Md. Sazedul Islam
Both hands and one leg of Laily Begum (not genuine name), resident of a village in Kalai thana of Joypurhat district, became useless due to leprosy. The poor woman faced the problem as she failed to take timely treatment. She is not alone, many others also met the same fate in our country.      
The disability has caused a big problem as many of our people turned disabled due to the disease. Though people are also becoming disabled due to other causes, leprosy is one of the big causes. The disability is preventable with timely and regular treatment, which is available for free across the country. According to World Health Organization (WHO), among communicable diseases, leprosy remains a leading cause of peripheral neuropathy and disability in the world, despite extensive efforts to reduce the disease burden.
According to a report of National Leprosy Elimination Programme (NLEP), there were about 26,479 people with disability (WHO definition: Grade 2 deformity) due to leprosy from 1985 to 2015 at the time of diagnosis. People with leprosy in Grade 1 deformity at the time of diagnosis also turned to Grade 2 deformity as they could not take appropriate care. Total new leprosy cases were 203423 from 1985 till 2015 in our country.  
The data indicated that over 10% of the total leprosy patients became disabled during the period mentioned above.  
It should be remembered that the disability is the main cause of all social and physical problems. A disabled person may lose his/her working capacity. Besides, prejudice over leprosy is created among people due to the disabled condition of leprosy victims. Disability, caused by the disease, has generated fear among people’s minds for ages and also created misconception.           
Leprosy is today curable and manageable. However, in the long history of humankind, until recently leprosy has been regarded as highly contagious and incurable. Leprosy patients consequently were despised, isolated, abandoned and even feared. The associated deformities to varying degrees in some leprosy patients added to people’s psychologically negative attitudes towards leprosy patients. Furthermore, discrimination existed not only against leprosy patients but also against their families.
As leprosy is one of the big causes of disability in our country, it is urgently needed to eradicate the disease by taking necessary steps such as raising awareness on the disease and bringing the affected people under treatment timely and regularly.
According to The Leprosy Mission International-Bangladesh (TLMI-B), a unique feature of leprosy-related disability is its preventable nature. If leprosy and its complications are detected and treated in time, almost all disability can be prevented.
Hence the fact that prevention of disability constitutes a major component of leprosy services. This ranges from the treatment of immunological reactions to self-care of affected eyes, hands and feet.
There is still a substantial hidden caseload. 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. Stigma is a serious obstacle to case finding and to the effectiveness of treatment.
We should keep in mind that ulcers, wounds, discharges that occur in leprosy are not a source of leprosy infection. They do not discharge leprosy germs. Leprosy is a mild infectious disease caused by a bacterium called Mycobacterium leprae. Mycobacterium leprae comes out from untreated MB (multibacillary) patient at the time of sneezing and coughing. It spreads as droplet infection through air and enters healthy human being through respiratory system. Fortunately most people have natural resistance to the infection.
“The leprosy bacillus uniquely infects the peripheral nervous system leading to nerve damage mainly in the face, hands and feet. In turn, this leads to the characteristic features of advanced leprosy. These include blindness, facial disfigurement, loss of fingers and/or toes and chronic wounds due to an inability to feel pain and pressure. These physical features lead to difficulties in performing activities of daily life, such as fastening buttons, writing, picking up objects, and walking”, said TLMI-B.
However, the most important impact of leprosy on those affected is social exclusion. Leprosy is still stigmatized in almost all leprosy-endemic countries. This, combined with any physical limitations in functioning, can have a profound negative effect on a person’s social participation. The stigma is such that often whole families are affected. Many of the manifestations of stigma are violations of human rights.
Social exclusion and other effects of stigma should be addressed through social and economic rehabilitation, including facilitation of inclusive education, promoting equal employment opportunities, personal empowerment and self-advocacy. These activities can be implemented using a community-based rehabilitation (CBR) strategy. Because of the high level of stigma, promoting social inclusion often involves mainstreaming leprosy in the general field of disability, e.g. promoting that persons with leprosy-related disabilities become members of multi-disability Disabled Peoples’ Organisations (DPOs), as well as mainstreaming in the general development field.
Leprosy is not only a disease requiring medical treatment, rather it is also an important social problem. Hence, social awareness needs to be created. The mass media can play an important role in raising the awareness. As patients’ ability to sweat and feel pain is impaired, and injuries are common as a result. As patients do not feel pain in body, they sometimes don’t want to come for treatment. If the awareness is created, then such people will come for diagnosis and treatment voluntarily.                       
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 Multidrug therapy (MDT) and making sure that they take treatment timely and regularly.
It is needed to highlight the importance of early case detection and minimize social stigma by increasing community awareness regarding the early sign of leprosy, curability with treatment and availability of treatment free of cost. It is also needed to provide efficient diagnostic and treatment services to all the leprosy patients.
Work on finding new case is being hampered now due to lack of necessary manpower. If we can utilize the field level health employees of the government such as community health care providers (CHCP) and health assistants (HA), we can derive better result regarding the case detection. There has been an instruction on service manual of CHCP and HA for utilizing them in the task, but they are yet to be engaged.      
People, infected with leprosy, also are entitled to the same rights as everyone else. They have the right to work and be treated on an equal basis with others vis-à-vis recruitment, hiring, promotion, and salary. They are not to be denied admission to or be expelled from schools or training programmes on the grounds of leprosy.
All kind of treatment such as  ulcer care, complication management, re-constrictive surgery and as well as other treatment for people with leprosy should be ensured through general health facilities e.g. upazila health complex, district general hospital, medical collage etc. It will not only reduce the treatment burden of leprosy patients but also reduce social stigma and isolation.
To prevent the transmission of the disease, it is necessary to ensure support in the community and supportive mentality of trained staff at facilities. It is also imperative to take leprosy care near to the community so that people can not only get the services easily but also can overcome stigma associated with it.