(LML) A day on the ground

Leprosy Mailing List – November 15,  2016

Ref.:   (LML) A day on the ground

From:  Joel Almeida, London and Bombay

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Dear Pieter,

 

Lepromatous leprosy is much rarer than self-limiting forms of leprosy. It is also more difficult to suspect or recognize. Even the person affected does not suspect any illness. This is true of previously untreated patients as well as those reinfected after MDT.  Unfortunately, people with lepromatous leprosy spread far more M.leprae than do others with the disease. We ignore this at our peril.

 

Silent neuritis, without overt signs of inflammation, is responsible for 85% of nerve damage among South Asian populations on MDT. Even the person affected does not suspect the problem until it is too late. If we ignore this, and are content to focus on "reactions" with obvious signs of inflammation, then patients who develop silent neuritis during MDT can be condemned to avoidable visible deformity.

 

So, despite our best intentions and vigorous efforts with MDT, leprosy continues to spread and to disfigure people. We need to be pro-active in tackling these challenges, not waiting for people to come to our health centres. Unsuspecting individuals can't be expected to seek help for problems of which they're unaware. Instead, the expertise needs to go out to people wherever they are. The Indian government's increasingly pro-active approach is a step in the right direction.

 

Trained leprosy workers need to cover a large population so that they can make a big difference.  That's because lepromatous leprosy has an incidence rate much lower than the incidence rate of other forms of leprosy. Nerve damage is confined to under about 30% of all patients on MDT.  By covering a large population, each skilled leprosy worker can yield a rich harvest of good outcomes.

 

Skilled leprosy workers need to be mobile, so that they can cover a large population. In urban areas, they can cover a population of millions. In rural areas, they can cover hundreds of thousands of people. This means that even a huge country such as India could transform outcomes with as few as 1000 to 2000 trained, skilled and mobile leprosy workers. 

 

We raise tens of millions of dollars per year in contributions for leprosy work, and a fraction of that would suffice each year. We could train and employ the skilled, mobile leprosy workers needed to transform outcomes. Workers with leprosy expertise are so valuable that they deserve a generously funded career path. Then they will rush to be trained in leprosy.

 

Let's implement the simple measures that bring huge benefits. Then we can hope to reverse the rising tide of leprosy in India. Otherwise we continue to give M. leprae a free pass, and expose nerves to avoidable permanent damage. Then we wring our hands and wonder why M. leprae continues to outwit us.

 

Our message to governments and noble-minded donors can be clear: train and employ skilled leprosy workers, and reduce the spread of leprosy while protecting patients against disfigurement. We can explain exactly what the skilled, mobile workers are needed for:

 

1) Actively detect, monitor and protect people with lepromatous leprosy (both before and after MDT)

2) Actively detect and reverse silent neuritis, by monitoring patients during the first 2 years after starting MDT.

 

Zero transmission and zero disability will come only if we pay attention to what happens on the ground. For the past 15 years we have been fighting (and losing) a war while breaking the legs of our own soldiers. Now we can start restoring the skilled front-line workers who can transform outcomes.

 

Regards,

 

Joel Almeida

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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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