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World Leprosy Day

by Ann Samuel on  January 30, 2008 at 3:54 PM Health In Focus   - G J E 4
31st January, 2008

Messala: "Look for them in the Valley of the Lepers, if you can recognize them".
World Leprosy Day
World Leprosy Day
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Judah: "I have just come from the Valley of Stone. My mother and sister live what's left of their lives. By Rome's will, lepers, outcasts without hope..".

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'Ben-Hu'r (the movie, 1959)

On the fourth Sunday of each January, many pause to ponder on the scourge, that once haunted the world and, which continues to exist unshackled in certain parts of the globe  - leprosy. The day was set apart in honor of a Belgian priest, Father Damien, who gave his life ministering to the shunned lepers of Molokai, a Hawaiian Island.

Though eradicated in many nations, this neglected, tropical disease is still prevalent in several countries such as India, Mozambique, Brazil, Angola, Central African Republic, Democratic Republic of Congo, Madagascar, Nepal, Tanzania and China.

 The Disease

Leprosy, or Hansen's disease, is one of the oldest recorded diseases in the world. It is a chronic, infectious ailment which targets the nervous system, particularly the nerves of the hands, feet and face.

 Leprosy is caused by the bacteria, Mycobacterium leprae, which is similar to the one causing tuberculosis. The disease spreads mainly through air-borne bacteria, expelled from an infected person or through long-term contact with an infected individual.

Other potential sources of Mycobacterium leprae include soil, bedbugs and mosquitoes.

Symptoms 

It is an established fact that about 95 percent of people who are exposed to Mycobacterium leprae do not develop leprosy. This is because their immune system fights off the infection.

Among those affected, the infection could vary from a milder form known as tuberculoid leprosy, which is not contagious, to a more severe form lepromatous leprosy.

Characteristic symptoms include-

• The presence of cuts on the body 
• Loss of sensation, beginning at the fingers and toes.
• External injuries result from loss of sensation which in turn get infected.
• In severe cases, gangrene may set in and the flesh may rot on the patient leading to loss of body parts.

It is in this manner that leprosy leaves its victims deformed, with severe disabilities. This happens mainly due to a lack of timely treatment. This disfiguring is probably one of the reasons that led leprosy victims to be shunned and feared by others, throughout the ages.

Disease symptoms are manifested at least a year after a person has been infected. This is because the bacteria that cause leprosy multiply very slowly.  The symptoms generally appear 5 to 7 years after infection as characteristic rashes and bumps. These could be without sensation and whitish in color. Facial skin infection can lead to areas of swelling and lumps, which disfigure the face. Some victims develop sores on the soles of the feet and suffer damage of the nasal passages, which could even lead to a complete loss of the nose.

Diagnosis

Even today it is difficult to diagnose the disease with precision. Diagnosis is usually made on the bases of -

• Distinctive and persistent skin rashes,
• Loss of the sense of touch and
• Deformities resulting from muscle weakness.

Currently, there is a joint attempt, for the development of a rapid diagnostic test, by the Seattle-based Infectious Disease Research Institute (IDRI) and Chembio Diagnostics.

Management

Leprosy is contagious only in the untreated lepromatous form.


It must be understood that isolation of a leprosy patient is not a necessity.

Even in the lepromatous form, the disease is not easily transmitted to others.  Most importantly, once treatment has begun, the disease cannot spread. 

Patients are given a mix of strong antibiotics  -Rifampicin, Clofazimine and Dapsone. This Multi-Drug Therapy (MDT) can completely cure a milder form of the disease within six months or a more serious form, within two years.  A cocktail of drugs is resorted to, as the bacteria causing leprosy is known to develop resistance to antibiotics very quickly.

Health experts reiterate that antibiotic therapy should be continued for a long time, as the   causative   bacteria are difficult to eradicate.  Taking into account the extent of the disease, treatment period ranges from 6 months to many years. Some doctors recommend lifelong treatment for people having lepromatous leprosy.

Though the disease   is completely curable, health specialists stress that the effectiveness of treatment remains dependant on an early diagnosis. The WHO has since 1982 recommended the multi-drug therapy for the treatment of leprosy and has, since 1995, been providing this free of charge to patients worldwide.  

Current Statistics 

• The World Health Organization (WHO) reports 830,000 cases of the disease, worldwide.
• According to official reports, each year there are more than 200,000 children, and adults being affected.
• Every couple of minutes, a person is infected with leprosy.
• Every twenty minutes, a little child contracts this devastating disease.
• Despite the discovery of a cure in 1982, leprosy predominantly continues to be a poor man's disease.

The silver lining

One fact that gives cheer is that the number of new cases detected worldwide, has fallen by 13.4 percent in the year 2006, as against 2005.

The global number of new cases identified has also continued to dip dramatically at an average rate of nearly 20 percent per year.

The WHO estimates that till now, more than eight million patients have been completely cured of leprosy.

Future Of Leprosy Control

Leprosy detection and treatment should be merged into existing general health services in order to reach the most vulnerable (i.e) the poorest-of-the-poor and people who live in remote areas. Many are not aware of the fact that leprosy is curable.

The WHO aims to eliminate the disease as a public health threat. In this quest, it hopes to promote access to information, diagnosis and treatment with MDT.

Information campaigns about leprosy in highly endemic areas, is carried out through workshops, rallies, radio talks, press conferences and other activities.

Following up treated leprosy patients and rehabilitating these ostracized individuals and their families is the need of the hour. These individuals need to be assured that there is a complete cure for this terrible disease and that there is life after leprosy.

Over the years, various NGOs, like the Nippon Foundation of Japan have invested millions of dollars into the empowerment and rehabilitation of leprosy patients, in countries like India.

In Chengalpattu, Tamil Nadu a ray of hope is offered by way of a school, the Bindu Art School, where leprosy sufferers can paint their pain out with a rainbow of colors. Their paintings are sold across the world, earning them the dignity which this disease had deprived.

On World Leprosy Day, 2008, let us orient our thoughts towards the victims of this disease, and solemnly resolve to contribute our mite to the welfare of these fellow travelers.

Source: Medindia
Ann Samuel/K
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Our hospital for leprosy is a historical milestone in public health. It was built in 1708. Still not named as a heritage to preserve. Although new patients are not admitted now, since there are 45 old patients with disabilities hospital should give them the tender loving care... Having life stories of negligence, fear and stigma, most have pretty photos of their youth. They say they had died on the day when they were diagnosed and heard they had leprosy. There is a temple and a church in the hospital premises.This is a small health village but not paid a proper attention to preserve. The smallest [Ballet] polling station is in this leprosy hospital. It is adjacent to the river and they get a relaxing environment for rehabilitate the mind and bodily weakness. Most rare cats and pet dogs. They are part of their beating hearts.Some wanted to go out and worship Lord Buddha. They have their own workshop repairing bicycles, wheelchairs and preparing the shoes for disabled by them.Its amazing to see nice curvatures of furniture made by them with the movements of half preserved fingers and disabled palms after complications of leprosy.You may feel ashamed of your both hands with all fingers intact. Now they are living happily and peacefully under government health care ,but still their family members reject them......They are not taken to their homes. So you can see how the stigma still persists even after decades of elimination.....in Sri Lanka. This hospital has the footprints of public health development of my country and urgent attention should be paid to preserve the center as a museum. Dr Uthpala Amarasinghe (MBBS.MSc.MD), Community Medical Officer , Ministry of Health Sri Lanka. 94716843332
Uthpala.Amarasinghe Wednesday, January 19, 2011

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