Leprosy Mailing List – June 24, 2022
Ref.: (LML) Unequal distribution of leprosy in Mozambique
From: Sunil Deepak, Scio. Italy
Dear Pieter,
The latest InfoNTD newsletter (23 June 2022) mentions a sociological paper about leprosy in Mozambique, " Health and ethnic inequalities in Mozambique with special reference to leprosy " ( WIDER Working Paper 2022/50, United Nations University). The full paper is available from the following link:
It stimulated my curiosity when I read its abstract which said, " The colonial regime, by neglecting and creating ineffective leprosaria in central and northern Mozambique, 'ethnicized' Lazarus disease, a fact corroborated by its current unequal distribution."
The paper makes the following considerations (some examples are quoted here) regarding the unequal distribution of leprosy in Mozambique:
" Considering that, following the precepts of the World Health Organization (WHO), Mozambique has been free of Lazarus disease since 2008, two pertinent questions arose: (i) 'Why has leprosy reemerged in Mozambique?' 3 ; (ii) 'Why is leprosy more prevalent in northern and central Mozambique?':
- The 20th Century Health Inventory available in the Historical Archive of Mozambique has relevant data on colonial policies in relation to leprosy. The effects of these policies are still being felt today. The reports of the Ministry of Health document the effort to eradicate leprosy, but also issues concerning its regional distribution (among certain ethnolinguistic groups).
- Leprosy, eradicated in 2008 but subsequently resurged, has raised the interest of various scholars, ranging from ethnographers (Dias and Dias 1998; Junod 1996) to historians (Liesegang 1994; Roque 2016; Zamparoni 2017: 13–39), anthropologists (Palhota 2012), epidemiologists (GrauPujol et al. 2019; Griffiths and Ready 2001; Marrega et al. 2019; Silva 2007; Stuip et al. 2003), and biologists/botanists (Conde et al. 2014; Sitoe 2020).
- We propose to reflect on 'what conditions make health inequalities unjust' and to consider 'the merits of policies that prioritize the elimination of health disparities' (Arcaya et al. 2015: 1) caused by leprosy, in other words the conditions and policies that put some ethnic groups at risk of developing leprosy and how they operate at a social level (Lockwood 2004). "
Reading this paper raised up some issues in my mind, including the following:
(1) It is a comment on WHO's "elimination goal" which continues to be misunderstood not just by lay persons but also by other professionals, who understand it as "eradication of leprosy". Yet, in some ways, people engaged in leprosy related work, we continue to use the terms like leprosy elimination, more than 15 years after the goal was achieved.
(2) Sister disciplines like sociology looking at history of medicine may not have any dialogue with the health services and professionals involved in programmes like leprosy control, have no or limited understanding about the roles and limitations of leprosariums, about the different issues related to the continuing limitations of leprosy diagnosis and treatment, though a huge amount of literature is available about it. The authors of this paper quote different other papers written by other professionals such as historians, anthropologists, epidemiologists, etc. who seem to have done similar studies and who share the same kinds of understandings. So I was asking myself, how can this gap be bridged?
Warm regards,
Dr Sunil Deepak
Schio (VI), Italy
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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