Leprosy
mailing list – March 11th, 2005
Ccn: all.
Ref.: leprosy
elimination – where do we stand?
From:
A Salafia
,
Bombay
,
India
.
Leprosy Elimination - Where do we stand?
Dear Salvatore,
The Government
of India has decided to take over the work of leprosy, doing away with
the various NGOs that have, so far, ensured a good leprosy control.
Was the Government too much in a hurry to take over? Many feel that
the Govt. should have let the NGOs finish the job that they have been
doing so well, and when elimination was finally achieved, then the
Govt. could take over to mop up the few sporadic cases which are bound
to prop up here and there for a few more years to come.
There are many
more questions which need answers.
In October 2004
Alert-India (a NGO actively engaged
in the leprosy
control) called for a meeting of various NGOs and representative of
the State Government as well as the central Govt. to discuss the
feasibility of “Integration of
Leprosy in
the GHC (general Health System, i.e. the Govt. system) system in
Cities and Towns”.
The questions
raised by two speakers are worth noting. The replies are mine.
Dr. B.K. Girdhar
from Jalma, Agra. Asked
many questions to which he replied in his inimitable style; some of
the answers are mine.
a) Have we reached
the stage of integration? Even States well organized, like Tamil Nadu,
have note been able to achieve the objective. And I say: frankly not.
b) How important
is leprosy to the States? The States have 20 different health programs
to deal with and leprosy is the Cinderella.
c) How willing are
the health officers to take up leprosy?
Honestly they are not willing at all!
d) Do
the health officers have sufficient expertise to take on the job?
Generally they ignore leprosy and they
are not willing to learn.
e) Do the patients
get personal attention in a Govt. clinic? Usually they are shunted from one place to
another: even the poorest of man will realize when he/she is not
welcome, consequently his/her treatment will be incomplete.
f)
In Tamil Nadu the integration of
leprosy in
the PHC was started in 1997. What is the experience of these
years, asks Dr. Girhar? “…Against 613 patients detected by
surveys in earlier 4 years, only 33 patients were diagnosed in
the 4 years following integration. Even
if adjustment is made for possible decreasing incidence, this clearly
reflects that a large number of patients remain undiagnosed and
therefore untreated….the higher deformity rate among the new
patients, diagnosed after integration, indicates delay in seeking
treatment…”
While Dr. G.P.
Dhillon, the Dy. Director General (Leprosy),
New Delhi
, depicted a rosy picture, he did make few blunders like “If at the
end of 12 months you feel that your patient needs treatment for
another year, you can give it to him, but please delete him from the
active registry.” And
another “Active survey in any form should be discouraged as the same
brings chances of wrong diagnosis (sic)”.
I told him that
when an experienced doctor feels that a particular patient needs more
than one year treatment he does so because he feels that the patient
is not cured, and if the patient is not cured, why should he/she be
deleted from the active registry? To have nice-looking statistics? He
had no answer to this.
Dr. Anil Kumar,
from Jalma,
Agra
, presented some interesting statistics; he argued that contrary to
Dr. Dhillon statement that in
Agra
the prevalence was 1-2 per ten thousand, a well-planned survey done by
his team has shown that the prevalence is actually 33 per 10 thousand.
Further he asked why the
Govt. was so much in a hurry to take over when it did not have the
expertise nor the will. And he quoted some Govt.-published statistics
which proved that about 40% of the Govt. Primary Health Centres had no
doctors; so what type of integration is this? Integration into what? A
non existing Primary Health System!
You realize
that I could go on and on.
Here in
Bombay
it is the Municipal Corporation that has taken over; but requested the
NOGs to carry on pocket-survey, because they do not have enough
personnel. They requested the NGOs to carry on Health Education and
finally requested us to be present when medicines are given – by
their doctors - to the patients. Our PMWs know more than the Govt.
Doctor about leprosy and its treatment, hence when one of our PMW
pointed out that a child had been given an adult blister packet, the
medical officer got offended and sent all the PMW away; the
consequence, he is alone, he is ignorant (and not ready to learn) and
the patients…?
In the past,
the Govt. used to hand us over the medicines, to be given free of
cost, which we did. At what price? Endless paper work, to abide by the
Fixed Duration Therapy (I am totally against and the reason where
published a few years ago in the Leprosy Review), to dance to their
erratic tune… We
finally decided to buy the medicines and treat the patients the way we
think they should; so we got rid of the Govt. and its policy and its
reports. We will keep the
statistics with us, if and when they want, we are ready to pass on to
them, but we do not have to abide by the whims and caprice of a Govt.
officer.
I stop at this.
Antonio
Senior
Leprologist Vimala Dermatological Centre,
Bombay
.
