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Leprosy far from over

Rashad Ahamad, Savar
When he saw rashes in the arms, Kabil, a rickshaw-puller, dismissed those as some benign skin condition. But the pale skin patches continued to plague him until he met an expert doctora few days ago in pretty unexpected circum-stances-the physician was riding his rickshaw-and came to know that what he had been carrying for 12 years is actually leprosy, a disease many think no longer exists.
“I never thought of seeing a doctor for the rashes because they were not creating any trouble in my daily work. I never imagined that I was having such a disease!" said the man. "When the doctor told me I was a leprosy patient, I was really speechless."
Though like many places in the world, leprosy is believed to have ceased to exist in Bangladesh, the scourge is far from stopping haunting humanity. The first known written mention of leprosy is dated 600BC, but at the end of 2012, official figures from 115 countries show the global registered prevalence of leprosy at 189,018, according to the World Health Organization. The number of new cases reported globally in 2012 was 232,857 compared with 226,626 in 2011.
In Bangladesh, at least 3,000 new cases are detected every year, but many patients are going unreported due to a lack of awareness-both among general people and doctors, say experts.Most people in Bangladesh see leprosy as a plague buried in the past, a disease relegated to biblical times or, perhaps, to the poorer section and the remotest parts of the country, says The Leprosy Mission International, Bangladesh (TLMIB).
Like Kabil, electronic mechanic Liton had faced a similar problem in detecting his case. He first felt the symptoms in 2003 and had hopped from hospital to hospital for 10 long years receiving wrong treatment before he could be diagnosed properly.
The 28-year-old said he had visited at least five hospitals since early 2013 when the condition became a real
trouble. He was even advised to undergo surgery.
"A doctor of International Medical College Hospital at Panishail of Gazipur told me to put together Tk 3 lakh for an operation. But it was impossible for me, so 1 gave up my treatment," he told The Daily Star at Shaheed Mansur Ali Medical College Hospital at Uttara where he is being treated with about 30 other leprosy patients.
In July this year, when the problem became too acute, he visited Prime General Hospital at the capital's Uttara where Dr King Sutradhar advised him to contact TLMIB at Banani DOHS for a test. It was there he got the remedy finally.
Since leprosy is caused by a slow-multiplying bacillus, Mycobacterium leprae, the symptoms can take as long as 20 years to appear, according to WHO. The disease mainly affects the skin, peripheral nerves, mucosa of the upper respiratory tract, and eyes, lead-ing to permanent disabilities. Throughout history, people afflicted have often been ostracised by their communities and families because it was a synonym for stigma.
'There are many Kabils and Litons unknowingly suffering from the ail-ment," said Jiptha Boiragee, programme support coordinator at TLMIB, a non-government organisation working to create awareness about
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the diagnosis and treatment of the disease, which is now fully curable through multidrug therapy, or MDT, a drug combination provided free by WHO.
Between 1985 and 2012, about 16 million leprosy patients have recovered taking MDT worldwide. WHO declared leprosy eliminated from the world in 2000. Elimination of leprosy is defined as a prevalence rate of less than 1 case per 10,000 persons.
In Bangladesh, it was declared eradicated in 1998 but a few districts including Bandarban, Khagrachhari, Nilphamari, Gaibandha, Rangpur, Lalmonirhat, and Dinajpur, and Dhaka and Chittagong cities still see some occurrences, according to the leprosy mission. Currently, new cases are being detected in Bhola, Comilla, Munshiganj and some southern districts.
The 58-year-old rickshaw-puller, Kabil, is getting free treatment at Gonoshashthaya Hospital in Savar, on the outskirts of the capital, under the sponsorship of TLM1B. Three patients are being treated there.
Several of the patients shared the experi-
ences with this correspondent, which reflected one thing-all had got wrong treatment for a long time and realised their condition only recently.
Although not highly infectious, leprosy is transmitted via droplets, from the nose and mouth, during close and frequent contacts with untreated cases.
According to TLMIB, some 3,800 infections were detected in Bangladesh in 2011, 3,688 in 2012 and3,156 in 2013.
"These are the known cases, but the actual figure is much higher," said Thomas Singha, project manager ofTLMIB. “When no patient comes to us for a longtime, we run a door-to-door campaign for leprosy tests. We detect many patients in the process.” Singha said, "Recently we got six patients-three at Uttara, one at Savar, and two in Munshiganj."
Dr Safiruddin Ahmed, deputy programme manager of the National Leprosy Elimination Programme, said, "Medical students study only one course on leprosy in their entire academic period, so general doctors have no clear knowledge about the disease. It is one reason why many patients are going unidentified in time."