Thursday, October 4, 2018

FW: (LML) Where are the Styblos of leprosy?


Leprosy Mailing List – October 4,  2018

Ref.: (LML)  Where are the Styblos of leprosy?  

From:  Joel Almeida, London and Bombai

Dear Pieter,


In the 1980s self-proclaimed TB experts were celebrating the last mile of TB elimination. New bactericidal drugs would work miracles, according to the promises.


Karel Styblo did not join the chorus of celebration. He went to Tanzania and set up a well-documented population-based programme to control TB. Good outcomes were observed quarter after quarter.


Arata Kochi at WHO HQ reviewed many TB control programmes across the world and understandably identified Styblo's programme as the best effective option. 


In 1993 the WHO officially recognised TB as a global emergency. An updated version of Styblo's programme was devised in the following years, for widespread use. Country after country documented consistently good outcomes. Since then, millions of lives have been saved thanks to this programme.


One country, which shall remain unnamed, was slow to adopt the strategy. Their reason? TB had almost been eliminated in their country. It was a false boast. Their slowness to admit the real epidemiological situation was responsible for a huge number of unnecessary deaths.


In leprosy we still have people so busy congratulating themselves over imaginary successes that patients continue to be neglected. They too often suffer unnecessary disfigurement and disability despite treatment. Isn't it time for the self-congratulatory posturing to give way to better care for patients, so that they can be protected against avoidable disfigurement?


New thinking and a fresh start would help, without attachment to past errors. How do we attract bright young people to leprosy work?


Think back to how you became interested in leprosy. For me, it was a simple question from Dr. Job, the pathologist. "Would you like to work in leprosy?" Combined with a specific opportunity.


We need Styblos in leprosy. People who will integrate fragments of scientific knowledge into coherent and effective front-line interventions to protect people against disfigurement by leprosy. These pioneers need to be on the ground in core-funded population-based programmes that rigorously document successes and failures. Then they can tweak operations continuously to improve outcomes.


Then we will have a real chance of devising programmes capable of protecting people reliably against the disfigurements of leprosy. 


We need to create opportunities and ask bright young people the simple question, "Would you like to work in leprosy?" M. leprae is a slippery foe, because it can play dead for months or even years at a time. The disfigurements arise not only from bacterial proliferation but also inflammatory responses. Isn't this a fascinating challenge for bright young minds, unattached to past errors? Aren't there plenty of bright young minds in India, Brazil, Indonesia and other leprosy endemic countries? Don't such countries export intellectual firepower, and have exemplary people of compassion working on the front lines? Can't we create more opportunities for bright young people in the leprosy endemic countries?


For the past few decades we have too often been content to congratulate ourselves and boast, sometimes even suppressing inconvenient evidence. Some of the worst offenders have been those who make exaggerated claims and predictions about M. leprae disappearing, in the process repelling young people from leprosy work. Isn't it time to devise measurably effective programmes instead? Isn't it time for Styblos in leprosy? Isn't it time to core-fund a few large population-based field programmes, that can evolve demonstrably effective programmes and test a wide variety of interventions?


Our past habits made the future bright for M. leprae. Let's make it bright for the people of leprosy-endemic countries instead. Let's keep drawing bright young talent into leprosy work at the front lines, and fund population-based field programmes that are continuously improved and rigorously documented.


Joel Almeida

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

LML blog link:

Contact: Dr Pieter Schreuder <<

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