(LML) Burial customs of leprosy patients in past and present

 

Leprosy Mailing List – February 6,  2015

Ref.:   (LML) Burial customs of leprosy patients in past and present 

From:  Jingquan Wang, Wukang,Deqing Zhejiang,  China

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Dear Pieter,

Greetings from China.

I have read Professor Charlotte's tip of "Burial customs of leprosy patients in the past and present", published on Feb 4, 2015 in LML.

I provide some clues below:

I am a doctor working in a leprosy colony in Zhejiang, China. I have worked here for 12 years. In our colony, most of the ex-patients have to be buried here. Most of the relatives are reluctant to let the dead return to their home village and be buried near the family graveyard, even though they have gotten the news of the dead relatives. In the 90ties the government began to ask the people to adopt cremation. However, most of the public refuse to get cremation when they are dead. It is our colony that first implemented cremation; the first three cremations in our country happened in our colony. Now most of the dead people are first cremated and then buried in our colony cemetery. None of our dead people are buried in the public cemetery of our county.

In addition, I have supervised leprosy control work of Sichuan and Tibet regions of China. I have heard that the celestial or sky  burial is a funeral practice in which a human corpse is placed on a mountaintop to decompose while exposing to the elements or to be eaten by scavenging animals, especially birds of prey. Sky burial are the popular burial style in the Tibetan areas there, but leprosy affected people are forbidden to use celestial burial They have to use the inferior burial: inhumation or burial in the ground.

I wish my information will be of any help to Professor Charlotte's research.

Best regards

Jingquan Wang, Bachelor of Medicine
Chief Physician and Deputy Director
Inpatient Department

Institute of Dermatology of Zhejiang Province,
China,313200
No. 61,Wuyuan Street,Wukang,Deqing,313200，Zhejiang,China.

Academic Secretary of China Leprosy Association since 2010
Science Communication Expert of Leprology of China Association for Science and Technology  since 2013  

Phone:86-0572-8296002

Fax:86-0572-8061517

E-mail:Jingquanwang.cn@hotmail.com, wjingquan@126.com

 

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LML blog link: http://leprosymailinglist.blogspot.it/

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(LML) How Efficacious is MDT

Leprosy Mailing List – February 6,  2015

Ref.:    (LML) How Efficacious is MDT

From:  Jerry Joshua,Kolkota, India

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Dear Pieter,

I have been following the discussions on this topic.

It seems difficult from the clinician’s point of view and from the patient’s point of view to say whether MDT is effective. Public health practitioners are really convinced. Clinicians continue to have doubts. Patients are usually not convinced.

All patients of Leprosy are treated with MDT. In MDT, completion of MDT is considered a cure. That is, a completion of a task (an output) is equated with a goal accomplished.

Both the patient and the clinician are dissatisfied. They have no outcome indicators to show that the treatment (MDT) has been effective.  A patient with 3 patches ends MDT with the same three patches with no change in symptoms. Usually in any disease, management results in disappearance of symptoms or a change in symptoms. In leprosy, this is true if the patient develops reactions, and is managed with steroids, (most of the reaction symptoms recede and there is some degree of satisfaction, because the symptoms serve as indicators). But in other cases (many cases of leprosy where the course is completed without clinical Type 1 or type 2 reactions), the symptoms do not change during treatment and even at the completion of treatment. Therefore completion of a course of MDT is regarded as a cure.

This is not in keeping with the principles of management. Changes in values of Indicators have always been the means of assessing success of interventions and have served as milestones or the goal posts. Completion of the task of interventions is not accomplishment of a goal.

We can assume that MDT is the correct intervention and we accomplish a cure with it. But we have no indicators for this at the moment and the clinician and the patient end up being dissatisfied.

There is a suggestion to use mRNA PCR as an indicator before starting treatment and after completion of treatment. Maybe this will be the way to go to convince clinicians and patients in the future.

We take great pains in all leprosy programmes or in Integrated programmes to have a whole host of indicators (output indicators and outcome indicators) to evaluate the success or effectiveness of the management of leprosy programmes. But we do not pay much attention to indicators when it comes to managing the disease in the individuals. The only indicator we use is an output indicator (completion of MDT), because we do not bother to come up with an outcome indicator for MDT. Therefore none of us can actually prove whether MDT is effective or not. We just believe it is effective, looking at programme output and outcome indicators.

 

Regards

Jerry Joshua

Head : Health Programmes

The Leprosy Mission Trust India

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(LML) Issues for donation of International Journal of Leprosy and Other Mycobacterial Diseases

 

Leprosy Mailing List – February 5,  2015

Ref.:    (LML) Issues for donation of International Journal of Leprosy and Other Mycobacterial Diseases

From:  Richard I. Frankel, Hawai’i, USA

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Dear Dr. Schreuder:

 

I have the issues of International Journal of Leprosy and Other Mycobacterial Diseases from Volume 57 (1989) through Volume 73 (2005).  I will be happy to donate  these to a library, health care facility, or NGO, with preference to such an entity in a non-industrialized country.  If anyone is interested, they may contact me by email at rfrankel@hawaii.edu or by post at Richard Frankel, 931 Uwao Street, Honolulu, HI 96825-1062, U.S.

 

I will appreciate your distributing this to the LML if you feel it is appropriate.

 

Best regards.

 

Richard I. Frankel, M.D., M.P.H., F.A.C.P.

Emeritus Professor of Medicine

University of Hawai'i John A. Burns School of Medicine

 

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LML blog link: http://leprosymailinglist.blogspot.it/

Contact: Dr Pieter Schreuder << editorlml@gmail.com

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(LML) Burial customs of leprosy patients in past and present

Leprosy Mailing List – February 4,  2015

Ref.: (LML) Burial customs of leprosy patients in past and present  

From:  Charlotte Roberts,Durham, UK

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Dear Pieter,

 

 

 

I am just running this question I have by you, which I thought the people on the email list might be able to help with. 

 

I do not work in clinical leprosy (although I was a nurse once!) but I research on the history of disease (and focus on infectious diseases, as seen in archaeological skeletons). Leprosy is something I have studied for over 30 years!

 

My question is: 

 

Today, is there any evidence of people anywhere in the world, who have leprosy or had leprosy that was cured, being buried away from their community's burial ground when they die, or on the margins of it, or in some different way to the norm for the community (i.e. reflecting stigma, isolation, fear?). I know people's concepts of disease vary considerably globally and I wondered if that was reflected in how people with leprosy are treated in death today.

 

Can you or anybody on the list help answer this question, or can you point me in the direction of any literature on the subject?

 

Thanking you in anticipation

 

 

Charlotte

 

 

Professor Charlotte Roberts BA MA PhD SRN FSA FBA

MSc Palaeopathology Director

Deputy Editor of the Int. J. Paleopathology 2012-2015

President of the Paleopathology Association 2011-2013

Department of Archaeology

Durham University

South Road

Durham DH1 3LE

England

Tel: +441913341154

Fax: +441913341000

 

Webpage:

https://www.dur.ac.uk/archaeology/staff/?id=163

 

Books:

Author of: Health and Disease in Britain. From prehistory to the present day (2003), The Bioarchaeology of Tuberculosis (2003), The Archaeology of Disease (2010), Human Remains. A Handbook (2009), and editor of The Past and Present of Leprosy (2002) and The Global History of Paleopathology (2012)

 

Current research Projects:

Bamburgh Project: https://www.dur.ac.uk/archaeology/research/projects/?mode=project&id=278

Leprosy Project: https://www.dur.ac.uk/archaeology/research/projects/?mode=project&id=279

Biomolecular archaeology of Ancient Tuberculosis in Britain and Europe Project: https://www.dur.ac.uk/archaeology/research/projects/?mode=project&id=353

Palaeopopulation Genomics of Tuberculosis Project: https://www.dur.ac.uk/archaeology/research/projects/?mode=project&id=667

Invisible Dead Project: https://www.dur.ac.uk/archaeology/research/projects/?mode=project&id=624

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LML blog link: http://leprosymailinglist.blogspot.it/

Contact: Dr Pieter Schreuder << editorlml@gmail.com

 

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(LML) How Efficacious is MDT

 

Leprosy Mailing List – February 3,  2015

Ref.:    (LML) How Efficacious is MDT

From:  Maneesha Godbole, Karnataka, India

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Dear Pieter,

 

Have been following the discussions on MDT efficacy. It is true that a there are a lot of relapses, sometimes even after a decade or two of completing MDT.

 

It is suggested that close monitoring be done of treated cases to detect relapse at the earliest stage. Close monitoring will require the services of personnel well trained in leprosy and thus having a sharp eye to detect signs and symptoms at the earliest. However, the situation in the post elimination era in India is such that the leprosy services have become truncated. The funding for leprosy has come down, post integration the pool of expertise in leprosy has come down Laboratory services are rudimentary even at the district level. I think even slit skin smears are not being done routinely and even that expertise is getting lost. The priority for the disease on the whole has been pushed down. In such circumstances, is it going to be possible to monitor closely for relapses? The result will be that relapses will transmit disease to many contacts before they are identifies and treated again.

 

What can be done in such circumstances? Apart from continuous sensitisation of the medical people in the diagnosis of leprosy, the patients cured of leprosy should be well educated regarding recognition of relapse. It is not only enough to educated them, but frequent communication should be established with these people to re-educate them. Empowering them will help in their early reporting.

 

Regards,

 

Dr.Maneesha Godbole

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(LML) How Efficacious is MDT

 

Leprosy Mailing List – February 2,  2015

Ref.: (LML)  How Efficacious is MDT

From:  Joseph Kawuma, Kampala, Uganda

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Dear Pieter,

 

As usual, this is evolving into a very interesting and informative discussion.

 

I am concerned that several suggestions do not specify the type or level of settings for implementation. Today we are in a world where some lucky patients can access experienced clinicians with facilities like measuring anti-PGL1 antibodies and there are others where there are still hardly any easily accessible, functional basic health services to talk about. When recommendations are made, they should include those that are feasible in the less than ideal settings where (unfortunately) the majority of people receiving leprosy treatment (at least in Africa) are found. There are concerns about not only the completion of the relatively short MDT regimens but also the organisation of follow up after MDT as well as the diagnosis and management of relapses in those same settings. How shall we derive the answer to the question "how efficacious is MDT" in those settings?

 

 

H Joseph Kawuma

GLRA, Uganda

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(LML) How Efficacious is MDT

Leprosy Mailing List – February 2,  2015

Ref.:   (LML) How Efficacious is MDT

From:  P.K. Das, Birmingham, UK

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Dear Pieter,

 

Dr Grace Warren has spoken with full of Wisdom (LML, January 31, 2015). The bottom line of here email is that by following the WHO's regimental MDT treatment schedule, many RFT patients who are declared controlled or cured, most likely not.

Since it is now well recognised that several parameters like serum antibody titres of ant PGL-1, and some cytokines can serve as good biomarkers to monitor the patients for their prognosis in addition to clinical observation, we should adopt such approach before declaring the patients cured. Such approach is justifiable for LL, BL and BB patients.

Regards,

Pran

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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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