Shifting of leprosy management to peripheral health staff

Leprosy Mailing List – January 3^rd, 2011

Ref.:   Shifting of leprosy management to peripheral health staff

From: Kar H K, New Delhi, India

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Dear all leprosy fraternity,

When merging of the vertical organised leprosy control programme with the general health services, there was a hue and cry among leprosy workers and a lot of apprehension regarding early detection of cases and their appropriate management.  But it does not so happen.  WHO has taken a wise decision motivating all endemic countries to do so at the appropriate time for shifting of leprosy management to peripheral health staff with assistance from higher centres for management of difficult cases and their complications.

I would like to complement Dr Noordeen and Dr Pannikar and the whole WHO team for the above decision.  We must go forward and improve our strategy and activities depending on the need of the hour rather than looking back and pretending to repent. We have a sizable population having leprosy clinically and potential number of subclinical infected population.  The new clinical cases will continue to come for few more years including child cases and with Grade 2 deformities.

  

There is no shortage of clinical teaching material and specialists in the field of leprosy. In India there are many registered dermatologists, ortho surgeons, plastic surgeons, pathologists, microbiologists, and eye surgeons etc.  Only motivation is lacking, so far as leprosy is concerned. It is the same situation in Brazil and Africa.

   

Teaching/training in leprosy, particularly at medical under graduate level should be given top priority. The Indian Association of Dermatologists, Venereologists and Leprologists are coming out with a dedicated under graduate level  text book in dermatology  giving special  importance to leprosy.  We are increasing the hours of teaching in leprosy (both theoretical and clinical/practical) for better understanding of the disease, so that they can diagnose the disease while working at primary health care (PHC) level or practising at peripheral level helping in private public partnership in management of leprosy cases.

The core strategy of the National Rural Health Mission (NRHM) of the Government of India includes decentralisation of villages and district level Rural Planning and Management and to appoint ASHA - trained community volunteers - for creation of awareness, to counsel women and for the mobilisation of community facilities for accessing health related services.  In the NRHM programme ASHA suspect/detect new cases and bringing them to PHC level for diagnosis and treatment with multi-drug therapy (MDT).  It is an assuring sign of future success.

   

No doubt, we have practical difficulties for detecting hidden cases in difficult areas, where innovative techniques can be introduced like skin camp approach, utilising ASHA forces for detection of cases and supplying accompanied MDT regimen for the whole course treatment with effective counselling.  We have to strengthening our Deformity Prevention and Medical Rehabilitation (DPMR) approach for disabilities prevention and management and IEC program.  Research in leprosy must not be neglected. The Indian Council of Medical Research (ICMR), particularly after Dr V M Katoch, an eminent leprologist took over as DG ICMR, recently is giving much more importance to leprosy research.  Other countries health authority should behave in same way including WHO till we could eradicate this disease from the globe.

We should be optimistic.  One day we will win the race in eradicating this disease from the globe with the present strategy with minor modification from time to time.

Dr (Prof) H K Kar
Consultant & HOD
Department of Dermatology, STD & Leprosy
P.G.I.M.E.R. and Dr Ram Manohar Lohia Hospital
Baba Kharag Singh Marg
New Delhi-110001