Field level training on leprosy

If adequate attention is not paid by the government, leprosy will continue to inflict sufferings on us. Budget scarcity hindering leprosy control programme

Saleha Begum (not her real name), a middle-aged woman of Kholahati in Lalmonirhat district, is now leading a disabled life due to leprosy. Daughter of a day labourer, the illiterate woman was affected by the disease at her young age and turned disabled. Her two legs were later amputated, which brought huge sufferings in her life. Her disability could be checked if her case had been detected and brought under treatment at an early stage. She is not alone. There are many in our country who met the same fate for the same reason.     
Detecting new leprosy cases is one of the components in the leprosy control programme, but it is being hampered due to funds crisis. Other relevant activities such as training of the government staff, follow-up, monitoring, awareness campaign and production of materials and survey on leprosy cases are also important, but these are being hampered due to lack of funds.
According to National Leprosy Elimination Programme (NLEP) sources, the government had allocated over Tk. 28.14 lakh in the fiscal year 2014-15 and over Tk. 19.22 lakh for 2013-14 fiscal year for leprosy elimination programme.
The allocation is meagre compared to the needs. Both the government officials and development activists, working in the field, think that the amount is inadequate and it should be increased. The development activists said that about Tk. 25 lakh is needed only for training of the relevant government staff of a district.  
There are a total of 64 districts in Bangladesh and you can imagine how much money is needed for making the programme a success across the country, they said, adding that the increased allocation can take the programme toward fulfilling the Global Leprosy Strategy 2016-2020 by WHO. The goal of the strategy is to further reduce the global and local leprosy burden.    
Early case detection and treatment is the key to achieving elimination as detection of leprosy cases early in the community will lead to depletion of source of infection in the community and so interrupt the transmission of the disease. According to The Leprosy Mission International-Bangladesh (TLMI-B), leprosy is a chronic infectious disease caused by Mycobacterium leprae, affecting primarily peripheral nerves and secondarily skin, nasal mucosa and other tissues of the body.
There is a delay in seeking initial care because of a lack of information and awareness about what is available and a lack of understanding about the urgency. At the initial stage of the disease, most people are not concerned about it because it does not hamper their day-to-day life. The nature of leprosy is different than any other disease. Affected persons do not look for treatment until any deformity occur of someone inform/diagnosis them earlier.  
According to NLEP and TLMI-B, annually on an average 3,000 to 4,000 new leprosy cases are detected in the country in the recent years. About 10 percent of the affected later turned disabled for their failure to take timely treatment. There are about 34,000 to 35,000 people in the country with deformity caused by the disease at the moment. Leprosy is curable with timely treatment, but failure to do so may result in disability. The disability could be checked if they were detected and brought under treatment at early stage.
The government has to take the leading role, otherwise, anti-leprosy programme would not succeed. When a leprosy case is detected in an area, it is needed to carry out a survey in the areas to ascertain whether there is any other case in that area. But it has not been properly done by the actors due to shortage of resources.    
NLEP is the key government authority to implement, coordinate and monitor leprosy work in Bangladesh. It has trained expertise to train Tuberculosis Leprosy Control Assistant (TLCA), Programme Organizer (PO), Health Assistant (HA) and Community Health Care Provider (CHCP), but with budget shortage it has become difficult to train those who need knowledge and skill for detecting leprosy case.        
Jiptha Boiragee, programme support coordinator of TLMI-B, said NGOs are implementing anti-leprosy programme in many districts with the guidance of NLEP and NGOs are detecting more than 75% new case every year but NGOs have limitations, they cannot continue their works for a long time, more attention by the government is needed for sustainable leprosy services in the country. “If there were adequate financial allocation for the leprosy control, leprosy case detection and other related activities would have been done more smoothly, preventing the chance of disability caused by leprosy”, he said.
Funds problem is also hampering skill development in the leprosy sector. There is scarcity of experts in dealing with the issue. Specialized leprosy services are limited in our country. Sometimes, a patient’s condition may worsen due to reaction after taking medicine. Our all institutions are not capable of handling such a situation. Dr. Rizia Akhter Begum, deputy director of NLEP, opined for taking up necessary steps for creating leprosy experts as there is dearth of such experts in our country.  
Field visit and awareness raising activities by TLCAs and POs are being disrupted for funds scarcity. They also failed to do other relevant works for lack of money. TLCAs and POs need necessary training on leprosy and to participate in awareness raising activities. It is needed to carry out skin camp to identify leprosy cases. Monitoring and follow-up are urgently needed.
It is known that the posts of TLCA and PO remained vacant in number of upazilas for a long time, which hampered the leprosy
services.  Leprosy case detection would be more fruitful if the government health staff can be engaged in it. We can derive benefits if we can involve the CHCP and HA in leprosy control programme. They can play a vital role in early case detection if leprosy issue is added in their foundation training and separate training on leprosy is arranged.
There is no denying the fact more steps need to be taken relating to leprosy.  Specialized medical services such as reconstructive surgery should be made available at government medical colleges across the country so that people can avail of the necessary services. A leprosy victim, who is going to be disabled due to effect of the disease, can regain working capacity through the reconstructive surgery. Hence, adequate fund is needed.   
International assistance to leprosy control programme in Bangladesh is decreasing gradually. It a matter of concern that leprosy control programme is being slowed down at the field level due to lack of necessary funds and trained employees. Few NGOs, working in the field with their limited resources amid dwindling of foreign funds, find it tough to handle the task. The government should come up with necessary steps, including allocating more funds, for the leprosy control programme.
The government should pay more attention to the leprosy issue, because it is a still health problem. Bangladesh’s position is fifth in terms of leprosy infection in the world. With increased allocation, we can not only solve a health problem but also prevent the disability (caused by leprosy) of many people. Besides, we can turn them into force capable of working, contributing to our economy. If adequate attention is not paid by the government, leprosy will continue to inflict sufferings on us. It is hoped that the government, taking the matter into consideration, would allocate more money for the elimination progra­mme in the current fiscal year.        

The writer, is a freelancer and  can be contacted at [email protected] 

Field level training on leprosy

If adequate attention is not paid by the government, leprosy will continue to inflict sufferings on us. Budget scarcity hindering leprosy control programme

Saleha Begum (not her real name), a middle-aged woman of Kholahati in Lalmonirhat district, is now leading a disabled life due to leprosy. Daughter of a day labourer, the illiterate woman was affected by the disease at her young age and turned disabled. Her two legs were later amputated, which brought huge sufferings in her life. Her disability could be checked if her case had been detected and brought under treatment at an early stage. She is not alone. There are many in our country who met the same fate for the same reason. Detecting new leprosy cases is one of the components in the leprosy control programme, but it is being hampered due to funds crisis. Other relevant activities such as training of the government staff, follow-up, monitoring, awareness campaign and production of materials and survey on leprosy cases are also important, but these are being hampered due to lack of funds. According to National Leprosy Elimination Programme (NLEP) sources, the government had allocated over Tk. 28.14 lakh in the fiscal year 2014-15 and over Tk. 19.22 lakh for 2013-14 fiscal year for leprosy elimination programme. The allocation is meagre compared to the needs. Both the government officials and development activists, working in the field, think that the amount is inadequate and it should be increased. The development activists said that about Tk. 25 lakh is needed only for training of the relevant government staff of a district. There are a total of 64 districts in Bangladesh and you can imagine how much money is needed for making the programme a success across the country, they said, adding that the increased allocation can take the programme toward fulfilling the Global Leprosy Strategy 2016-2020 by WHO. The goal of the strategy is to further reduce the global and local leprosy burden. Early case detection and treatment is the key to achieving elimination as detection of leprosy cases early in the community will lead to depletion of source of infection in the community and so interrupt the transmission of the disease. According to The Leprosy Mission International-Bangladesh (TLMI-B), leprosy is a chronic infectious disease caused by Mycobacterium leprae, affecting primarily peripheral nerves and secondarily skin, nasal mucosa and other tissues of the body. There is a delay in seeking initial care because of a lack of information and awareness about what is available and a lack of understanding about the urgency. At the initial stage of the disease, most people are not concerned about it because it does not hamper their day-to-day life. The nature of leprosy is different than any other disease. Affected persons do not look for treatment until any deformity occur of someone inform/diagnosis them earlier. According to NLEP and TLMI-B, annually on an average 3,000 to 4,000 new leprosy cases are detected in the country in the recent years. About 10 percent of the affected later turned disabled for their failure to take timely treatment. There are about 34,000 to 35,000 people in the country with deformity caused by the disease at the moment. Leprosy is curable with timely treatment, but failure to do so may result in disability. The disability could be checked if they were detected and brought under treatment at early stage. The government has to take the leading role, otherwise, anti-leprosy programme would not succeed. When a leprosy case is detected in an area, it is needed to carry out a survey in the areas to ascertain whether there is any other case in that area. But it has not been properly done by the actors due to shortage of resources. NLEP is the key government authority to implement, coordinate and monitor leprosy work in Bangladesh. It has trained expertise to train Tuberculosis Leprosy Control Assistant (TLCA), Programme Organizer (PO), Health Assistant (HA) and Community Health Care Provider (CHCP), but with budget shortage it has become difficult to train those who need knowledge and skill for detecting leprosy case. Jiptha Boiragee, programme support coordinator of TLMI-B, said NGOs are implementing anti-leprosy programme in many districts with the guidance of NLEP and NGOs are detecting more than 75% new case every year but NGOs have limitations, they cannot continue their works for a long time, more attention by the government is needed for sustainable leprosy services in the country. If there were adequate financial allocation for the leprosy control, leprosy case detection and other related activities would have been done more smoothly, preventing the chance of disability caused by leprosy, he said. Funds problem is also hampering skill development in the leprosy sector. There is scarcity of experts in dealing with the issue. Specialized leprosy services are limited in our country. Sometimes, a patients condition may worsen due to reaction after taking medicine. Our all institutions are not capable of handling such a situation. Dr. Rizia Akhter Begum, deputy director of NLEP, opined for taking up necessary steps for creating leprosy experts as there is dearth of such experts in our country. Field visit and awareness raising activities by TLCAs and POs are being disrupted for funds scarcity. They also failed to do other relevant works for lack of money. TLCAs and POs need necessary training on leprosy and to participate in awareness raising activities. It is needed to carry out skin camp to identify leprosy cases. Monitoring and follow-up are urgently needed. It is known that the posts of TLCA and PO remained vacant in number of upazilas for a long time, which hampered the leprosy services. Leprosy case detection would be more fruitful if the government health staff can be engaged in it. We can derive benefits if we can involve the CHCP and HA in leprosy control programme. They can play a vital role in early case detection if leprosy issue is added in their foundation training and separate training on leprosy is arranged. There is no denying the fact more steps need to be taken relating to leprosy. Specialized medical services such as reconstructive surgery should be made available at government medical colleges across the country so that people can avail of the necessary services. A leprosy victim, who is going to be disabled due to effect of the disease, can regain working capacity through the reconstructive surgery. Hence, adequate fund is needed. International assistance to leprosy control programme in Bangladesh is decreasing gradually. It a matter of concern that leprosy control programme is being slowed down at the field level due to lack of necessary funds and trained employees. Few NGOs, working in the field with their limited resources amid dwindling of foreign funds, find it tough to handle the task. The government should come up with necessary steps, including allocating more funds, for the leprosy control programme. The government should pay more attention to the leprosy issue, because it is a still health problem. Bangladeshs position is fifth in terms of leprosy infection in the world. With increased allocation, we can not only solve a health problem but also prevent the disability (caused by leprosy) of many people. Besides, we can turn them into force capable of working, contributing to our economy. If adequate attention is not paid by the government, leprosy will continue to inflict sufferings on us. It is hoped that the government, taking the matter into consideration, would allocate more money for the elimination programme in the current fiscal year. The writer, is a freelancer and can be contacted at [email protected]