Hospital-based services imperative for leprosy eradication

If leprosy damages the lining of the nose, it can cause frequent nosebleeds and constant stuffiness. If leprosy damages your eyes, it can lead to glaucoma and even blindness

Rahela Begum (not real name), aged 60, a resident of Bhola Sadar upazila, turned disabled due to lack of timely and proper treatment. 

She noticed few pale anesthetic skin patches on her body about ten years ago. She did not know what these were. She ignored it and was doing her normal work because people of her area actually were unfamiliar with signs and symptoms of leprosy. After three years, she went to a local village doctor to show her skin patches and numbness on her hand. 
The village doctor was totally unable to diagnose leprosy and treated her otherwise. Meanwhile, she had to spend lot of money which she saved for a long time, but every effort in vain.  Day by day she became poor to poorer. As a result of her illness, she developed claw fingers on her right hand, both eyes lagophtholmos and ulcer on right foot. She had been suffering from type I reaction and neuritis too but did not get proper management and treatment.
In October 2013, a team of Leprosy Mission International-Bangladesh (TLMI-B) organized an Extended Contact Survey in the area through community volunteers and detected her as new case of leprosy with disability. 
Before having disability, her occupation was day labourer and the villagers accepted her cordially. Due to disability, she looks abnormal in appearance and people started avoiding and hating her. At present, nobody likes her to work for them as she has claw fingers, ulcer as well as body weakness. She has two sons and four daughters. Her elder son works in the capital as a day labourer and lives separately. He does not look after her. 
Her three daughters got married and are living with husband and children. Her younger son, 15/16 years old, with little income looks after her. They are living in a small cottage. 
She is not alone, there are many who suffers due to lack of timely and proper treatment. If she had received proper health facilities nearby her area, her condition would not have been so bad.       
The complications of leprosy depend on how quickly the disease is diagnosed and effectively treated. Very few complications occur if the disease is treated early enough, complications that can occur when diagnosis and treatment is either delayed or started late in the disease process.
Without treatment, leprosy can permanently damage skin, nerves, arms, legs, feet, and eyes. The complications can include: Blindness, disfiguration of the face (including permanent swelling, bumps, and lumps), erectile dysfunction and infertility in men, kidney failure, muscle weakness that leads to claw-like hands or an inability to flex the feet, permanent damage to the inside of the nose, which can lead to nosebleeds and a chronic, stuffy nose, said TLMI-B.
“Nerve damage can lead to a dangerous loss of feeling. A person with leprosy-related nerve damage may not feel pain when the hands, legs, or feet are cut, burned, or otherwise injured. The sensory loss causes people to injure body parts without the individual being aware that there is an injury. This can lead to additional problems such as infections and poor wound healing”.
TLMI-B said, “If leprosy damages the lining of the nose, it can cause frequent nosebleeds and constant stuffiness. If leprosy damages your eyes, it can lead to glaucoma and even blindness. Lepromatous leprosy can reduce the amount of the male hormone testosterone and sperm counts in men, which can lead to erectile dysfunction and infertility. In more severe cases, leprosy can also damage the kidneys, which can lead to kidney failure”.
Many individuals are living with disabilities because of leprosy. Not only does a leprosy-related disability limit their activities in their daily lives, they also bring about stigma and exclusion from their communities.
Let us train health personnel to be competent in identifying, screening, & providing treatment for leprosy. Decrease prevalence of disability among people affected by leprosy by providing them quick access to quality healthcare. Together, we can work to see reduced prevalence rates of leprosy, associated disability & stigma among affected individuals, especially women & the illiterate community in Bangladesh.
There is no major surgery such as reconstructive surgery carried out in the government-run hospitals in the country. Such surgery may be needed to make body operational by carrying out surgery on certain body parts, which become ineffective due to effect of leprosy. Hence, it intensified sufferings of the leprosy victims, who are mostly poor. It needs special attention to address the problem, said sources.
After failing to get required health services, many leprosy patients turned disabled. Stigma grows among people after seeing the disability. Besides, those who disabled due to leprosy, become economic burden of the respective families. They then cannot contribute to their families due to the disability. After remaining in disabled condition, the disabled person dies. Hence, it is important to address the leprosy issue by providing leprosy expertise services at least in the country’s government medical college hospitals.
The hospitals have necessary set-up. What it can do now is to train up the orthopaedic physicians. Such physicians can carry out the major surgery. If everything is available at the medical college hospitals, the affected people can easily avail of required health services near their location. It can prevent the affected people becoming disabled due to leprosy. It is hoped that the government would take necessary steps in this regard, said the rights activists. 
Leprosy is a leading cause of permanent disability in the country and predominantly affects the poor marginalized people. The chronic symptoms often afflict individuals in their most productive stage of life and therefore impose a significant social and economic burden on society.
In addition to its economic impact, leprosy imposes a heavy social burden upon affected individuals and their families. Patients are often shunned, stigmatized, isolated and sometimes displaced from their work, marriage and social set-up, needing care and financial support leading to further insecurity, shame, and consequent economic loss.
The government should take the responsibility for ensuring adequate social and medical support for people with leprosy. The government should make policies and programmes to ensure that no individual is neglected. They deserve to have the opportunity to participate in their country’s economic growth.
People with leprosy deserve to live with dignity and be loved by people around them. It has been observed that people with leprosy and their families were often subjected to stigma, discrimination and human rights violations.
Incorporating disability and leprosy into the mainstream national development agenda should be one of the priority areas of the country. Raising awareness and positive efforts can contribute significantly to life-changing experiences for many. 
The Global Leprosy Strategy 2016-2020 “Accelerating towards a leprosy-free world” was endorsed by the WHO Technical Advisory Group on leprosy. The strategy is built around three major pillars: (i) strengthen government ownership and partnerships; (ii) stop leprosy and its complications; and (iii) stop discrimination and promote inclusion. Its goal is to further reduce the global and local leprosy burden. 
It is upto the state to ensure better healthcare for all. We cannot build a better Bangladesh by keeping a large number of people in trouble.  To gain momentum in our development, the leprosy victims need to be assisted so that they can contribute to progress.   

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

Hospital-based services imperative for leprosy eradication

If leprosy damages the lining of the nose, it can cause frequent nosebleeds and constant stuffiness. If leprosy damages your eyes, it can lead to glaucoma and even blindness

Rahela Begum (not real name), aged 60, a resident of Bhola Sadar upazila, turned disabled due to lack of timely and proper treatment. She noticed few pale anesthetic skin patches on her body about ten years ago. She did not know what these were. She ignored it and was doing her normal work because people of her area actually were unfamiliar with signs and symptoms of leprosy. After three years, she went to a local village doctor to show her skin patches and numbness on her hand. The village doctor was totally unable to diagnose leprosy and treated her otherwise. Meanwhile, she had to spend lot of money which she saved for a long time, but every effort in vain. Day by day she became poor to poorer. As a result of her illness, she developed claw fingers on her right hand, both eyes lagophtholmos and ulcer on right foot. She had been suffering from type I reaction and neuritis too but did not get proper management and treatment. In October 2013, a team of Leprosy Mission International-Bangladesh (TLMI-B) organized an Extended Contact Survey in the area through community volunteers and detected her as new case of leprosy with disability. Before having disability, her occupation was day labourer and the villagers accepted her cordially. Due to disability, she looks abnormal in appearance and people started avoiding and hating her. At present, nobody likes her to work for them as she has claw fingers, ulcer as well as body weakness. She has two sons and four daughters. Her elder son works in the capital as a day labourer and lives separately. He does not look after her. Her three daughters got married and are living with husband and children. Her younger son, 15/16 years old, with little income looks after her. They are living in a small cottage. She is not alone, there are many who suffers due to lack of timely and proper treatment. If she had received proper health facilities nearby her area, her condition would not have been so bad. The complications of leprosy depend on how quickly the disease is diagnosed and effectively treated. Very few complications occur if the disease is treated early enough, complications that can occur when diagnosis and treatment is either delayed or started late in the disease process. Without treatment, leprosy can permanently damage skin, nerves, arms, legs, feet, and eyes. The complications can include: Blindness, disfiguration of the face (including permanent swelling, bumps, and lumps), erectile dysfunction and infertility in men, kidney failure, muscle weakness that leads to claw-like hands or an inability to flex the feet, permanent damage to the inside of the nose, which can lead to nosebleeds and a chronic, stuffy nose, said TLMI-B. Nerve damage can lead to a dangerous loss of feeling. A person with leprosy-related nerve damage may not feel pain when the hands, legs, or feet are cut, burned, or otherwise injured. The sensory loss causes people to injure body parts without the individual being aware that there is an injury. This can lead to additional problems such as infections and poor wound healing. TLMI-B said, If leprosy damages the lining of the nose, it can cause frequent nosebleeds and constant stuffiness. If leprosy damages your eyes, it can lead to glaucoma and even blindness. Lepromatous leprosy can reduce the amount of the male hormone testosterone and sperm counts in men, which can lead to erectile dysfunction and infertility. In more severe cases, leprosy can also damage the kidneys, which can lead to kidney failure. Many individuals are living with disabilities because of leprosy. Not only does a leprosy-related disability limit their activities in their daily lives, they also bring about stigma and exclusion from their communities. Let us train health personnel to be competent in identifying, screening, providing treatment for leprosy. Decrease prevalence of disability among people affected by leprosy by providing them quick access to quality healthcare. Together, we can work to see reduced prevalence rates of leprosy, associated disability stigma among affected individuals, especially women the illiterate community in Bangladesh. There is no major surgery such as reconstructive surgery carried out in the government-run hospitals in the country. Such surgery may be needed to make body operational by carrying out surgery on certain body parts, which become ineffective due to effect of leprosy. Hence, it intensified sufferings of the leprosy victims, who are mostly poor. It needs special attention to address the problem, said sources. After failing to get required health services, many leprosy patients turned disabled. Stigma grows among people after seeing the disability. Besides, those who disabled due to leprosy, become economic burden of the respective families. They then cannot contribute to their families due to the disability. After remaining in disabled condition, the disabled person dies. Hence, it is important to address the leprosy issue by providing leprosy expertise services at least in the countrys government medical college hospitals. The hospitals have necessary set-up. What it can do now is to train up the orthopaedic physicians. Such physicians can carry out the major surgery. If everything is available at the medical college hospitals, the affected people can easily avail of required health services near their location. It can prevent the affected people becoming disabled due to leprosy. It is hoped that the government would take necessary steps in this regard, said the rights activists. Leprosy is a leading cause of permanent disability in the country and predominantly affects the poor marginalized people. The chronic symptoms often afflict individuals in their most productive stage of life and therefore impose a significant social and economic burden on society. In addition to its economic impact, leprosy imposes a heavy social burden upon affected individuals and their families. Patients are often shunned, stigmatized, isolated and sometimes displaced from their work, marriage and social set-up, needing care and financial support leading to further insecurity, shame, and consequent economic loss. The government should take the responsibility for ensuring adequate social and medical support for people with leprosy. The government should make policies and programmes to ensure that no individual is neglected. They deserve to have the opportunity to participate in their countrys economic growth. People with leprosy deserve to live with dignity and be loved by people around them. It has been observed that people with leprosy and their families were often subjected to stigma, discrimination and human rights violations. Incorporating disability and leprosy into the mainstream national development agenda should be one of the priority areas of the country. Raising awareness and positive efforts can contribute significantly to life-changing experiences for many. The Global Leprosy Strategy 2016-2020 Accelerating towards a leprosy-free world was endorsed by the WHO Technical Advisory Group on leprosy. The strategy is built around three major pillars: (i) strengthen government ownership and partnerships; (ii) stop leprosy and its complications; and (iii) stop discrimination and promote inclusion. Its goal is to further reduce the global and local leprosy burden. It is upto the state to ensure better healthcare for all. We cannot build a better Bangladesh by keeping a large number of people in trouble. To gain momentum in our development, the leprosy victims need to be assisted so that they can contribute to progress. The author is a freelancer, can be contacted at [email protected]