Leprosy Mailing List – February 22, 2014
Ref.: (LML) Hazards of setting targets to eliminate disease: lessons from the leprosy elimination campaign
From: Krishnan Vijay, Hyderabad, India
Dear Dr. Schreuder,
More and more people started recognising the fact that something went wrong in leprosy work. In all endemic countries, the ‘elimination’ achievement did huge losses to humanity by breaking down the attack on leprosy – and not leprosy itself. The “political commitment” happening in global conferences as described by Dr Denis Daumerie, does not have any flavour of or impact on the grassroots realities. People in remote villages and those living in difficult terrains and even those in poor urban slums are never equipped to report voluntarily at general health centres with cardinal signs of leprosy – which is the reason why the new cases detected around ‘elimination years’ fell dramatically. Leprosy work included committed grassroots level activities covering information education, rehabilitation and case detection and treatment – all of which were stopped untimely – imagining that “leprosy is eliminated’.
Surely elimination declaration made an impression among decision makers and the general public that the “prevalence rate” and other figures around leprosy, represented actual situation – grossly underestimating the reality. In the year 2013 (from 1st April 2012 to 31st March 2013) 13,387 children were reported as new cases in India. 4,650 of them were reported with Grade II disability. It does not mean that only this much children were the existing child cases – so many of them would get detected with further delay in later years. Is it not a tragedy that with so much concern on “scientific evidences” and possession of all knowledge and know-how, children of our modern era are at risk of leprosy disability? Or is it because we do not value human lives when they are poor?
It is unfortunate that we still bother about clean registers and over-diagnosis rather than ensuring timely diagnosis and treatment.
The evidence from Malawi study of 2012 (http://www.biomedcentral.com/1472-698X/12/12) suggests the folly of elimination in a country which “achieved” elimination as early as 1994. Indonesia, after ‘achieving’ elimination in 2000, stands another testimony with increasing number of child cases and disabilities. India instead of learning from others’ experiences is waiting for our own.
If we didn’t have this twisted explanation of the word ‘elimination’ in 1981, perhaps we would have been much more practical.
Regards,
Vijay
Fontilles India
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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