Untreated leprosy can cause disability

Momenuzzaman Leon
Johra Begum (not genuine name), 48, a resident of Dimla upazila of Nilphamari district, was divorced by her husband when she was diagnosed as a case of leprosy. Her husband could not tolerate her following detection of the disease. Her two hands and legs developed deformity as she failed to take treatment timely due to lack of awareness. She was unaware of the curability of the disease as well as the availability of its free treatment. Lack of awareness can cause great troubles and the case history of the woman is a glaring example.             
She is not alone. Many other victims turned disabled for lack of timely treatment in our country.   
Leprosy is a public health problem in Bangladesh. Annually, on an average about 3,000 new cases are detected in the country in the recent years. There are about 34,000 to 35,000 in the country with deformity caused by the disease at the moment. If timely action was taken, deformity could be avoided.  
According to The Leprosy Mission International-Bangladesh (TLMI-B), untreated leprosy can cause progressive and permanent damage to the skin, nose, nerves, limbs, eyes, muscle paralysis in the extremities and face.
“Leprosy is not highly infectious. It is transmitted via droplets, from the nose and mouth, during close and frequent contacts with untreated cases. The main symptom of leprosy is disfiguring skin sores, lumps, or bumps that do not go away after several weeks or months. The skin sores are pale-colored”.
If patients come early, treatment with multidrug therapy (MDT) is highly effective. It can prevent disability and deformity, said TLMI-B.
Early detection and treatment are essential for prevention of nerve damage. Many patients delay seeking treatment until they have infected many contacts and developed irreversible deformities and disability. There is still a substantial hidden caseload. The reasons for these hidden cases are complex. People in rural areas have poor access to diagnosis and treatment because of the limited coverage of leprosy services. The stigma surrounding leprosy also creates a tremendous psychological barrier for patients to seek timely treatment.
Leprosy is feared because of the associated deformities and social stigma. Fear of contagion also contributes to the enforced isolation of leprotic patients.
“Stigma around leprosy is so prevalent in our society that many leprosy victims continue to incur untold sufferings, resulting in violation of human rights”, said Jiptha Boiragee, programme support coordinator of TLMI-B.   
We can eradicate leprosy by spreading correct information on leprosy, persuading people with leprosy (or suspected leprosy) not to hide, but to come forward for examination, encouraging patients to accept MDT and making sure that they attend regularly for supervised medication every month and that they regularly take their daily, unsupervised tablets or capsules at home and that they continue the treatment for the prescribed periods.
We should inform the leprosy affected persons regarding management of complications of leprosy and make them skilled for their self-care, motivate the close relatives of leprosy affected persons for cooperation regarding self-care of the patients.
We should develop appropriate messages for posters, stickers, radio spots, and materials for newspaper and leaflets from time to time targeting the communities according to local situations, assist and participate in health education camps, exhibition, mela and other special occasions in order to promote leprosy awareness especially about availability of free treatment and curability, meet local community leaders and groups to arrange education programme on leprosy and seek their support/cooperation for the National Leprosy Elimination Programme.
In order to ensure that leprosy is contained and eliminated, political commitment needs to be sustained. In order to reach all patients, leprosy treatment needs to be integrated into general health services. Partners in leprosy elimination need to continue to ensure that human and financial resources are made available for the elimination of leprosy. Because the stigma of leprosy is an obstacle to self-reporting and early treatment, the image of the disease must be changed, and a new environment, in which patients will not hesitate to seek diagnosis and treatment, must be fostered.
World Health Organization (WHO) recommended the following to contain and eliminate leprosy: Accessible and uninterrupted multidrug therapy services for all patients through flexible and patient-friendly drug delivery systems, sustainability of multidrug therapy services by integration of leprosy services into general health services and training general health workers to treat leprosy, encouragement of self-reporting and early treatment by promoting community awareness and changing the image of leprosy, monitoring the performance of multidrug therapy services, the quality of patient care, and the progress made toward elimination via national disease surveillance systems.
Mass campaigns are needed to stimulate public awareness of the disease and its cure. Remote communities, in particular, need access to information to reduce prejudice and stigmatisation.
People must accept leprosy as a simple curable disease and be aware of the availability of free and effective treatment. Patient education can also prevent neuropathic sequelae and improve compliance with medication.
Information, diagnosis and treatment MDT are essential for eliminating the disease. Reaching the remaining patients with MDT drugs in places that haven't been reached before because of different reasons is the key to elimination.
Information campaigns in high-risk areas are important so that patients who have been ostracized historically by the disease can come forward and receive treatment. The high level of stigma associated with the disease is a major barrier to elimination that needs to be overcome.
We need to expand MDT services to all health facilities and make leprosy diagnosis available and train health workers to diagnose and treat leprosy.
Educating the population on leprosy, maintaining a regular supply of free MDT doses even in remote regions and monitoring the progress of elimination programmes are all crucial in ensuring that leprosy can soon become a thing of the past.
After drug treatment or surgery, physical rehabilitation and attention to the social and psychological well-being of patients with disabilities are essential to facilitate re-integration into society.
Those who have been disabled due to leprosy should be properly rehabilitated so that they can live with proper dignity, contributing to their families as well as the country.       
Eliminating leprosy has far greater implications than simply resolving a public health problem. Leprosy is closely linked with poverty and its elimination will contribute to poverty alleviation. Poverty is both a cause and a result of leprosy. A "cause" because poor people are more prone to suffering from the disease, owing to their weaker immune systems and the higher transmission rates created by living in such close proximity to each other. A "result" because it is one of the leading causes of permanent disability with the chronic symptoms often afflicting individuals at the most productive stage of their lives, preventing them from generating income. In this way they are forced to impose significant economic and social burdens on their families.
By strengthening our leprosy control programme we can make a final push to eliminate leprosy and, thus, a direct attack on one of the major causes of poverty. Eliminating leprosy will have a dramatic impact on the overall economic empowerment of the millions affected by it.
The author can be contacted at
[email protected]

 

Untreated leprosy can cause disability

Momenuzzaman Leon Johra Begum (not genuine name), 48, a resident of Dimla upazila of Nilphamari district, was divorced by her husband when she was diagnosed as a case of leprosy. Her husband could not tolerate her following detection of the disease. Her two hands and legs developed deformity as she failed to take treatment timely due to lack of awareness. She was unaware of the curability of the disease as well as the availability of its free treatment. Lack of awareness can cause great troubles and the case history of the woman is a glaring example. She is not alone. Many other victims turned disabled for lack of timely treatment in our country. Leprosy is a public health problem in Bangladesh. Annually, on an average about 3,000 new cases are detected in the country in the recent years. There are about 34,000 to 35,000 in the country with deformity caused by the disease at the moment. If timely action was taken, deformity could be avoided. According to The Leprosy Mission International-Bangladesh (TLMI-B), untreated leprosy can cause progressive and permanent damage to the skin, nose, nerves, limbs, eyes, muscle paralysis in the extremities and face. Leprosy is not highly infectious. It is transmitted via droplets, from the nose and mouth, during close and frequent contacts with untreated cases. The main symptom of leprosy is disfiguring skin sores, lumps, or bumps that do not go away after several weeks or months. The skin sores are pale-colored. If patients come early, treatment with multidrug therapy (MDT) is highly effective. It can prevent disability and deformity, said TLMI-B. Early detection and treatment are essential for prevention of nerve damage. Many patients delay seeking treatment until they have infected many contacts and developed irreversible deformities and disability. There is still a substantial hidden caseload. The reasons for these hidden cases are complex. People in rural areas have poor access to diagnosis and treatment because of the limited coverage of leprosy services. The stigma surrounding leprosy also creates a tremendous psychological barrier for patients to seek timely treatment. Leprosy is feared because of the associated deformities and social stigma. Fear of contagion also contributes to the enforced isolation of leprotic patients. Stigma around leprosy is so prevalent in our society that many leprosy victims continue to incur untold sufferings, resulting in violation of human rights, said Jiptha Boiragee, programme support coordinator of TLMI-B. We can eradicate leprosy by spreading correct information on leprosy, persuading people with leprosy (or suspected leprosy) not to hide, but to come forward for examination, encouraging patients to accept MDT and making sure that they attend regularly for supervised medication every month and that they regularly take their daily, unsupervised tablets or capsules at home and that they continue the treatment for the prescribed periods. We should inform the leprosy affected persons regarding management of complications of leprosy and make them skilled for their self-care, motivate the close relatives of leprosy affected persons for cooperation regarding self-care of the patients. We should develop appropriate messages for posters, stickers, radio spots, and materials for newspaper and leaflets from time to time targeting the communities according to local situations, assist and participate in health education camps, exhibition, mela and other special occasions in order to promote leprosy awareness especially about availability of free treatment and curability, meet local community leaders and groups to arrange education programme on leprosy and seek their support/cooperation for the National Leprosy Elimination Programme. In order to ensure that leprosy is contained and eliminated, political commitment needs to be sustained. In order to reach all patients, leprosy treatment needs to be integrated into general health services. Partners in leprosy elimination need to continue to ensure that human and financial resources are made available for the elimination of leprosy. Because the stigma of leprosy is an obstacle to self-reporting and early treatment, the image of the disease must be changed, and a new environment, in which patients will not hesitate to seek diagnosis and treatment, must be fostered. World Health Organization (WHO) recommended the following to contain and eliminate leprosy: Accessible and uninterrupted multidrug therapy services for all patients through flexible and patient-friendly drug delivery systems, sustainability of multidrug therapy services by integration of leprosy services into general health services and training general health workers to treat leprosy, encouragement of self-reporting and early treatment by promoting community awareness and changing the image of leprosy, monitoring the performance of multidrug therapy services, the quality of patient care, and the progress made toward elimination via national disease surveillance systems. Mass campaigns are needed to stimulate public awareness of the disease and its cure. Remote communities, in particular, need access to information to reduce prejudice and stigmatisation. People must accept leprosy as a simple curable disease and be aware of the availability of free and effective treatment. Patient education can also prevent neuropathic sequelae and improve compliance with medication. Information, diagnosis and treatment MDT are essential for eliminating the disease. Reaching the remaining patients with MDT drugs in places that havent been reached before because of different reasons is the key to elimination. Information campaigns in high-risk areas are important so that patients who have been ostracized historically by the disease can come forward and receive treatment. The high level of stigma associated with the disease is a major barrier to elimination that needs to be overcome. We need to expand MDT services to all health facilities and make leprosy diagnosis available and train health workers to diagnose and treat leprosy. Educating the population on leprosy, maintaining a regular supply of free MDT doses even in remote regions and monitoring the progress of elimination programmes are all crucial in ensuring that leprosy can soon become a thing of the past. After drug treatment or surgery, physical rehabilitation and attention to the social and psychological well-being of patients with disabilities are essential to facilitate re-integration into society. Those who have been disabled due to leprosy should be properly rehabilitated so that they can live with proper dignity, contributing to their families as well as the country. Eliminating leprosy has far greater implications than simply resolving a public health problem. Leprosy is closely linked with poverty and its elimination will contribute to poverty alleviation. Poverty is both a cause and a result of leprosy. A cause because poor people are more prone to suffering from the disease, owing to their weaker immune systems and the higher transmission rates created by living in such close proximity to each other. A result because it is one of the leading causes of permanent disability with the chronic symptoms often afflicting individuals at the most productive stage of their lives, preventing them from generating income. In this way they are forced to impose significant economic and social burdens on their families. By strengthening our leprosy control programme we can make a final push to eliminate leprosy and, thus, a direct attack on one of the major causes of poverty. Eliminating leprosy will have a dramatic impact on the overall economic empowerment of the millions affected by it. The author can be contacted at [email protected]