Leprosy is not merely medical relief; it is transforming frustration of life into joy of dedication, personal ambition into selfless service"--- Mahatma Gandhi.
Bangladesh is one of the countries where leprosy is still endemic. Despite reaching the 'elimination' target of less than one registered case per 10,000 inhabitants for the whole country in 1998, the prevalence is still above target in some of the poorest areas of Bangladesh. Last year (2014), 3,621 new cases of leprosy were detected in Bangladesh, and it is a public health concern. In the poverty stricken northwest part of the country, where the Leprosy Mission International-Bangladesh is operating a leprosy control programme, the new case detection rate is still 1.25 per 10,000
The World Health Organisation (WHO) mentioned, "Poverty is both a cause and result of leprosy. A cause insofar as poor people are more prone to suffering from leprosy as they have weaker immune system and live in close proximity to one another resulting in higher risk of contracting the disease. Leprosy also leads to poverty, as it is a leading cause of permanent disability in the world. The chronic symptoms often afflict individuals in their most productive stage of life, and impose a significant economic and social burden on their families and society at large."
Socio-economic circumstances are considered to be a major determinant. However, leprosy causes long-term immunological complications, disability and deformity. The healthcare activities of treating and preventing disabilities need to be provided in an integrated setting. The integrated approach has many advantages including widening the healthcare network, thus bringing the diagnostic and treatment services closer to the patients. Integration is a cost-effective mode for delivering leprosy services given the present levels of prevalence. This advantage could be nullified, if there are no staffs in primary healthcare centre. In addition, there must be a sufficient number of health centres available to eradicate leprosy.
Malnutrition affects the immune system negatively, causing infected individuals to be more vulnerable to developing a clinically apparent infection. Malnutrition as an aspect of poverty plays an important role in the development of the clinical signs of leprosy. So, nutritional support for high risk groups should be included in leprosy control programmes to reduce risk of disease.
Leprosy patients need our help. Photo: Internet.
In 1873, the Norwegian G A Hansen discovered the Mycobacterium Leprae. It was one of the first bacteria to be identified as causing the disease leprosy in humans. A current problem is that most of the public still regard Hansen's disease as the incurable illness that it was throughout most of recorded history, which is one of the reasons many sufferers do not seek treatment. Eradication of the disease worldwide is now a realistic goal. However, the stigma associated with leprosy remains a major problem and those affected with leprosy are marginalised. They suffer continual psychological as well as physical distress. It often seems to be a disease of poverty, and those who contract leprosy are often tipped from poverty into extreme poverty very quickly. Stigma is linked with the perception of deformity.
To reduce stigma, socio-economic rehabilitation is another important component of caring for patients. Many patients are marginalised by their communities after being diagnosed. Stigmatisation continues, and it needs to be combated using community-based approaches. Leprosy should be included in the portfolio of diseases associated with poverty. And leprosy works including detecting and treating cases and reducing disability should be incorporated into poverty-reduction programmes. Awareness must be created that leprosy is not hereditary; it cannot be caught by touch; because it is not contagious. And it is not curse of God. Leprosy is curable with multidrug therapy (MDT), which was developed in the 1980s.
However, to eradicate leprosy, more health education within communities is needed, based on a multidisciplinary approach and taking into account cultural beliefs. This needs to be backed up by treatment that concentrates on the prevention of impairment and disability. Leprosy is more common in rural as opposed to urban areas. Leprosy has a bimodal age distribution, with peaks observed at ages 10-14 years and 35-44 years. Children seem to be more susceptible to developing leprosy than adults and tend to have the tuberculosis form rather than the lepromatous form. Rural communities across the country are without access to hospitals and clinics. Inhabitants that seek out treatment face long-distance travel, and often settle for care at the most convenient locations instead of finding the specialised care that their conditions demand. Some of these patients are further inconvenienced by loss of a day's wages to receive attention.
Considering those life-threatening problems, health experts recommend that in Bangladesh, for example, Mohakhali, Nilphamari, and Sylhet - those three specialised hospitals must be equipped soon with skilled human resources (e.g. Anaesthetists) and modern technologies. In addition, the medical colleges outside Dhaka city especially in the district level, complication management services must be available. The specialised hospital facilities do not exist in Khulna, Chittagong and Barisal division. So, the government and NGOs must work together to reduce the sufferings of the leprosy patients of those coastal, vulnerable regions through addressing their problems properly to offer required treatment and services. Moreover, it must be ensured that no one is left behind due to any cause.
Leprosy-related researchers observed that school-based curriculum needs to be introduced. It is a major challenge to sustain the knowledge, skills and experience in leprosy management, particularly in prevention and management of disability. Community rehabilitation, including skills training for income generation, is a priority for people living in poverty, exacerbated by the effects of leprosy.
Health experts suggest that commitments of ministers of different ministries are important to make a positive change of existing problems of leprosy. Public Private Partnership is a must to reach the sufferers and needy through changing the negative mindset of the people.
We need tools, assistive devices to be available and used for better service of leprosy. Contacting tracing, follow up, chemoprophylaxis is important. Print, electronic and social media must be involved in leprosy eradication programme to campaign through disseminating informative messages among the people soon. We need to ensure heal and justice to people affected by leprosy and eradicate the causes and consequences of this disease to make Bangladesh free of leprosy through integrated and multidisciplinary approach.
Parvez Babul is an award-winning journalist, columnist, author, and a member of Health Information for ALL (HIFA), London. Email: [email protected]