Leprosy Mailing List – January 25, 2016
Ref.: Fighting leprosy in countries in war
From: Federica Dassoni, South Sudan
Dear Pieter,
If leprosy is difficult to
eliminate in countries like India or Brazil, the challenges are still much more
in countries at war.
I'm coming from an experience
in Western Equatoria, South Sudan, where I was following the leprosy outreach
project, supported by GLRA and Comboni missionaries. The project was already
active for many years before I arrived.
- The first problem we encounter was the continuing
decreasing funds for leprosy.
- Secondly, the MDT blisters provided by the
government (from WHO) were sometimes sent very late from the capital because of
the insecurity, leaving gaps of 2 or 3 months or more; during that time, we
could provide just vitamins to the patients waiting for their therapy. All this
when the compliance of patients was already low.
- Another challenge is that we noticed low interest
for leprosy among some of the peripheral health workers (but not all of them);
sometimes they were not present on the appointment day, sometimes they didn't
wait for us to tell the next appointment, when it was lunch time – they just
disappeared.
- Some patients were careful and always taking the
tablets, some not. Patient tracing was almost impossible.
- Another problem were the conditions of the roads
and climate. Travelling to the villages on unpaved roads with lots of huge
holes, dust or mud depending on the season, sleeping out in tents in remote
areas with terrible hot climate, only few tukuls around, taking water from the
boreholes, was hard. I must congratulate our leprosy team for their efforts.
Examination of the patients in those conditions was really difficult.
- More than this, health workers were often not
trained to recognize leprosy. We once met a man with very classic lepromatous
leprosy in a village, who was treated for years as syphilis and filariasis and
then arrived to us very late. Another woman with a very advanced lepromatous
leprosy and plantar ulcers (no dressing on them) was just staying at her
village since years without any therapy; we met her by chance when we decided
to go to a new village just to give information. All people with skin diseases
were called at the time. A nurse from our staff understood her disease from
far.
- It was not easy to find young people who were
interested to follow the leprosy outreach, but the very few ones were well
trained and I must say they were good in diagnosis and physical examination.
They were trained in Uganda, sponsored by the GLRA and Comboni missionaries.
The reason that encouraged me
to write today is that to date the situation is getting worse. The insecurity
of the roads is now very high because of fighting (shooting) and robberies, so
that it's not safe for our medical staff to travel to the villages. People
don't move any more. The leprosy outreach program, which was already full of
challenges, had to be discontinued for some time now. This is very sad, in my
opinion. Many more people are dying of life - threatening diseases as malaria,
malnutrition, HIV just because they cannot reach the hospital. But also leprosy
patients cannot be cured. Leprosy is still far from being eradicated in
countries at war.
Best regards,
Federica
LML - S Deepak, B Naafs, S
Noto and P Schreuder
Contact: Dr Pieter Schreuder << editorlml@gmail.com
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