Leprosy Mailing List – June 9, 2015
Ref.: (LML) What every Indian should know about leprosy
From: Joel Almeida, Kochaikanal, India
Dear Pieter,
I would be glad to have some feedback from LML on the note below, before its general release.
What every Indian should know about leprosy
1. A new leprosy case is diagnosed every few minutes, in India. This is a great achievement by India’s health care system, since it allows treatment to be started before disability sets in. This contributes to WHO’s new goal for leprosy: to detect all cases before disability sets in, and provide everyone affected by leprosy with a high standard of treatment and care.
2. The Indian Law Commission has recently prepared a draft law titled “Eliminating Discrimination Against Persons Affected by Leprosy (EDPAL) Bill, 2015”. This draft law promotes equal protection before law and social inclusion for persons and families affected by leprosy.
3. Leprosy is a curable disease caused by a germ. No socio-economic class in India is exempt from leprosy. Most people who are infected with the germ will show no signs of disease, because they are naturally immune to leprosy. Others may show skin patches, or show a mild thickening of skin, numbness of hands or feet, or even suffer visible deformities before they are diagnosed.
4. Experience from various countries suggests that alleviation of poverty, probably aided by BCG vaccination and anti-microbial treatment, can stop the transmission of leprosy. The alleviation of extreme poverty – in rural areas and urban slums - benefits not only the poorest Indians but also everyone in India.
5. Infectious leprosy cases are currently found some years after they first become infectious. This is because active case finding was suppressed since 2005, and skin smear services were dismantled. The delay in finding cases has exposed Indians to serious disabilities before diagnosis, while encouraging transmission of the germ to others. Active case finding and skin smear services cost very little compared to the costs of caring for permanent disability.
6. If you think you might have skin patches which cannot feel the tip of a ball-point pen, or your earlobes seem thickened, or your hands and feet repeatedly suffer painless wounds, you should approach your nearest government health centre. They should be able to arrange for free diagnosis, and – if necessary – free MDT treatment.
7. MDT treatment kills leprosy germs rapidly. Life can continue as normal during treatment, you will be able to live at home and continue with your normal routine. You will just have to take some medicines once a day, for no more than a year. Within days of starting MDT, even the most infectious types of leprosy become non-infectious.
8. Untreated leprosy can damage nerves. Sometimes, as explained below, nerve damage can occur despite MDT. The nerve damage of leprosy can deprive you of pain sensation on your skin and eyes. As a result, repeated injuries can gradually erode your fingers, toes, feet and eyes. It is much better to get diagnosed and treated promptly, before any nerve damage.
9. A person with residual deformities from treated leprosy is just like you in every way, except that their nerves were once invaded by a germ. That germ has long since been killed by treatment. Now you can show them the same respect and affection which you show to others. It might easily have been you. Reconstructive surgery, rehabilitation and support are provided for by the Indian leprosy programme and partners.
10. MDT is necessary but not sufficient to prevent nerve damage in treated patients. Many thousands of Indians each year suffer serious but avoidable nerve damage during the first 2 years after starting MDT. This is because of the body’s own inflammatory responses to killed leprosy germs. Sometimes this inflammation is “silent”: even the patient remains unaware of it until serious nerve damage has occurred.
11. Monthly monitoring of nerves, and prompt anti-inflammatory treatment when required, are necessary to prevent the nerve damage which can occur despite MDT. The cost of this monitoring is much lower than the cost of coping with permanent nerve damage.
12. Every Indian citizen could usefully write to their local MP, MLA, panchayat member and councillor, expressing support for the Indian leprosy programme but urging better protection of citizens against the nerve damage of leprosy: by monthly monitoring of nerves during the first 2 years after starting MDT, and prompt anti-inflammatory treatment when required.
Regards,
Joel G Almeida, PhD, MBBS
AlmeidaFam@aol.com
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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