Loss of clinical expertise in leprosy in Africa

Leprosy Mailing List – December 18^th, 2010

Ref.:   Loss of clinical expertise in leprosy in Africa.

From: Noto S., Genoa, Italy

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Dear Dr Pannikar,

Thank you very much for your important contribution to the LML dated Dec. 5^th, 2010.  I would like adding my comment on your second issue, the one about the “the rapid loss of expertise in leprosy at all levels”.  Particularly I refer to the African Region and to the loss in clinical expertise only.

In the last years there has been loss of clinical expertise in leprosy.  The situation is complex.  On one side there still are good leprosy doctors in Africa and I regularly meet excellent leprologists there; on the other side the service offered to the patient is getting poorer.  The matter has evolved in such a way that even when good leprologists are involved in leprosy control activities their clinical knowledge is frustrated. 

Leprosy control activities are mostly oriented to the delivery of multi-drug therapy (MDT) but, MDT is only part of the correct patient’s management.  Actually the most important aspect of the job is the patient, not the delivery of MDT.  That is why clinical expertise is “cardinal”.   

There is lack of clinical leprosy teaching at different levels: - peripheral health clinic, leprosy programme, medical and paramedical schools.  Herewith I briefly comment about the first two levels only.

Clinical expertise is based on “bedside teaching”, i.e. where the patient is, at the health clinic.  Here all three involved actors have to be present together, namely: - patient, local health staff and leprosy control staff.  They all learn and teach from and to each other.  I underline that local and leprosy staff learn from the patient.  The correct evolving of this process ensures creation and improvement of clinical expertise and higher quality of the service delivered.

Unfortunately in the last years I have seen that leprosy staff do not assess patients and, local staff do it by themselves when the leprosy staff is not present.  The consequences are that they loose opportunity for improvement in clinical knowledge and the quality of the service decreases.

Best regards,

S. Noto