Fw: Ref.: (LML) Dr Noordeen and Leprosy elimination strategy

 

Leprosy Mailing List – August 25,  2021

 

Ref.:  (LML) Dr Noordeen and Leprosy elimination strategy

From:  Sunil Deepak, Schio, Italy

 

Dear Pieter,

 

I am saddened by the news of passing away of Dr Noordeen. As Dr Narsimha has written he was a visionary and was passionately involved in pursuing the global goal of leprosy elimination envisaged in the year1990. As part of ILEP medical/technical commission for more than a decade and later as ILEP president, I had interacted with him many times and had many passionate discussions with him regarding the elimination strategy.

 

Over the past couple of weeks, some of us have written about the impacts of the leprosy elimination goal, especially about the negative impacts. While remembering Dr Noordeen, I think that it will also be useful for our discussions, to also think of the other side of this story - the positive impacts of the elimination strategy. The following are 3 things which come to my mind -

 

(1) Greater responsibility of the Governments in the leprosy programmes: Till early 1990s, with a few exceptions, the leprosy related activities were fragmented in geographically limited areas and were under NGOs and Christian missions, while the national programmes were mostly on paper and governments played a limited role. After the elimination strategy, gradually governments took more responsibility, even if a lot of funding was still coming from NGOs.

 

(2) Better data about leprosy: During the 1980s, university of Louvain in Belgium was collecting global leprosy data with support from ILEP but it was patchy and limited. Availability and quality of data about new cases of leprosy changed completely within a few years after the launching of the elimination strategy. Some of the epidemiological analysis which we take for granted today, would have been impossible till early 1990s.

 

(3) MDT implementation received a huge boost: During the leprosy meeting in Brazzaville in 1990, 8 years after WHO had been recommending MDT, the number of people being treated with MDT were very low - in many countries, less than 10% of the new cases. Even in the AIFO/Italy projects, which I was coordinating, they were less than 15%.

 

I remember a lot of discussions from that period with doctors working in the AIFO supported leprosy programmes and with other ILEP associations - almost all of them had big doubts about starting MDT. Most felt that they had to directly supervise the monthly dose and many of them preferred to admit patients for the whole duration of the treatment. In terms of attention given to it, the public health dimension of leprosy control was a poor cousin of clinical aspects of leprosy diagnosis and treatment.

 

Within a few years after the elimination strategy, MDT implementation had increased exponentially. In some countries like India and to a certain level, in Brazil, reaching 100% MDT implementation had taken much longer. For example, in India, the northern part of the country had few NGOs and government services were poor, and we used to think that there the leprosy incidence was very low. Starting leprosy services and treating everyone with MDT was an enormous effort. The push from elimination strategy had found hundreds of thousands of undetected new cases in states like UP and Bihar and by 1998-99, all were being treated with MDT. The kind of effort that had gone into it is difficult to imagine today.

 

Over a period of about two decades, at least a few million persons were diagnosed early and treated with MDT, most of whom would have otherwise waited for years for diagnosis and developed disabilities. This was the biggest achievement of the elimination strategy. 

 

Warm regards,

 

Dr Sunil Deepak

Schio (VI), Italy

 

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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