Leprosy Mailing List – June 19, 2015
Ref.: (LML) What every Indian should know about leprosy
From: Joel Almeida, Kochaikanal, India
Dear Pieter,
I am very grateful for the thoughtful comments from Profs. Rao, Warren and Darlong on my writing (LML, June 9, 2015).
Cost per DALY averted is probably the relevant figure when deciding whether any intervention merits investment. Viewed through that lens, regular expert monitoring of nerves during the first 2 years after the start of MDT - and prompt anti-inflammatory treatment when required - is probably among the most cost-effective interventions available in the health sector. It helps avert decades of disability in an important proportion of each cohort of patients who start MDT. Not only does this investment offer financial savings by averting decades of disability in persons so protected, and economic benefits from the earnings of these persons, but also a lot of human suffering is averted. That is the advantage of investing in the health sector, instead of competing sectors (e.g., armaments etc.).
Prof. Rao is completely right in characterising this investment as very, very useful. Now the leprosy fraternity has only to put such a case convincingly to the world. Most other causes of morbidity and mortality have their advocates, and populations at risk of leprosy deserve equally powerful and informed advocacy. Then we can avoid a virtual "bonfire" of human nerves among patients during the 2 years after starting MDT. That is an avoidable tragedy - occurring despite MDT - which should trouble, if not outrage, the conscience of mankind.
WHO NTD's second report (2013) once and for all defined elimination as the "reduction to zero of the incidence of infection caused by a specific pathogen in a defined geographical area as a result of deliberate efforts". So now we know what elimination is. This ushers in a new era. Everyone interested in leprosy can now pull together towards meaningful intermediate goals en route to eventual elimination. Intermediate goals can include a world free from new disabilities of leprosy, plus better care and more opportunities for people formerly discriminated against on grounds of leprosy. Elimination needn't automatically mean elimination of leprosy services. Instead we can ask what is required (whether through leprosy-specific or general or disability-related services) to achieve the most important and immediate goals, formulate plans that demonstrably work, build reasoned budgets from those plans, and launch advocacy sufficiently vigorous to raise the required resources.
People and populations affected by other diseases benefit from sound decision-making, augmented by strong advocacy. That approach works. People and populations affected by leprosy too deserve a fair chance. It can be done. It is cheaper and better to do it.
Regards,
Joel Almeida
Note: I have a request to esteemed Indian colleagues among LML participants:
If you can help translate a short document about leprosy from English into Hindi or a regional Indian language, over the next few days, please contact me directly.
( almeidafam @ aol.com : remove spaces)
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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