Dr Mohammad Didare Alam Muhsin :
World Leprosy Day has been celebrated on the last Sunday of January every year since 1953 to raise public awareness about leprosy. The disease is one of the oldest one recorded in human history. Today, thanks to modern science, we are well aware of the causes and symptoms of leprosy and progression of the disease. We also have its effective treatment under our control. The milestone in the course of this trajectory was the groundbreaking discovery by the Norwegian scientist Gerhard Hansen in 1873. The scientist proved through his research that leprosy is actually a microbial disease caused by a slow-growing bacterium known to us today as Mycobacterium leprae. Since then, the disease has also become known as Hansen’s disease.
The causative organism Mycobacterium leprae spreads from the patient in the atmosphere as droplets during coughing and sneezing. If a genetically predisposed, immunologically compromised person stays in close contact with such a patient for a long time and repeatedly inhales contaminated droplets released from the patient when coughing or sneezing, he may be infected. The immunity of the person concerned is very important here. In fact, 95% of adults do not get infected even after exposure due to their strong immunity. There is almost no possibility of spreading this disease through touch. This is because the germ of this disease cannot penetrate the intact skin. Symptoms of the disease usually appear in the body 3 to 5 years after the germs enter the body. In some cases it can take up to 15 to 20 years for symptoms to appear. The disease mainly affects the peripheral nerves, skin, eyes and the mucous membranes of the upper respiratory tract. There may be light and dark patches/ nodules on the skin and subsequent sores, reduced or lost sensation in the affected parts, tingling and weakness in the hands and feet and swelling in the face and earlobes. If left untreated, the disease later can cause progressive and permanent sequelae, including deformities and mutilations, reduced limb mobility and even blindness.
In Bangladesh strong public/private campaigns to eradicate leprosy are in place. The World Health Organization (WHO) target of reducing the number of leprosy cases to 1 per 10,000 has already been achieved in 1998. The Prime Minister called upon all to work towards building a leprosy free Bangladesh by 2030. With this goal in mind, in recent years, the National Leprosy Program has been in action to implement the National Leprosy Strategy formulated in the light of the World Health Organization’s Global Leprosy Strategy (2016-2020). In the country we have three specialized public hospitals for the treatment of leprosy. Moreover, according to an article published in a national daily, leprosy treatment is available in all levels of other government hospitals starting from Upazila Health Complexs to District Sadar and Medical College Hospitals. These hospitals also have provisions for bacteriological diagnosis, skin biopsy, nerve biopsy and other immunological tests. Various non-governmental voluntary organizations including The Leprosy Mission International Bangladesh (TLMI-B) are also treating leprosy patients through hospitals and clinics. In addition, medicines used to treat leprosy (MTD) are provided free of charge with funding from the World Health Organization (WHO).
The question that becomes important here is, having a look at the annual statistics of new cases, doesn’t it seem like that we’ve been stagnant at one point for the last ten years even after all these endeavours? Keep in mind, we are in the top five in the world in terms of the number of new cases identified. Therefore, if we want to build a leprosy free country, we need to pay special attention to this point. The spread of the disease must be stopped; the road to the creation of new patients must be closed. How is that possible? It has been found that within a few days of starting multi-drug therapy, the patient loses the ability to spread the disease. Also, if a leper is brought under treatment in the early stages of the disease, he can recover completely, without any risk of disability. Therefore, what we need is to undertake a crash program to quickly identify potential leprosy patients in the leprosy-prone areas of the country in the very early stage of the disease and bring them under treatment. For this, massive mass training and publicity activities have to be undertaken to make the people aware about the symptoms of leprosy. Platforms like schools and colleges, mosques and madrasahs and socio-political organizations in the area can also be engaged to this end. In addition to the actual doctors in the area, people like the village doctors and drug dealers, who have a large crowd of financially indigent rural people, can also be brought under the training in this kind of leprosy identification project. This will create opportunities for advising a person with signs of leprosy to consult immediately a specialist doctor, health center or hospital. The country’s print and electronic media can also take special initiatives to create public awareness. After all, since it is basically a public health problem, good results can be expected if public health professionals could be actively engaged in the overall planning and implementation.
(Dr Muhsin is Professor of Pharmacy, Jahangirnagar University).
