Leprosy Mailing List – December 5, 2015
Ref.: (LML) ILA Congress, Beijing, 2016
From: Grace Warren, Sidney, Australia
Dear Pieter
I am very interested in the many letters recently regarding the case rates of Leprosy, and especially the low detection rates especially in some of the countries of the world., . I have been involved in Leprosy care since 1959 and have been involved in drug trials and surveys in several countries. I am interested in the many statements by professionals who should know, that there are many patients whose diagnosis is missed. Personally I think that the WHO aims and statement referring to the Eradication of leprosy is largely to blame. For a number of years now I get greeted with the comment “but leprosy is eradicated” and have found that it is barely taught, if at all, in most of the Medical colleges – even in countries where Leprosy is endemic the teachers are often honest enough to tell me “ Oh but we do not teach leprosy and claim there is none now. Travelling in counties where I know there is leprosy I often get greeted with statements that support the idea that many medical workers really do not know what to look for and in fact the diagnosis of Leprosy rarely crosses their mind. “What one does not think about, one never sees”, “What one does not recognise, one will never diagnose”.
The official WHO definition that states that for a diagnosis of leprosy the patient should have an anaesthetic skin patch does not help as many of the early cases have very vague lesions with no definite edges, hardly called patches and many have no infiltration to assist diagnosis. Many patients have no anaesthesia for 5-10 to even 20 years about first symptoms. In the old days we did many slit skin smears but it seems they are not often done these days. One patient with multiple nodules, treated by many physicians for years, eventually got his diagnosis when a med student was looking at a path slide of one of his nodules and said” Is that not leprosy”? It sure was! But the diagnosis has been missed and the senior pathologist, in that teaching hospital, had previously given me a wrong diagnosis for another patient and I had got the correct diagnosis, for the second patient from a specialist in UK. I knew it was leprosy but the locals did not.
I have been fascinated by the reports from Indian specialists as to the large numbers of children in India with leprosy that are not registered as they do not fulfil the required description. From my experience in many countries (I have treated leprosy in 26 countries) I know the same is common and I have often diagnosed children with anaesthetic areas and even paralysis associated with large nerves that have not been correctly diagnosed., The Primary persistent Neuritic leprosy of S.E. Asia is often brushed aside by WHO consultants –“ It does not fulfil the requirement of an anaesthetic skin patch”. One poor boy was put in a psychiatric institution for years as he complained of “funny feelings” in the index and long finger. No one checked his sensation and he had total loss of pain perception in the back of the fingers as well as definite palpable hard nerves in several sites on the same arm, and elsewhere.
I note the upcoming conference and wonder if it is possible to get some alteration in these aspects of leprosy care and diagnosis. The general medical personnel needs to think of leprosy and what can be done to alert the general physicians especially those who work in areas where Leprosy is present and that there is a need to check contacts, etc., and remember it is present. We must remember that Leprosy is present in the areas at present affected by the ISIS problems and who amongst the refugees may be taking leprosy with them???
I hope the conference is a great success. I worked in Hong Kong for years and would love to go if I were fit but I will not be there so hope some progress is made on alerting people to look for and diagnose leprosy early.
With kind regards,
Grace Warren
Now in Sydney, Australia, but previously Adviser in Leprosy and Reconstructive surgery for The Leprosy Mission In Asia ( 1975-1995)
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << editorlml@gmail.com
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