Md. Sazedul Islam :
The left leg of Dipika Ghosh (not real name), a leprosy patient of Kushtia town, is being disabled due to her delayed treatment. The poor housewife initially could not understand when leprosy signs developed in her body. When the symptoms turned unusual, she visited local doctors, who failed to identity her disease. As her problem increased, she went to a leprosy hospital in Nilphamari where she was diagnosed as a leprosy case. Doctors at the hospital said, delay in taking proper treatment worsened her condition and predicted that she might face disability.
Like her, many leprosy victims turned disabled due to lack of timely and proper treatment. Necessary steps need to be taken for eradicating leprosy, which is still our health problem.
According to The Leprosy Mission International-Bangladesh (TLMI-B), integrated health services, if fully introduced in our country, can reduce the burden of leprosy. The services include five key areas such as raising community awareness on leprosy, detecting new leprosy case, adequate supply of multi-drug therapy (MDT), ensuring leprosy complication management, and rehabilitation support.
According to National Leprosy Elimination Programme (NLEP), there were 26,479 people from 1985 to 2015 in the country with deformity caused by the disease. Some 203423 people were diagnosed as leprosy cases in the country during the period.
The data indicated that over 10% affected people were disabled due to the disease a year.
We need to ensure that all persons affected by leprosy have an equal opportunity to be diagnosed and treated by competent health workers, without unnecessary delays and at an affordable cost. To achieve this goal, the major thrust of our efforts must focus on integrating leprosy into the general health services. Health workers at all levels must be taught the simple methods required to diagnose and manage leprosy. This will improve access to leprosy services and reduce the stigma and discrimination faced by persons affected by the disease.
World Health Organization (WHO) Global Strategy for further reducing the leprosy burden focuses on reducing the disease burden further in all endemic communities.
We need to ensure that sustainable activities are carried out and quality services provided within an integrated set up that includes an effective referral network to manage leprosy-related complications effectively. The overall goal of WHO’s strategy is to provide access to quality leprosy services for all affected communities following the principles of equity and social justice.
Six basic principles for successful integration are advocated by WHO: Every health facility in an endemic area should provide MDT services on all working days; at least one trained staff member should be available in every health facility; adequate amounts of MDT drugs should be available, free of cost, for patients; Information, Education and Communication (IEC) materials should be available for the patient and their family members; a simple treatment register should be available; referral services should be available and accessible, and general health staff should know where and how to refer patients.
Effective leprosy control requires an integrated approach, which provides wider equity and accessibility, improved cost-effectiveness and long term sustainability. This implies that leprosy control activities should be implemented by the general health services, including integrated referral facilities. Integration not only improves accessibility to treatment, but also reduces the stigma and discrimination faced by persons affected by leprosy.
Integration means that day-to-day patient management, recording and reporting become the responsibility of general health staff. However, integration does not mean that specialist expertise disappears from the health service. On the contrary, this expertise must be available within the general health service at the central and intermediate levels for planning and evaluation, provision of training, technical supervision, advice, referral services (including those at hospitals) and research.
A system should be in place for the referral of difficult or complicated cases to the hospitals or specialists (e.g., general medical officers with some additional training in leprosy, dermatologists or surgeons) and referral by specialists back to the peripheral health facilities for continuation of treatment. The specialized referral services for leprosy are part of the general health services, just like a surgeon in a district hospital is part of the general health services.
Centres treating the difficult complications of leprosy and providing rehabilitative surgical services will be even more centralized, but could also provide some referral services through mobile units.
Rehabilitation may include a medical component (such as reconstructive surgery) but its scope is much broader. It is likely that some people affected by leprosy would benefit from socio-economic rehabilitation (for example, vocational training or a small loan). Staff in the health services need to be familiar with what is being done in the locality, and know how and where to refer people who need these services.
Integration has become the major strategic component of the WHO leprosy elimination strategy. The need for integration has been recognized in virtually all leprosy endemic countries and increasing number of countries has embarked on the integration.
In Bangladesh, we need to do more for introducing the integrated services. There will be more voluntary case reporting of leprosy if we can create community awareness. The community should be informed about symptoms of leprosy and the availability of services. The government has health employees and other facilities, if these can be used properly, there will be more awareness and detection of new leprosy cases, said concerned sources.
Leprosy is curable with timely and regular treatment. Test and treatment of leprosy are available for free in the country. But lack of timely treatment causes disability. Hence, the issue of awareness aimed at detecting leprosy case and bringing the patients under treatment is very important.
According to sources, some parts of our country have not required supply of MDT, a combination drugs used for treatment of leprosy. The supply should be ensured in the interest of leprosy eradication.
Regarding complication management, it can be said that we have only three leprosy hospitals but those are not fully equipped to deal with the issue. A section of people turned disabled due to leprosy. On the other hand, reaction may occur due to intake of drugs by a patient. We need specialized services such as ulcer care and reconstructive surgery to deal with the problems. Complete specialized health services for leprosy should be available in the country.
Jiptha Boiragee, programme support coordinator of TLMI-B, observed that the government has manpower and facilities. It would be very helpful in introducing the integrated services in the country if these can be utilized properly. “If the government takes necessary steps to introduce integrated health services at least in the country’s all the medical college hospitals, it would help reduce leprosy burden. It would be better if the services are made available at district level general hospital”.
Rights activists, working in the field, said that our country would be free from leprosy if steps are taken in line with the integrated health services.
The left leg of Dipika Ghosh (not real name), a leprosy patient of Kushtia town, is being disabled due to her delayed treatment. The poor housewife initially could not understand when leprosy signs developed in her body. When the symptoms turned unusual, she visited local doctors, who failed to identity her disease. As her problem increased, she went to a leprosy hospital in Nilphamari where she was diagnosed as a leprosy case. Doctors at the hospital said, delay in taking proper treatment worsened her condition and predicted that she might face disability.
Like her, many leprosy victims turned disabled due to lack of timely and proper treatment. Necessary steps need to be taken for eradicating leprosy, which is still our health problem.
According to The Leprosy Mission International-Bangladesh (TLMI-B), integrated health services, if fully introduced in our country, can reduce the burden of leprosy. The services include five key areas such as raising community awareness on leprosy, detecting new leprosy case, adequate supply of multi-drug therapy (MDT), ensuring leprosy complication management, and rehabilitation support.
According to National Leprosy Elimination Programme (NLEP), there were 26,479 people from 1985 to 2015 in the country with deformity caused by the disease. Some 203423 people were diagnosed as leprosy cases in the country during the period.
The data indicated that over 10% affected people were disabled due to the disease a year.
We need to ensure that all persons affected by leprosy have an equal opportunity to be diagnosed and treated by competent health workers, without unnecessary delays and at an affordable cost. To achieve this goal, the major thrust of our efforts must focus on integrating leprosy into the general health services. Health workers at all levels must be taught the simple methods required to diagnose and manage leprosy. This will improve access to leprosy services and reduce the stigma and discrimination faced by persons affected by the disease.
World Health Organization (WHO) Global Strategy for further reducing the leprosy burden focuses on reducing the disease burden further in all endemic communities.
We need to ensure that sustainable activities are carried out and quality services provided within an integrated set up that includes an effective referral network to manage leprosy-related complications effectively. The overall goal of WHO’s strategy is to provide access to quality leprosy services for all affected communities following the principles of equity and social justice.
Six basic principles for successful integration are advocated by WHO: Every health facility in an endemic area should provide MDT services on all working days; at least one trained staff member should be available in every health facility; adequate amounts of MDT drugs should be available, free of cost, for patients; Information, Education and Communication (IEC) materials should be available for the patient and their family members; a simple treatment register should be available; referral services should be available and accessible, and general health staff should know where and how to refer patients.
Effective leprosy control requires an integrated approach, which provides wider equity and accessibility, improved cost-effectiveness and long term sustainability. This implies that leprosy control activities should be implemented by the general health services, including integrated referral facilities. Integration not only improves accessibility to treatment, but also reduces the stigma and discrimination faced by persons affected by leprosy.
Integration means that day-to-day patient management, recording and reporting become the responsibility of general health staff. However, integration does not mean that specialist expertise disappears from the health service. On the contrary, this expertise must be available within the general health service at the central and intermediate levels for planning and evaluation, provision of training, technical supervision, advice, referral services (including those at hospitals) and research.
A system should be in place for the referral of difficult or complicated cases to the hospitals or specialists (e.g., general medical officers with some additional training in leprosy, dermatologists or surgeons) and referral by specialists back to the peripheral health facilities for continuation of treatment. The specialized referral services for leprosy are part of the general health services, just like a surgeon in a district hospital is part of the general health services.
Centres treating the difficult complications of leprosy and providing rehabilitative surgical services will be even more centralized, but could also provide some referral services through mobile units.
Rehabilitation may include a medical component (such as reconstructive surgery) but its scope is much broader. It is likely that some people affected by leprosy would benefit from socio-economic rehabilitation (for example, vocational training or a small loan). Staff in the health services need to be familiar with what is being done in the locality, and know how and where to refer people who need these services.
Integration has become the major strategic component of the WHO leprosy elimination strategy. The need for integration has been recognized in virtually all leprosy endemic countries and increasing number of countries has embarked on the integration.
In Bangladesh, we need to do more for introducing the integrated services. There will be more voluntary case reporting of leprosy if we can create community awareness. The community should be informed about symptoms of leprosy and the availability of services. The government has health employees and other facilities, if these can be used properly, there will be more awareness and detection of new leprosy cases, said concerned sources.
Leprosy is curable with timely and regular treatment. Test and treatment of leprosy are available for free in the country. But lack of timely treatment causes disability. Hence, the issue of awareness aimed at detecting leprosy case and bringing the patients under treatment is very important.
According to sources, some parts of our country have not required supply of MDT, a combination drugs used for treatment of leprosy. The supply should be ensured in the interest of leprosy eradication.
Regarding complication management, it can be said that we have only three leprosy hospitals but those are not fully equipped to deal with the issue. A section of people turned disabled due to leprosy. On the other hand, reaction may occur due to intake of drugs by a patient. We need specialized services such as ulcer care and reconstructive surgery to deal with the problems. Complete specialized health services for leprosy should be available in the country.
Jiptha Boiragee, programme support coordinator of TLMI-B, observed that the government has manpower and facilities. It would be very helpful in introducing the integrated services in the country if these can be utilized properly. “If the government takes necessary steps to introduce integrated health services at least in the country’s all the medical college hospitals, it would help reduce leprosy burden. It would be better if the services are made available at district level general hospital”.
Rights activists, working in the field, said that our country would be free from leprosy if steps are taken in line with the integrated health services.
(The author, a journalist, can be reached at [email protected])
