Leprosy Mailing List – November 1, 2016
Ref.: (LML) A day on the ground |
From: Grace Warren, Sidney, Australia
Dear Pieter,
I would love to congratulate Joel Almeida on the letter regarding the diagnosis of leprosy (LML, October 31, 2016). Working in Hong Kong and Taiwan in the 1960s I saw many patients who did not have the classical "Anesthetic skin patch" that WHO states is essential for the diagnosis of leprosy.
Yes many of our patients had skin that was obviously infiltrated on palpation, but there was no obvious patch and no altered sensation - only on slit skin smear we were able to definitely diagnose leprosy. They of course would be highly infectious and at an ideal time to start treatment.
Also I have often seen many present with a foot drop or a partly clawed hand and no other complaints but on careful examination we often found there were enlarged nerves in the affected area and often some altered sensory perception.
I have been disturbed for many years regarding the lack of training of medical students. I have worked in many South Asian countries and lectured in medical colleges. In one endemic country I lectured in every medical college and was often told it was the first lecture on leprosy in that college!!!!. Yes I agree with Joel Almeida we need to have better trained personnel looking for the patients and able to assess the suspects; and ideally to check the contacts of those who could be spreading the disease. How can we influence those concerned to improve early diagnosis in order to really control this problem.
I am so often greeted by the comment "But there is no leprosy today" and the speakers are horrified when I tell them that " leprosy is present in every country of the world if you look for it ". How can we spread the information needed to enable us to find those who do need the full treatment? Also how can we get the older medical personnel to look for leprosy when they have never really learnt how to do it?
Yours sincerely,
Grace Warren
Previously Medical Superintendent of the Hong Kong Leprosarium in 1960s and Travelling Consultant in leprosy and Rehabilitation Surgery for the Leprosy Mission in Asia 1975-1990
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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