The legacy of leprosy

28 World Health • 48th Year, No. 5, September-October 1995 The legacy of leprosy Denis Daumerie The ostracism that leprosy patients face is likely to be overcome only slowly, os communities realize that former leprosy patients living among them hove been totally cured, cannot transmit the disease to others, and must be encouraged to overcome their residual impairments and to integrate themselves into the community. A leprosy patient making arrows in a hospital in Bhutan. communities realize that cured patients li ving among them cannot transmit the disease to interpret, while the prevalence of disability among leprosy patients varies widely from country to coun- try; different studies have shown figures as low as 9% and as high as 57%. No stati stics can convey the true disability that stems from social rejection. In 1992, WHO estimated that the number of individuals suffer- ing physical impairment because of leprosy ranged between 2 and 3 million. The present study concludes that, whi le the precise prevalence of such impairment is still not known, there are today between one and two million cases. l eprosy earned its sinister reputa-tion because of its potential to disable and disfigure human beings. The dread of the deformities it causes only served to burden the sufferers with a further handicap: that of social ostracism. Today we know that leprosy can be cured; WHO is spearheading the drive to eliminate the disease as a public health prob- lem by the year 2000. New cases will continue to be diagnosed but, since person-to-person transmi ss ion will be stopped, a few decades into the 21st century should see the final eradication of leprosy from our planet. The key to this long-hoped-for goal is multidrug therapy (MOT)- a "cocktail" of three drugs which effect a cure and prevent the leprosy bacil- lus from developing resistance. But MOT cannot "cure" impairments and disabilities already present in pa- tients when the disease is diagnosed. Such persons will continue to be disabled and will require nursing care and rehabilitation. However, the ostracism that leprosy patients face is likely to be overcome only slowly, as others, and need encouragement to overcome their residual impairments. The message that cured but dis- abled patients cannot infect others has to be accepted by patients, fami- lies and communities if they are to be reintegrated into the mainstream of society. Formal health education can help to bring about such changes; informal methods of education can be used too , such as group discus- sions involving disabled leprosy patients, their families and opinion leaders (schoolteachers, village elders). When understanding re- places fear and stigma about the phys- ical and social handicaps, a major step will have been taken towards generating supportive measures to rehabilitate the image of leprosy. WHO has recently published a brief study entitled "Leprosy disabil- ities: magnitude of the problem", which reviews the global situation and attempts to estimate the burden and the impact of control pro- grammes based on MOT (Weekly epidemiological record, 22 September 1995, No. 38). Available statistics are scanty and not easy to The application of MOT is ac- tively reducing the overall incidence of impairment because it shortens the duration of the disease and limits the incidence and seriousness of compli- cations. This reduction is due to the efficacy of the drugs, as well as leprosy workers' regular monthly contacts with patients and improved monitoring and treatment of reac- tions. As the application of MOT may have prevented the occurrence of 80-90% of disabilities, it is esti- mated that between one and two million persons have been spared impairment. • Or Den is Doumerie is Chief of the Monitoring and Evaluation of Elimination of Leprosy Unit, Action Programme for the Elimination of Leprosy, World Heolth Orgonizotion, 1211 Genevo 27, Switzerland.