Leprosy Mailing List – July 24, 2018
Ref.: (LML) Manifest against the implementation of U-MDT
From: Arry Pongtiku, Papua, Indonesia
Dear Pieter,
I would like to join in LML discussion about Manifestation against the implementation of U-MD. I would like to refer to the letter from P Narasimha Rao, LML on 13 July 2018; Diana Lockwood and Steve Walker LML on July 6,2018, as well as Jaison Barreto on 7 July 2018.
The letter from Narasimha Rao, about new guideline MDT, 3 drugs for 6 months PB with 6 months duration, I would like to say for practical reasons and limited availability of PB drugs, we have already practiced three drugs (MB blister) for PB patients for 6 months for many years in Papua and West Papua Indonesia. It works OK. The reasons: it is sometimes difficult to take clofazimine out from MB blister to give to those PB patients where we have low level health workers. We have very many remote areas. Also it does not look very professional to give the partly damaged blister to PB patients. Clofazimine itself is liquid with soft capsule and is easily broken.
How can we achieve leprosy elimination in provinces and districts in Indonesia? It may take a long time. Many times we faced none availability or insufficient supply of MDT. Few times we wanted to buy MDT with our budget, but it is not available in the market. The world must ensure MDT coverage.
I agree with point 9 from Diana Lockwood and Steve Walker about MDT toxicity. With high of incidence of DDS allergy in Papua, we always dream to have different and safe drugs for leprosy. Field workers in Papua and West Papua have many experiences and successes in treating DDS allergy, however some patients died. We also consider anaemia because of DDS (haemolytic anaemia in some patients). Leprosy as a chronic disease and malaria are commonly coincidence to make it worse for anaemia. We also want to hear about alternative treatment. ROM (Rifampicin, Ofloxacin, Minocycline), is mentioned as alternative. However, O and M are hardly to be found in Indonesia.
The letter from Jaison Barreto on 7 July 2018 mentioned cohort study in state of Mato Grosso from 1800 patients relapses clinically and histo-pathologically confirmed. Average time of relapses were 5.9 years for PB and 7.25 years for MB patients. There was mentioned Rifampicin regiment kill almost all alive M.leprae and the phenomenon of lag phase (dormant) for long time. We saw recently patients in Papua with relapse after 3-5 years and after 10 years. I consider it to be reinfection rather than dormant, but is this true?
Therefore, in practice we have to exam all people at home and neighbours to make sure there will be no more source of infection? I agree to expand chemoprophylaxis to make sure there will be no more sources of infection. From our experience in making a blanked chemoprophylaxis for the tribal Mumugu ,isolated area, in Asmat Papua (350 population, half of the population with leprosy). We treated them with MDT for those who have clinical leprosy and single chemoprophylaxis with Rifampicin for those without symptoms. May be next year (after 4 years) will be followed up by National Biomedic Research in Papua.
I also learned from the field, some leprosy patients with schizophrenia on the street, we treated them with head of MB blister (Double Rifampicin, DDS, lamprene), due to his/her disease, we could not expect them to finish all treatment and we just continued the rest of blister as possible, the results were good. We hope 3 drugs could be as treatment and as chemoprophylaxis to cut transmission.
Leprosy trend remains stable in Indonesia and especially in my place Papua. Again, MDT coverage, chemoprophylaxis, BCG, door to door, leprosy in curriculum, health awareness, economic improvement all combined go to create the world free of leprosy as is our dream.
Thank you,
salam,
Arry Pongtiku
Former National Leprosy Advisor in Papua and Papua Barat, Indonesia.
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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