Leprosy still a health hazard

Mohammad Mostaque (57), who was affected by leprosy earlier, is now fully cured and is earning livelihood for his family. Mostaque, a resident of Aziz mohalla of Mohammadpur in Dhaka city, has a grocery shop. He was cured after taking medicines for two years after a team of The Leprosy Mission International-Bangladesh (TLMI-B) identified him as a leprosy patient. He stayed with his family and even conducted business attending his shop while he was a patient.
"My ailment has not created any problem for leading my normal life", he said. He, however, admitted that neighbours hated him because of the disease.  
He is not alone. There are many leprosy patients who got cured after taking drugs regularly and they are now leading normal life. "There should be no reason for panic, because leprosy is curable, provided regular treatment is taken for the required period", said Dr Safir Uddin Ahmed, Deputy Programme Manager, Leprosy (Training and Logistics) DGHS, Mohakhali. Early detection is very important. If non-itching, pale or reddish patches with loss of feeling and dry surface or smooth shiny reddish patches, nodules or tumours on the skin persist for more than a month, a qualified doctor or leprosy specialist should be consulted without delay.         
The majority of leprosy cases can now be cured with six months' regular treatment with multi-drug therapy (MDT). Persons with multi-bacillary leprosy, however, need at least two years' MDT. MDT, if started early and taken completely and regularly, cures the disease, checks the spread of the disease in the community, prevents deformities and disabilities such as blindness, non-healing wounds or ulcers, loss of fingers and toes, which may occur in neglected or late-treated cases, said Dr Safir.                
The isolation of leprosy cases is not necessary; even persons suffering from the infectious type of leprosy (multi-bacillary leprosy) can be made non-infectious quickly within a few days or weeks by MDT. Leprosy, considered the oldest disease in the history of mankind, is a chronic infectious disease caused by a bacterium called Mycobacterium leprae, said doctors.
If an untreated multi-bacillary patient sneezes and coughs, billion of germs come out and enter the body of well people. Such bacteria can survive till seven days in the natural environment. However, germs never come out from ulcers caused by leprosy. More than 90% of people living in areas where leprosy is prevalent are naturally immune, that is to say, they have high resistance to the disease and do not catch it. People with poor immunity are susceptible to the disease. Poverty, malnutrition and unhygienic living condition are reasons of infection. If left untreated, leprosy can cause progressive and permanent damage to the skin, nerves, eyes, and limbs.
Dr Aung Kya Jai Maug, Medical Specialist of Foundation Damien, Bangladesh, said the disease is not due to misdeeds committed in the present life or a previous incarnation. Nor is it due to witchcraft, evil spirits, curses or punishment by God, hot food or a hot climate. It is not hereditary and cannot be caught by touch. It is caught through droplets of moisture passing through the air from someone who has leprosy but has not yet started treatment. Symptoms can be slow to appear and it may be five or ten years before the disease appears after initial exposure, said Maug.
Though curable and a disease like other diseases, leprosy still carries a lot of stigma and prejudices in our society. People diagnosed with the disease are stigmatised, rejected by their families and communities. They may lose their jobs and end up without a home or source of income, said TLMI-B. Though leprosy is an ancient disease, for a long time there was no effective remedy for it. This lack of treatment and the resultant deformities/disabilities due to leprosy have created scope to grow misconception, prejudices and stigma around leprosy. This ostracism leading patients to hide their early lesions and thereby delaying treatment with resultant more risk for development of deformities/disabilities and acting as a reservoir of infection for more periods.
Experience showed that isolation produced more problems than it solved. The misconception and stigma over leprosy has created a social problem. Hence, it is essential to create social awareness on leprosy along with controlling the disease, said Dr Safir. "The physical disease of leprosy is not a curse. It is curable with modern scientific treatment, which is freely available in the country. It is extremely important to get treatment as soon as one is detected with leprosy. There should not be any place for social discrimination suffering from leprosy. Any form of discrimination against people affected by leprosy is a crime", said TLMI-B.
About 16 million (1.60 crore) leprosy patients were cured after taking MDT treatment around the world from 1985 till 2012, said TLMI-B sources. "Since its inception in 1874, Leprosy Mission International has been working at different parts of the world. None of our staff was affected by leprosy while closely dealing with patients anywhere in the world. Why people are scared of the disease?" Matthew S Halder, Country Director of TLMI-B, posed the question.
Halder said many patients, especially women, declined to take treatment fearing ostracism due to stigma attached to the disease. Though curable, leprosy remains a major health problem due to lack of awareness, non-availability of necessary treatment centre in the country's many places and non-detection of leprosy cases in the remote areas.   
According to TLMI-B, annually on an average 3000 to 4000 new cases are detected in the country in the recent years. According to World Health Organisation (WHO), some 36,772 people were affected by leprosy in Bangladesh in the last seven years from 2006 till 2013. "All kinds of publicity should be carried out to spread the message that leprosy is curable. We can transform the lives of affected people by defeating leprosy", said Halder.      
Many leprosy patients remained undetected and also deprived of proper treatment in the country's remote areas. We should address this taking it as our big challenge. Many doctors are not trained on this disease. Hence, they failed to identify patients due to lack of their knowledge. They should be imparted proper training about the disease. Persons affected by leprosy, and their family members should be treated as people with dignity, and be entitled to all the human rights and international freedoms proclaimed in the Universal Declaration of Human Rights.  
If all concerned, including health authorities and the media, make determined efforts to increase awareness of the disease among the general public and help in the large scale implementation of MDT recommended by the WHO, it will undoubtedly be possible to control leprosy in the near future.     
The writer is a journalist. He can be reached at [email protected]