Stigma over leprosy still high; awareness key to its control

Rezaul Karim :
Sagor Hossain, 21, a resident of Sabujbagh in Dhaka city, studied upto class VII. He was diagnosed as a case of leprosy 15 days after his marriage. After some treatment, he got reaction. His wife divorced him because
of his illness.
Sagor later was cured after taking regular treatment from a health centre run by The Leprosy Mission International-Bangladesh (TLMI-B). He now works at a garment
factory in Dhaka city.
The boy’s story is not an isolated one. There are many lepers who were victims of the stigma, which is hampering leprosy
control programme in our country.
Leprosy can affect people in many ways, not just physically. In some countries, largely due to myths and superstitions, there is a great deal of fear associated with leprosy – people diagnosed with the disease are stigmatised, rejected by their families and communities. They may be at risk of losing their jobs and end up without a home or
source of income.
In olden days, the scenario was very dreadful characterized by utter neglect and stigmatisation against people affected
by leprosy.
The disease has been around since ancient times, often surrounded by terrifying, negative stigmas and tales of leprosy patients being shunned as outcasts.
For centuries, attempts have been made to contain leprosy through isolation of patients by various methods. Experience showed that isolation produced more problems
than it solved.
“In our country, we still see the inhuman condition that leprosy affected persons have to live in. They are made to live their lives as burdens and they are marginalised and segregated from the community. Society and its outdated attitude devastate their lives
altogether,” said Damien Foundation, Bangladesh, one of the nine NGOs working for controlling the disease.
TLMI-B said, “Though leprosy is an ancient disease, for long time there was no effective remedy for it. This lack of treatment and the resultant deformities/disabilities due to leprosy have created scope to grow misconception, prejudices and stigma around leprosy. This deeply rooted social ostracism is still persisting even today when tremendous improvement has occurred regarding scientific knowledge about leprosy. This ostracism leading patients to hide their early lesions and thereby delaying treatment with resultant more risk for development of deformities/disabilities and acting as a reservoir of infection for more periods.”
We should aware people about the utter neglect, abuse of human lives perpetrated by some people towards the affected ones and appeal to them to speak up for the
protection of their human rights.
Leprosy is a disease like other diseases. It is a chronic infectious disease caused by
a bacterium called Mycobacterium leprae. This bacterium was discovered by Dr Armuer Hansen of Norway in 1873. If left untreated, it can cause progressive and
permanent damage to the skin, muscles, nerves, eyes and limbs, said doctors.
This disease is not due to misdeeds committed in the present life or a previous incarnation. Nor is it due to witchcraft, evil spirits, curses or punishment by God, hot food or a hot climate. These beliefs and prejudices associated with leprosy are totally wrong.
It is unfortunately not unusual for sufferers, including children, to be rejected and forced to leave their home, school job and village. This is unreasonable since well over 90 per cent of all cases are completely suitable for out-patient treatment throughout the course of their disease and infectivity declines fast to virtually zero soon after multi-drug therapy (MDT) is started.
Dr Aung Kya Jai Maug, Medical Specialist of Damien Foundation, Bangladesh, said that it is not a hereditary disease and cannot be caught by touch. Anyone may be affected, provided he or she has contact with a person suffering from untreated, especially
multi-bacillary leprosy.  
Leprosy is not an easily communicable disease and more than 90 per cent of the persons have natural resistance
(immunity) to the disease.
Leprosy is actually not that contagious. You can catch it only if you come into close and repeated contact with nose and mouth droplets from someone with untreated
leprosy. Children are more likely to
get leprosy than adults.
Once a person becomes infected with the bacteria Mycobacterium leprae, they immediately begin to multiply within the body. Since they grow slowly, it can take three to five years for symptoms to appear once
a person catches leprosy.
People with poor immunity are susceptible to the disease. Poverty, malnutrition and unhygienic living condition are reasons
of infection.  
The majority of leprosy cases can now be cured with six months’ regular treatment with MDT. Persons with multi-bacillary leprosy, however, need at least two years’ MDT.
Early detection is very important. If non-itching, pale or reddish patches with loss
of feeling and dry surface or smooth shiny
reddish patches, nodules or tumours on the skin persist for more than a month,
a qualified doctor or leprosy specialist should be consulted without delay.  
The best way to prevent leprosy is to reduce the sources of infection by early and adequate treatment of persons suffering from leprosy with MDT, said TLMI-B.  
The isolation of leprosy cases is not
necessary; even persons suffering from the infectious type of leprosy (multi-bacillary leprosy) can be made non-infectious quickly within a few days or weeks by MDT.
According to World Health Organisation (WHO), isolation of leprosy patients has never been considered as a useful public measure. Isolation before, during and after treatment has no relevance in the modern treatment of leprosy and may in fact work against current efforts to eliminate
the disease. Dr Allen S Baroi, Medical Officer of TLMI-B, said that if leprosy is not diagnosed early and well treated, the resultant disabilities, social stigma and economic implications add to the gravity of the problem.
“The disease is curable with modern scientific treatment, which is available for free in the country. There should not be any place for social discrimination suffering from
leprosy. Any form of discrimination against people affected by leprosy is a crime,” said TLMI-B.
According to National Leprosy Control Programme, some 188,585 new leprosy
cases were identified from 1985 till 2009 in the country. Of them, 180,343 were
cured after taking MDT treatment.
Dr Baroi said that they still see patients coming at quite an advanced stage of disease and the main reason is they fear rejection
by the society if they are known
to have the disease.
As stigma is still high over leprosy creating a social problem, awareness raising activities should be carried out at all level to dispel the stigma. Education with scientific knowledge and media campaign can correct false beliefs and raise awareness. Involvement of
community groups, stakeholders and professional organisations is essential for successful implementation of leprosy control activities. Coordination between the
government and NGOs in this regard
is also imperative.
We should spread the message that-leprosy is not a curse. It is curable and free treatment is available in the country.
We should educate all on leprosy to
promote early case detection and to accept full course of treatment. This would be the most effective method to increase awareness in the community and reduce social stigma. Mass media can play an important role
in raising the awareness.
Persons affected by leprosy, and their
family members should be treated as people with dignity, and be entitled to all the rights enshrined in the Universal
Declaration of Human Rights.
World Health Organization (WHO) said, “36,772 leprosy cases were detected in the last seven years from 2006 till 2013 in Bangladesh. Of them, 3141 were
detected in 2013.”According to TLMI-B, there are about 34,000 to 35,000 people in the country with deformity caused by leprosy at the moment. It said leprosy remains as a health hazard in Bangladesh due to inadequate health services in many areas, lack of awareness among people and non-detection of leprosy cases in remote areas. n