The letter of Dr Pannikar

Leprosy Mailing List – December 11^th, 2010

Ref.:   The letter of Dr Pannikar

From: Porichha D., Bhubaneswar, Orissa, India

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Dear Noto,

The letter regarding drug sensitivity testing (DST) for surveillance and loss of expertise by Dr V Pannikar (LML Dec. 5^th, 2010), an eminent contributor to the programme is timely.  While appreciating for this reminder, I would like to float the following stray thoughts.

1.                     

Some articles expressing concern about retaining of expertise and drying of fund for leprosy work appeared in leading journals.  In the integrated system for expertise there is need to look at the districts hospitals and medical colleges as per recent WHO guidelines.  This needs strengthening the chain of referral systems.  In certain state as Orissa, India, there is a district nucleus medical officer to facilitate services to the cases referred from the periphery.  An apex team consisting of orthopaedic surgeon and an ophthalmologist in addition to a dermatologist attends to higher order services.

2.

Other sources of expertise are Associations of Leprologists (this has membership from all age groups).  It is hoped that some of the endemic countries as Brazil are also having similar professional bodies.  Their members, though some time critical about the WHO strategy, have assisted the programme whenever they are asked for.  These bodies have members from other specialties, leprosy needs in addition to dermatologists.  No other disease probably has such rich expertise.  I feel, if leprosy is to be viewed as any other disease,  programme  need to be content with the support of these groups.

3.

Regarding resources, any country where leprosy control is a national programme, it has its separate budget.  There is also some provision in the state budget.  There should not be problem to divert fund to organize a surveillance unit at the state level as priority.  DST can be undertaken in pioneer leprosy institutes, as already done in India.  Side by side, trend in new cases detection and its relation other indicators need to be analyzed to know the impact of 30 years MDT.  Alternatively leprosy should be integrated in Integrated Disease Surveillance Programme.

4.

The ILEP and other International Agencies patronizing leprosy in terms of expertise and resources are still with us to support if the needs as surveillance are prioritized.

5.

Finally research has to be integrated in related departments in teaching and other pioneer institutions.

Yours Sincerely,

D Porichha

Medical Coordinator, LEPRA Society, Bhubaneswar