Leprosy Mailing List – October 9, 2024
Ref.: (LML) Our new doctors have no clue about leprosy': experts skeptical of India's target to eliminate the disease by 2027
From: Santoshdev Rathod, Ahmedabad, India
Note editor: the article called "Our new doctors have no clue about leprosy': experts skeptical of India's target to eliminate the disease by 2027'" was an article published in the Guardian, UK. (LML, October 1, 2024). https://www.theguardian.com/global-development/2024/sep/30/leprosy-hansens-disease-campaign-elimination-india-doctors-sceptical-target-political-resources?CMP=Share_iOSApp_Other
The experts quoted in this article were experts from India itself, and named by name in this article. Claudio Salgado wrote about how to solve the problem of "new doctors not having a clue about leprosy" related to the situation in Brazil and not a comment on the article as such or the situation in India. Be careful not to mix up the original Guardian article and the LML letter of Claudio Salgado about Mato Grosso, Brazil (LML, October 3, 2024).
Dear Pieter,
I would like to comment upon the above 'Viewpoint' by Claudio Salgado on 'Our new doctors have no clue about leprosy': experts skeptical of India's target to eliminate the disease by 2027'.
To understand this first we need to understand the altered narrative that has been brought out by the above article.
Firstly, article starts with a story of 60-year old who shares her experience when she was teen (probably some 45 years ago—> Meaning about the times of 1980.. the time when even WHO MDT was not introduced globally. So, her eventual development of disabilities are completely understandable. Secondly, the story portrays leprosy as a 'dreaded disease' leading to disintegration of bones and muscles… while it is true when the disease remains untreated and unaided.. Such is not the fate of all leprosy affected person in current times. Such fearful portrayal of the disease aids to 'Stigma' which we all are fighting against. So, though it may be a true story of 'Tanu bai' but here even 'Tanu bai' is not aware how her version is to be misconstructed and misunderstood.
Secondly, We ask governments to show 'Political Will'.. and when a national government shows a 'Political Will'.. We raise questions that it has not to do with us but it is for their 'Political Mileage'.. Isn't this a very contrasting opinion. The work going on in India, on changing of the age old leprosy laws is really commendable. Last week only, a district tuberculosis officer, who has to do duty also as a leprosy officer came to our medical college hospital OPD and checked the leprosy register. He was concerned and asked us to note down exact addresses so they can access their place and do a contact survey and give post exposure prophylaxis. These things are happening on ground.
On the shelved vaccination drive, Let me comment that with available knowledge we say firmly that in the 90% of population exposed to leprosy it self-heals and only less than 10% would go on to develop the disease. So, the question will arise 'whom' and 'how many' would you vaccinate in a country with 1.4 Billion people. It is we expert leprologists have to first realise and accept its efficacy and offer it to susceptible contacts on 'a case to case basis'. Now, no one has put any restrictions on us about not to use it. It is DCGI approved and hence can be used where deemed appropriate.
Then, a dermatologist of 'RML hospital' puts out a verdict that we will not be able to achieve the said target because he sees '30 patients a week of leprosy' in a tertiary care hospital in Delhi. Well, it is time now that we ourselves mature and show to 'APAL' about the real goals and targets than disease elimination and eradication. Achieving maximum recovery, not having functional limitation is as good as 'Cure' and eradication for the affected person and we need to aim for that not some country level statistics. First, we have to think as a clinician and then as an 'epidemiologist'.
lastly, I would congratulate you on the methods you have devised to train 'new hanseniologist' but let me also 'Re-assure' you that in Indian Medical education a 'post graduate degree in dermatology; is actually degree in 'Dermatology, Venereology and Leprosy (DVL)' and in the 'PG curriculum' it is a core competency and basic one needed to pass the degree exam. And there are 1268 post graduates dermatology seats in India. Hence, Every year about 1200 dermatologists with training in Leprosy diagnosis and treatment are added to the society.
So, there appears lots of 'Selection bias' in writing the article and also they reached a conclusion without waiting for the 'results' of the efforts being available. Hope this alleviates your pain and anxiety on how medical doctors are being trained in india to fight leprosy.
Regards,
Dr. Santoshdev Rathod
Professor, 'Dermatology, Venereology and Leprosy (DVL)'
Hon. Secretary, 'The indian Association of Leprologists
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Dr. Santoshdev Rathod
Deputy Medical Superintendent, SCL General Hospital,
Professor of dermatology, Smt. NHL Municipal Medical College, Ahmedabad.
Hon. Secretary, IAL
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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