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Leprosy — an Example of Man's Inhumanity to Man

by Dr Derek Lobo WHO Dhaka
LET mr begin by prraenting an Engliah tranalauoti of a Gkrmati poem entitled What Happens by Erich Fned "It haa happened and it goes on happening
And will happen again
II nothing happens to slop it
Tlic poor do not nouce because they are loo poot
And die ri< h do not nonce because they are loo rich
The ignorant know nothing because they are loo ignorant
And the Innocent know nothing because they are lop innocent
The stupid shrug their shoulders because they are loo stupid
And the clever surge their shouldei because they arc too clever
The voung do not care because they are too young
And the old do noi care because they are too c4d
That Is why nothing happens to slop it
And that is why it has happened and goes on happening
And will happer) again'
Tills poem can well be adapted to the disease of leprosy and Its unfortunate \1ct nns Leprosy has tiappened tor over three thousand years and so has the fears stigma and prejudices attached to the disease and the rejection, ostracism. segregation injustices ■nd dlscriuiinauocis practised on leprosy patients
The disease is still consid ered by many as a curse or punishment from God and is full of misconceptions For the generations that lived in the past, such misconceptions are to be excused but those of us who pride ourselves of being Ixini and brought up tn this Jet or Computer age. cannot take shelter in the shade or ignorance and have no right or rea son to heap injustices on those suffering from this per (ectly treatable and fully curable disease
Every myth connected with leprosy has by now been shat tered by scientific facts The first of the many myths was in fact shattered in the last century. In the year 1873. when Dr Armauer Hansen of Norway established the cause of leprosy to be a germ — a bacteria Until then, leprosy was thoughl to be a hereditary disease It is a matter of great shame that 122 years later. In spite of all the advancement tn science, education and mass communication, 'we find it necessary to proclaim that leprosy is not hereditary.
H Is more than 45 years.
since the first effective drug against leprosy — Dapsone — was marketed and a cure established and proved and oxer the last few decades, more than fhe very effective and potent antl-leprosy drugs have come into the market, including the most potent of them all — RIFAMPICIN which is able to kill 99% of the organisms in a single dose Yet the simple fact that leprosy is fully curable, la not yet known to large sections of the coni muni ti-
lt is more than 40 years, since Dr Paul Brand — a British orthopaedic surgeon working In India, established and proved that wounds and infec lions that occur tn leprosy patients. do not discharge leprosy germs and therefore are not a sign or source of leprosy infection. These problems are caused by secondary infection by common organisms like Staphylococus and Sireptococus Forty years later this important scientific fact is not known to most doctors, nurses and health workers!
’IS LEPROSY REALLY CURABLE?" Is a question that Is commonly asked — you might think by an ignorant village farmer or uneducated city labour — no. the question Is posed by col|ege students, university teachers, some nurses and even few doctoral
GET THEM ARRESTED and PRISONED" Is a slogan you would expect to hear In relation to criminals but I have
heard the very sentence dl reeled against Lepzoay tieggar* — a group of human begina our own txelhrrn suffering Irani a 1UO% curable disease and a disease that is today consid ered to be one of the feast in leccuxca'
I do agree that tiw sight ot a rfeiormed leprosy beggar on our streets is displeasing and depressing to our aesthetic sense but should our normal reac tion be to abuse and ciuse them or to ponder over tne question — hou and urhp did they end up on our streets and what should or could have been done to detect them early treat and cure them?
Before proceeding further, n needs to be explained why leprosy is considered to be that tease infectious disease This is because of the following three reasons
a. Over 99% of the population in the world including Bangladesh has adequate resistance or Immunity against leprosy. This means that in over 99% of people, the leprosy germs are recognised and killed by their white blood cells, as soon as they enter their body
The main mode of transmission of leprosy is through the air — through droplets dis charged from the nose and mouth of untreated infectious cases. So in an endemic country like Bangladesh, the entire population Is exposed and inhales leprosy germs but less than 1% have the chance of contracting the disease
b. Over 85% of the leprosy gases* are non iryfectlous There are mainly tu>o types of leprosy, one Is Infectious and the other Is non-lnfectious. The majority of leprosy cases, belong to the non-lnfectious type.
c. An infectious case Is rendered non-lnfectious within one month of modern MultiDrug Treatment (MDT)
Baaed on the above facts all right thinking people should
ask oorsetvea three quesuons
I Wliy IS H that the lea»l Ulfortioua disease is popularly considered io be most infectious?
2 Why is H that the people suffering from I he least infectious and 1OO% curable dis eases, have the greatest stigma and prejudices in society?
3 Why is n that the people suffering from the least infec-and fully curable diaeaae. have the greatest nak of being kicked out of their home, marriage job education, village and social set-up?
1 think thia is one of the best example of man's inhumanity to man — that people suffering from the least infec llous and a perfectly treatable and curable disease, have suffered the greatest injustices and discriminations in society for so many centuries We are coming to the fag end of the 20th century. We have the right and duty to ensure that the myths and misconceptions about leprosy is not carried to the 21st century Even If we do not succeed in eradication of leprosy by 2000 AD we should succeed in fully eradicating the stigma attached to leprosy by 2000 AD.
Leprosy Is a disease that mainly affects the skin and peripheral nerves. In fact the first signs of the disease are usually manifested In the skin. therefore anybody can suspect leprosy if the knowledge about early signs is known. What are the early signs?
NON-INFECTIOUS TYPE (medically called Tuberculoid or Paucl-bacillary) Patches on the skin which are pale or red in colour, along with loss of sensations over the patches. There may be Just one patch or many patches.
INFECTIOUS TYPE (medically called Lepromatous or Multi-bacillary type): Generalised thickening of the skin or presence of smalt elevations in the skin called nod ules. In addition, patches may
or inav uol fje prrwnt
In botii the lypea there can hr ihickrnliig or damage (ilefor nil lies) oi the peripheral nerves with thia difference Dial the nerve damage occurs ■ urly and more severely In the nori tnlectious type! This is the great paradox ol the disease However. Il needs to be tin ’ phasised that nerve damage and deformities that can occur in leprosy patient a are luily preventable an4 atou U>ey are surgically currecUbte. Uhfonu naiely verv few leprosy eases get the benefit of reconstructive/ plastic surgery for correction of ihelr deformities because there are very few sur-geons and very few institutions that offer such facilities in Bangladesh or for that matter worldwide
Therefore on the medical front, leprosy is conquered on all fronts. Tod^y we have lour or five very effective and potent drugs against the disease, which are being given in a combined regimen of two drugs for non-infectious or Paucl-bacillary type and three drugs for the Infectious or Multl-baciUary type. The duration of treatment is six months for the non-infeclious type and two years for the infectious type. Therefore if the patient takes regular treatment for the prescribed duration, a cure is assured
So what is the problem? Here Is a disease caused by a germ, is easily treatable and fully curable and is considered to be one of the least infectious. The deformities are preventable or surgically cor-rectible. Yes. from the medical stand point, leprosy Is no more a big problem but 11 continues to be a major social problem. From the point of view of the leprosy patient, what is the use of treatment cure or surgery for his/her deformities, if at the end ol it all. he or she is disptaced or thrown out of his/her home, marriage. Job. village etc? Some of those who are displaced then end up in our streets as beggars or destitutes requiring rehabilitation.
H needs emphasis that re-habtlltauori Is required only if the patient is displaced trom society In practkal terms ev ery case of teproay that re quires rehabilitation signifies failure — failure lo detect early (allure to treat failure to pre vent deformities failure to prevent displacement failure ol medical l■lervenllona and tailure of community education and awareness Our primary aim should therefore be lo prevent displacement and to prevent the need Joe rehabdi lotion, by early detection and proper treatment of all cases
There are an estimated 1.36.000 leprosy cases in Bangladesh making it the country with third largest c ase-load in the world (next to India and Brazil) The Govern ment of Bangladesh has launched a very ambitious Na uonal Leprosy Control Pro gramme in collaboration with the World Health Organisation (WHO) and World Bank The three principle strategies of this programme are a) Early CASE-DETECTION b) MULTIDRUG TREATMENT of all detected cases, c) Conununity AWARENESS and Education using all available means of Information. Education and Communication (IEC) in order lo publicise the early signs of the disease and availability of free treatment throughout the country.
In conclusion. 1 wish to pose the three pertinent questions:
- WHEN WILL IGNORANCE TURN TO KNOWLEDGE?
- WHEN WILL KNOWLEDGE LEAD TO UNDERSTANDING?
— WHEN WILL UNDERSTANDING TURN INTO ACTION?
On this the WORLD LEPROSY DAY (today), let us all take a vow and lend our full support to the efforts of the Government of Bangladesh and the many Non-Government Organisations (NGOs) who are doing leprosy work in Bangladesh, so that we can achieve a leprosv-free country by 2000 AD.