Leprosy Mailing List – February 9, 2017
Ref.: (LML) India's Supreme Court issues order
From: Joel Almeida, Mumbay and London
Dear Pieter,
The recent Indian budget singles out the "Poor and the Underprivileged" as one of the main themes. This includes strengthening the systems of health care. Leprosy is specifically targeted. This means a boost of funding. We need to switch our mindset from scarcity to effectiveness. Ms. Lehman has offered an excellent account of graded monofilament use. We could now consider ways to make the most effective methods available to all.
People may be able to set their own bones after fracture, but we need to ask whether that is the most effective approach. It is the same with leprosy. We need to focus on what is most effective. Not on how we can save money by exposing people to permanent damage. Their limbs and eyes are as important as our own.
Our opinions about technical questions matter. Neglect of leprosy over the past decade arose from scientifically obsolete or invalid definitions. Some of these invalid definitions still surface from time to time.
"Burden of disease" has a standardised definition: prevalence of sequelae x disability weight of the sequelae. That's the definition for all diseases, and we need not treat leprosy differently. Else we disadvantage the population at risk of leprosy.
"Elimination" was defined by the WHO NTD report of 2013 as the reduction to zero of the incidence rate of infection in a defined geographical area as a result of deliberate efforts. That's the definition for all diseases. We need not disadvantage the population at risk of leprosy by condoning scientifically obsolete terms such as "elimination as a public health problem".
Further, over-optimistic predictions tend to encourage complacency and to hasten a premature drop in funding. So we need not ignore the rising trend in incidence rate of newly detected cases with visible deformities. Else our mathematical models tend to mislead and damage.
We have emerged from a dark period in leprosy control, where experts were in a mindset of premature self-congratulation and scarcity. There was a rush to destroy competent leprosy services. But there is no substitute for the trained, mobile leprosy workers who we dismissed. They are needed again, to transform outcomes.
The Supreme Court of India has ordered the Indian government to show how it intends to fill vacant staff posts at the ground level. "You need people to successfully implement your policies at the ground level," the court stated. The court has got it right, and we experts need to keep up. The people of India, through the courts, have been reclaiming what we experts took away. Now we can support the people of India in their quest to rebuild adequate leprosy services.
Regards,
Joel Almeida
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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