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Leprosy education in MBBS curriculum

Martin Adhikary
LEPROSY is not as big a problem in Bangladesh as many diseases like tuberculosis, malaria, typhoid, etc. are. But this disease is not merely a health hazard but also a social problem. Because of the stigma, which also causes self-stigma, the life of the affected person gets devastated. Nine NGOs have been working towards the eradication of this disease under the banner of National Leprosy Elimination Program under the Directorate General of Heal th Services.
The World Health Organization (WHO) had targeted leprosy for elimination as a public health problem, i.e. reducing prevalence to less than 1 in 10,000 people by the end of the year 2000.
Bangladesh achieved this goal at the national level in 1998. However, this is still to be achieved at the sub-national level.
I here are pockets of leprosy prevalence in parts of the country higher than that, e.g. in Bandarban, Khagrachori, Gaibandha. and Nilnhamari districts.
Besides, this does not necessarily mean that leprosy will be completely eradicated from the country within a foreseeable future.
It is necessary that our medical colleges give adequate amount of education on leprosy. Leprosy is taught in the MBBS course in our country. However, the teaching needs to be imparted in a systematic and integrated way. The following areas are basic:
• Public health and leprosy.
• Signs and symptomsof leprosy.
• Diagnosis and treatment of leprosy.
• Managing complication like reaction and neuritis.
Integration of leprosy treatment is being done at government health complexes, though in many places only officially because oflack of adequate staff, but total leprosy treatment should be made available at all private and government medical college hospitals. This will help in quick detection and treatment as the MBBS graduates can take up the respon-
sibility of treating the patients at those hospitals side by side with the care that the different leprosy related NGOs have been providing. The eradication of the cause and consequences of leprosy can thereby be accelerated.
The most important cause for concern in leprosy is the occurrence of disabilities, which are caused due to delayed case detection and wrong treatment. These disabilities are obvious and often result in severe impairment of working capacity, and seriously limit the social life of the person affected.
Globally there are strategic docu-ments/charters advocating for the protection of human rights of people with leprosy, such as the UN Charter of Universal human Rights, UN Convention on the Rights of Persons with Disabilities, Declaration of the Human rights Council, etc. The Bangladesh Constitution has nothing specifically against the enjoyment of human rights and privileges even by people who are/were affected or even disabled by leprosy.
The obsolete, segregating Lepers Act 1898 needs to be repealed so that leprosy affected people can be mainstreamed into the society. This will transform the lives of many people excluded from the society. The liners Act 1898 was nromul-
gated at a time which was very different from ours: there was no scientific treatment against leprosy. People having leprosy were cast away even by their own families and had to live on begging, and a sub-human life. Forbidden by the society to work with others, people with leprosy were forced to depend on charity.
In absence of effective treatment the disease could spread easily. Besides, leprosy was thought to be a hereditary disease. So they used to be arrested if found begging and were put into government custody or asylums. This was the context then. But there has been a remarkable change.
Since thel980s, effective treatment of leprosy, i.e. Multi-drug Therapy (MDT) is available. The truths about leprosy now arc; leprosy is curable; its treatment is freely available; and there is no place for social discrimination against people affected by leprosy. Therefore, the said Act is now obsolete, and is pre-judicial to the human interests of the leprosy-affected people. The very title of the Act is derogatory: we cannot call a person affected by leprosy a "leper." The irony is that, today, like in many other countries, (here is still stigma attached to leprosy in our country. Spouses are still divorced, jobs terminated. schooling for children is not easilv
accessible, so on and so forth.
The said Act and similar ones have been repealed by some state legislatures in India.
We appeal to all relevant authorities in the governmental machinery, including the Ministry of Law and Parliamentary Affairs, Ministry of Health and Family Welfare, and the parliamentary committee on health to take stens towards the
repealing of that Act by our parliament. This will add to public awareness about the present fact about leprosy, transform the mind-set of people and contribute towards the building of a society where the leprosy affected people will be able to live with dignity.
Reverend Martin Adhikary is Director, Advocacy & Promotions. The Leprosy Mission Bangladesh