation with Lamona.

SANTIANA: (Foreign language spoken)

UNIDENTIFIED WOMAN: She's saying thank you.

KIELTY: When Lamona thanked me and I butchered the return, that there's this giggle from Denis. And the thing is, as Nyeko says about Denis...

NYEKO: He's just in his own world, (unintelligible).

KIELTY: Except for that one brief moment.

NYEKO: Yeah. (Foreign language spoken)

KIELTY: And so what Nyeko and others hired by the ministry of health are trying to do is bring children like Denis back to some sort of normalcy.

(SOUNDBITE OF DOOR ROLLING OPEN)

KIELTY: Which is difficult to do here.

(SOUNDBITE OF DOOR CLOSING)

KIELTY: Healthcare in Uganda isn't good. Fewer than a third of the major health centers here are fully operational. Still, last year, the Uganda Ministry of Health carved our $1.4 million in its budget to mount a response to nodding syndrome. They hired and trained physicians and nurses like Nyeko. They bought big white vans and stuck blue lettering on the sides that reads Nodding Syndrome Response Team. They also bought over a million tablets of a generic anti-convulsant called sodium valproate, a drug that came on recommendation from the Centers for Disease Control and Prevention and the World Health Organization.

(SOUNDBITE OF CRUNCHING)

UNIDENTIFIED MAN: (Foreign language spoken)

KIELTY: Workers get the drug to nearly 3,000 affected children by covering thousands of square miles of dirt roads. As of now, there aren't numbers - or at least nothing peer-reviewed - to back up how well the drug is working. So, instead, you get anecdotes like Geoffrey Tabo.

GEOFFREY TABO: (Foreign language spoken)

KIELTY: Geoffrey started nodding four years ago when he was seven.

TABO: (Foreign language spoken)

KIELTY: After six months on sodium valproate, he can hold a conversation now - something his dad says he couldn't do before the drug. Geoffrey tells me he's returned to school. He's in third grade. He says he likes it. I heard other stories like Geoffrey's from parents and from health workers, stories like a child who couldn't speak now talks; a child who couldn't feel himself now can bring a handful of rice to his mouth.

ROBERT DOWNING: One of the ones I saw couldn't walk and now is walking.

KIELTY: This is Robert Downing.

DOWNING: I am a microbiologist.

KIELTY: At the Centers for Disease Control and Prevention campus in Uganda. The CDC back in Atlanta has spent hundreds of thousands of dollars and countless hours assisting the Ugandan government in investigating nodding syndrome. Among the possibilities explored is whether nodding syndrome can be caused by a war-related chemical exposure or a response to a local parasite or a vitamin deficiency or genetics. But so far, investigators have hit dead ends. So, short of a cause, they're trying to treat a symptom. Sodium valproate has proven effective in treating seizures similar to nodding syndrome, which is why the CDC and the World Health Organization recommended the drug to the Ugandan government as a potential treatment.

DOWNING: But it requires a bigger effort. I mean, that's the bottom line.

KIELTY: Downing says that any anti-convulsive treatment was only one aspect of a response plan the CDC helped draft with the Ugandan government last year.

DOWNING: There's a lot about nutrition. There's a lot about rehabilitation.

KIELTY: Reeducation was another one, but those programs were reliant on outside donors and have either withered up, gone unfunded or unimplemented. And NGOs that champion nodding syndrome as a cause are few and far between, leaving families with children who might not nod as much but are nowhere near normal.

DOWNING: So, they do need help and then that's - there's so little there.

(SOUNDBITE OF DOOR CLOSING)

KIELTY: The outreach team in the district of Pader made 27 house visits every month, going to see children one by one in a village. At this home, the parents were gone.

(SOUNDBITE OF DOOR CLOSING)

MORRIS OYO: (Foreign language spoken)

KIELTY: Morris Oyo lets us in. Inside, Oyo's brother Robert lies on the dirt floor, back against the clay wall, slowly eating rice from a bowl. A linked chain is wrapped around his ankle. It runs up to the roof, tied to a wooden beam.

OYO: (Foreign language spoken)

KIELTY: Oyo tells me his brother's been nodding for 10 years. When it got bad, his parents took to tying him up in the hut so they could continue to work the fields. Most parents fear if their child is left alone, they might wander off or drown in a nearby well. Oyo says his parents can't afford to do anything else. After we walked out of the hut, a few from the response team told me they will often forcibly remove children from their homes if they think the child is neglected. I ask them if this constitutes neglect. They tell me no. This is just the reality of the situation. From NPR News, I'm Matthew Kielty.

MARTIN: Matthew Kielty is an NPR Above the Fray fellow, sponsored by the John Alexander Project.

(SOUNDBITE OF MUSIC)

MARTIN: You are listening to WEEKEND EDITION from NPR News.

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