DYING DISEASE

By Esther Williams

Leprosy, once feared as a contagious, mutilating and incurable disease is no longer considered so. In fact, the disease which was recognized even in the oldest civilizations of China, Egypt and India is steadily on the decline with today's figures standing at less than one leprosy case per 10,000 population in most countries.

Research indicates that the global registered prevalence of leprosy at the beginning of 2006 stood at 219,826 cases from reports of 115 countries and territories. Sri Lanka's number stands at 1500 cases with less than 2000 new cases detected each year, thanks to the sustained efforts of the Ministry of Health, Anti Leprosy Campaign.

The campaign spearheaded by Dr. Sunil Settinayake since 1989 has had three key elements to their strategy to eliminate the disease, namely: Access to information; diagnosis; and treatment with the multi drug therapy (MDT). The message through their massive social marketing programme via TV, radio and other advertisements was simple: That leprosy can be cured without deformities; that leprosy starts with an anaesthetic patch (loss of sensation); and that effective treatment is available free of cost.

The elimination target of less than one case in 10,000 was achieved in 1995, with Sri Lanka being the second country in the region to achieve the target set by WHO. Since 2001, the Ministry has effectively integrated leprosy services into existing general health services. To enable the transition, doctors around the country were trained in diagnosis and treatment. Further drugs provided by the World Health Organisation through donations provided by Novartis Foundation were made available at all health institutions from central dispensaries to teaching hospitals.

People contracting the disease are now seen taking the initiative to come forward when noticing symptoms. Encouragingly, the majority of these cases are treated as OPD cases at the initial stage, long before any signs of disfiguration set in. "Currently, we only have about 1000 deformed patients (cured of leprosy) who suffered from the disease long ago, and all of them receive a social disability allowance," Dr. Settinayake says. "We have no new additions - so it is almost over," he says with a sense of satisfaction.

The two leprosy hospitals at Hendela (1701) and Batticaloa (1921) remain open simply to house old patients who have lost contact with their relatives and have no one to take care of them. "We need to keep those units open until the last patient dies," Dr. Settinayake explains.

However, the stigma attached to the disease has proved to be more of a problem than treatment itself. At one time communities segregated patients, isolating them for fear of the deformities the disease was known to cause. However, after consistent public education programmes, the stigma apparently is showing signs of reducing. It is no longer considered a divine curse.

"Because of a high literacy rate and sound accessible health infrastructure, our country has kept the disease under control." With the exception of a few defaulters who refuse to take the full course of medicine in which case they experience a relapse, our patients are satisfied," Dr. Settinayake says.

The Dermatology Units of tertiary and secondary care hospitals now handle leprosy cases. These hospitals also have the facilities to offer physiotherapy, surgery and when necessary reconstructive surgery to correct deformities. Very few patients require this today.

It is worth mentioning that families with member/s suffering from symptoms need take no precautions, as the disease can be detected early and treatment within six months to one year. To emphasize this, Dr. Settinayake points out, "I am the number one target for leprosy, having worked with patients for nearly 20 years. I have not got the mildly communicable disease though I have passed the incubation period of 8 years. We cannot have an epidemic, nor can we artificially infect another person," he assures.

Notably, 80% of people have an inborn natural immunity to the bacillus. The remaining 20% may not have developed the immunity in their body system, 5% of whom have no immunity whatsoever causing them to develop the severe form of the disease (MB) and also suffer from relapses.

Significantly, the infectious quality of the disease passes within two days of beginning the multi drug therapy while 99% of the germ is destroyed in a month.

As the world observes World Leprosy Day on January 28, the country needs to work towards addressing the remaining challenges the disease poses to ensure that all people have access to treatment and reduce further the disease burden.