Friday, February 12, 2016

Fighting leprosy in countries in war

Leprosy Mailing List – January 25,  2016
Ref.: Fighting leprosy in countries in war

From:  Federica Dassoni, South Sudan


Dear Pieter,

If leprosy is difficult to eliminate in countries like India or Brazil, the challenges are still much more in countries at war.

I'm coming from an experience in Western Equatoria, South Sudan, where I was following the leprosy outreach project, supported by GLRA and Comboni missionaries. The project was already active for many years before I arrived.

-       The first problem we encounter was the continuing decreasing funds for leprosy.
-       Secondly, the MDT blisters provided by the government (from WHO) were sometimes sent very late from the capital because of the insecurity, leaving gaps of 2 or 3 months or more; during that time, we could provide just vitamins to the patients waiting for their therapy. All this when the compliance of patients was already low.
-       Another challenge is that we noticed low interest for leprosy among some of the peripheral health workers (but not all of them); sometimes they were not present on the appointment day, sometimes they didn't wait for us to tell the next appointment, when it was lunch time – they just disappeared.
-       Some patients were careful and always taking the tablets, some not. Patient tracing was almost impossible.
-       Another problem were the conditions of the roads and climate. Travelling to the villages on unpaved roads with lots of huge holes, dust or mud depending on the season, sleeping out in tents in remote areas with terrible hot climate, only few tukuls around, taking water from the boreholes, was hard. I must congratulate our leprosy team for their efforts. Examination of the patients in those conditions was really difficult.
-       More than this, health workers were often not trained to recognize leprosy. We once met a man with very classic lepromatous leprosy in a village, who was treated for years as syphilis and filariasis and then arrived to us very late. Another woman with a very advanced lepromatous leprosy and plantar ulcers (no dressing on them) was just staying at her village since years without any therapy; we met her by chance when we decided to go to a new village just to give information. All people with skin diseases were called at the time. A nurse from our staff understood her disease from far.
-       It was not easy to find young people who were interested to follow the leprosy outreach, but the very few ones were well trained and I must say they were good in diagnosis and physical examination. They were trained in Uganda, sponsored by the GLRA and Comboni missionaries.

The reason that encouraged me to write today is that to date the situation is getting worse. The insecurity of the roads is now very high because of fighting (shooting) and robberies, so that it's not safe for our medical staff to travel to the villages. People don't move any more. The leprosy outreach program, which was already full of challenges, had to be discontinued for some time now. This is very sad, in my opinion. Many more people are dying of life - threatening diseases as malaria, malnutrition, HIV just because they cannot reach the hospital. But also leprosy patients cannot be cured. Leprosy is still far from being eradicated in countries at war.


Best regards,


Federica



LML - S Deepak, B Naafs, S Noto and P Schreuder

Contact: Dr Pieter Schreuder << editorlml@gmail.com

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