Leprosy eliminated?

Leprosy Mailing List, September 12^th, 2009

Ref.: Leprosy eliminated?

From: Schreuder Pieter AM, The Netherlands

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Dear Salvatore,

I refer to Drs de Koning’s and Vijayakumaran’s comments (LML Sept. 11^th and Aug. 27, 2009 respectively).

Even when there is a functioning primary health care and referral system still some patients are only diagnosed very late. Multibacillary (MB) Hansen’s disease (HD), especially close to the lepromatous end of the spectrum, may mimic (many) other diseases, and the patient can not be diagnosed without a biopsy or a slit-skin smear examination. Clinicians (including dermatologists) working in a HD endemic area do not always include HD in their differential diagnosis, especially when the clinical presentation is unusual. HD should be considered in all patients with skin lesions not responding to treatment, especially when they have neurological deficits, and live or have lived in an HD endemic area. Due to the increase in global travel and immigration, doctors in low endemic areas need to consider HD as a possible diagnosis.

Nery JA, Schreuder PA, de Mattos PC, de Mendança LV, Tardi RT, de Mello S, Azulay RD, Lehman LF, Naafs B. Hansen’s disease in a

general hospital: uncommon presentations and delay in diagnosis. J Eur Acad Dermatol Venereol, 2009; 23: 150-156.

Kind regards,

Pieter AM Schreuder

Announcement for project manager for leprosy programme in Mozambique

Leprosy Mailing List, September 11^th, 2009

Ref.: Announcement for project manager for leprosy programme in Mozambique

From: Deepak S., Bologna , Italy

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Dear Salvatore,

we shall be grateful if you can circulate the following announcement for a project manager for leprosy programme in Mozambique for AIFO. The announcement is in both English and Portuguese. Thanks in advance.

Dr Sunil Deepak

AIFO/Italy

>>>>>>>>English version (Portuguese version below)

PROFILE: Project Manager for AIFO social health initiative in Nampula Province ,Mozambique .

LOCATION: Nampula City – Nampula Province ( Mozambique )

REQUESTED AVAILIBILITY: 12 months, renewable

STARTING: November 2009

SALARY: based on AIFO contractual criteria, C.V. and previous experience/s.

QUALIFICATIONS:

- Advanced degree in physiotherapy, medicine or health program management.

- At least 5 years relevant professional experience in developing countries. Experience in Mozambique an advantage.

- Demonstrated experience in primary health care program management, particularly in leprosy control programs.

- Ability to draft project proposals (feasibility studies and project proposals based on Italian Ministry of Foreign Affaire and/or European Union guidelines).

- Fluency in Portuguese.

- Computer literacy.

- Excellent organizational, administration/financial and management skills.

- Ability to work in a team, interpersonal skills, flexibility and adaptability.

TASKS:

- Manage activities as foreseen in AIFO social health project in Nampula Province( Mozambique ) in partnership with Health Provincial Office (DPS), with local NGOs and religious congregations.

- Monitor, evaluate and report on AIFO social health initiative in Nampula Province; prepare project financial reports; manage AIFO bank account;

- Strengthen partners’ planning and activity management skills;

- Identify new collaborations and new projects; promote study and elaboration of new projects; draft project documents to be submitted to donors;

- Prepare and forward information material for AIFO Communication and Fund Raising Office for awareness raising campaigns and relevant events;

- Support AIFO expatriate personnel, interns, visitors, consultants logistically.

PLEASE E-MAIL YOUR CURRICULUM VITAE TO:

barbara.zoli(at)aifo.it

OR SEND TO:

Barbara Zoli

AIFO – Segreteria e Servizi Generali

Via Borselli n. 4-6

40135 Bologna (BO) - Italy

Tel. ++39 051 4393211 – Direct line: ++39 051 4393227

>>>>>>>>>>>>>>>>>>>Portuguese version

PERFIL: Responsável do projecto para actividades de gestão de iniciativas sócio-sanitárias promovidas pela AIFO na província de Nampula, Moçambique

LOCALIDADE : Sede na cidade de Nampula – Província de Nampula (Moçambique)

DURAÇAO DO CONTRATO: 12 meses, renováveis

DATA PREVISTA DE INÍCIO: novembro 2009

SALÁRIO: De acordo com os parâmetros dos contratos AIFO, tendo em conta o Curriculum Vitae e as experiências anteriores.

REQUISITOS:

- Formação: Licenciatura em Fisioterapia ,Medicina ou Gestão de Programas de Saúde.

- Experiência de trabalho sanitário em países em via de desenvolvimento. Será considerada preferencial a experiência anterior em Moçambique.

- Experiencia anterior no âmbito da gestão de programas sanitários de base, em particular em programas de controlo da lepra.

- Capacidade de elaborar propostas de projectos (estudos de viabilidade e elaboração de documentos de projectos com base nas linhas do Ministério da Saúde Italiano e/ou União Europeia).

- Fluente na língua portuguesa.

- Conhecimentos de Informática.

- Acentuadas competências de organização, de administração e de gestão.

- Capacidade de trabalhar em equipa, capacidade de se relacionar e mediar, flexibilidade e adaptação.

FUNÇÕES :

- Gestão das actividades previstas pelo projecto sócio-sanitário promovido pela AIFO na Província de Nampula, em parceria com a Direcção Provincial da Saúde (DPS) e com ONGs e Congregações Religiosas locais.

- Monitoria, avaliação e feitura de relatórios das actividades sócio-sanitárias promovidas pela Associação “AIFO na Província de Nampula; preparar os relatórios financeiros do projecto; gestão de uma conta bancária AIFO ;

- Fortalecer as competências dos parceiros na planificação e gestão das actividades ;

- Identificar novas colaborações e novos projectos ; promover o estudo e a elaboração de novos projectos; redigir documentos de projectos para apresentar a instituições financiadoras ;

- Preparar e enviar material informativo ao Serviço Comunicação e Recolha de Fundos da AIFO para campanhas de sensibilização e actividades relacionadas;

- Fazer o apoio logístico ao pessoal expatriado AIFO, preparar estágios, viagens estudo, consultorias.

PARA INFORMAÇÕES E ENVIO DE CV:

Barbara Zoli

AIFO - Via Borselli n. 4-6

40135 Bologna (Itália)

Tel. ++39 051 4393211 – Número directo: ++39 051 4393227

barbara.zoli(at)aifo.it

“Leprosy eliminated? … A wake-up call from Liberia ”

Leprosy Mailing List, September 11^th, 2009

Ref.: “Leprosy eliminated? … A wake-up call from Liberia ”
From: Koning Pieter de, Würzburg , Germany

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Dear Salvatore,

Please allow me to respond to Dr. Vijayakumaran’s comments (LML August 27, 2009).

The point I was trying to make is that almost all new cases were detected during “outreach village surveys”, none of the cases were referred. They were of course the result of deficient basic health services elsewhere, but had it not been for the outreach programme, none of the cases would have been found and none would have reached the “referral” hospital. This makes you wonder about the areas the outreach programme never reached, for whatever reason. I agree it is not entirely appropriate to extrapolate to the entire region and that a complete situation analysis is necessary…

My fear is that this analysis, if it ever takes place and is done properly, will come up with figures far more disastrous than my (probably very conservative) calculations.

Kind regards,

Dr. Pieter de Koning, MD, MPH

Medical Advisor

Deutsche Lepra- und Tuberkulosehilfe e.V (DAHW)

Mariannhillstraße 1c, 97074 Würzburg

Telefon: ++49 (0)931 7948-113, Fax: -160

E-mail: pieter.de-koning(at)dahw.de

Be aware of the word 'cured' in LL cases

Leprosy Mailing List, August 30th, 2009

Ref.: Be aware of the word 'cured' in LL cases.
From: Ganapati R., Mumbai, India
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Dear Dr Derek,

I refer to your LML message dated August 27th, 2009. Thank you for this. Your illustrious father Dr Stanley Browne who made his contributions mainly in the dapsone mono-therapy era had warned long ago about the relapses due to the “lurking bacilli”.

He continued to make observations during the early MDT period, but unfortunately did not live long enough to observe the outcome of the persistence of lurking organisms leading to relapse many years after completion of effective treatment with far more powerful bactericidal drugs.

We are encountering relapses 10 to 15 years after withdrawal of treatment in spite of satisfactory completion of universally prescribed schedules of treatment. This phenomenon reiterates the foresight of the “Mr Leprosy” who rightly advised to use the word ”cure” in LL cases with caution. Unfortunately the word is freely used particularly by some who want to underestimate relapses for public health reasons.

Relapse should be viewed from the clinical angle, as this is of concern to the affected individual. If the patient is BI and MI* positive at the time of relapse, he may be source of transmission of leprosy.

With regards,

Dr R Ganapati


*BI= bacteriological index
MI= morphological index

Enhanced Global Strategy 2011-2015

Leprosy Mailing List, August 29th, 2009

Ref.: Enhanced Global Strategy 2011-2015 (see attachment)

From: Pannikar V., New Delhi, India
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Dear Dr Noto,

Please find attached the final print version (English, PDF) of the Enhanced Global Strategy for Further Reducing the Disease Burden due to Leprosy (2011-2015). Several hard copies of the document will be distributed to all WHO Regions, countries and partners for distribution to all health programme managers responsible for leprosy control in their area.

The purpose of these documents is to help managers of national health services to develop detailed national policies applicable to their own situation, and revise the National Manual for Leprosy Control in their respective countries.

I would like to request you to share these documents with the national programme authorities from endemic countries and other interested colleagues. In addition, I would encourage programmes to translate the document into local languages, as appropriate.

With kind regards,

V. Pannikar

“Leprosy eliminated? … A wake-up call from Liberia”

Leprosy Mailing List, August 27th, 2009

Ref.: “Leprosy eliminated? … A wake-up call from Liberia”
From: Vijayakumaran P., Chennai, India

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Dear Dr. Noto,

Greetings from Damien Foundation India Trust. This is regarding Dr Diefenhardt’s message and attachment “Leprosy eliminated? … A wake-up call from Liberia”, LML, July 7th, 2009. Thank you for sharing the observation.

I came across a similar situation in India. It was one of the backward regions in socio-economic development and communication facilities. There was no civil war but this region was highly prone for natural calamities. The leprosy situation was far behind when compared to many other regions in the country.

We had an advantage that health infra-structure existed in this region though inadequate. In that time (year 1996) there was set of health staff exclusively for leprosy control programme (called vertical programme). There was gross inadequacy of staff in vertical structure.

There was lack of guidance to health staff to implement required activities. Capacity building and on-the-job guidance were the major components of new strategy (through Technical Support Teams). The primary health care system was enabled to participate in leprosy control programme from the beginning of implementing the new strategy. When the leprosy control programme activities were regularly implemented there was a remarkable progress. Basic leprosy care services were made available in all the primary health centres. The leprosy control programme was integrated into primary health care system (year 2002). The progress was sustainable as primary health care system was involved along with vertical system. The Technical Support Teams were totally withdrawn in the year 2007. The success was mainly because of good situation analysis, application of appropriate strategy and good coordination by programme managers at different levels.

I am not aware of the situation and health infra-structure in Liberia. The data discussed in the communication seemed to be from a referral hospital. Generally data from such sources may not reflect the actual situation. Hence it may not be appropriate to directly interpolate to the region. The term incidence was mentioned several times. The data referred to in the communication was actually case detection rate. Patchy coverage or spurts of activities may present a situation described in the communication. New case reporting in a referral centre increases when basic care in the general health system is deficient or inaccessible due to various reasons.

There is a clear indication for a complete situation analysis in this region.

With regards.

Dr.Vijayakumaran.P
Director (Prog),
Damien Foundation India Trust,
Chennai, India.

References for the information cited:

1. Trends in new case-detection leprosy in Bihar, India. Vijayakumaran P, Prasad B, Krishnamurthy P. Indian J Lepr. 2006 Apr-Jun;78(2):145-51.

2. "Instant" new leprosy case-detection: an experience in Bihar State in India. Rao TP, Krishnamurthy P, Vijayakumaran P, Mishra RK, Samy MS. Indian J Lepr. 2003 Jan-Mar;75(1):9-15.

3. Pace of leprosy elimination and support teams in Bihar state, India. Vijayakumaran P, Rao TP, Krishnamurthy P. Lepr Rev. 1999 Dec;70(4):452-8.

4. Utilizing primary health care workers for case detection. Vijayakumaran P, Reddy NB, Krishnamurthy P, Ramanujam R. Indian J Lepr. 1998 Apr-Jun;70(2):203-10.

Be aware of the word 'cured' in LL cases

Leprosy Mailing List, August 27th, 2009

Ref.: Be aware of the word 'cured' in LL cases.
From: Browne D., Brockenhurst, Hampshire , UK

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Dear Salvatore,

Grace Warren's contribution (LML 20th August, 2009) was a brave reflection on the actual 'current' leprosy problem now and possible future explosion of reactivated cases worldwide.

My father the late Dr Stanley Browne (Mr Leprosy) often told me to be aware of the word 'cured' in LL cases, ' you never know what's going to happen to the bacilli lurking dormant in the dartos muscles waiting for the right conditions to reactivate'

Thank you Grace for your contribution.

Derek Browne