Leprosy
mailing list – September 12th, 2005
Ccn: all.
From: W Hippke, Maputo,
Mozambique.
Dear Salvatore,
When Dr. Pannikar, a known
authority in leprosy, took over in Geneva, it was good news for
leprosy patients. And the
new 'Global Strategy
for Further Reducing the Leprosy Burden and Sustaining Leprosy Control
Activities - Plan period: 2006 – 2010' emphasizing care for the
patients is (finally) the way away from Case-finding and
Case-forgetting.
Nevertheless WHO continues to
talk about "Elimination" and leprosy being a "public
health problem" by an obscure definition based on caseload but
ignoring disabilities, the raison d'ętre of leprosy work. (If leprosy
would be just skin patch, it would be ignored like pityriasis
versicolor.)
And worse, we read in the
latest WHO statistics: "Efforts are
being made to ensure that these countries reach the elimination goal
at the national level as soon as possible." Leprosy has an extremely long
incubation period, cases we detect today, have been infected five (to
ten [or more]) years ago. So
the caseload reflects the infection epidemiology years ago.
Epidemiology in leprosy is a
very slow elephant. All
active case finding activities will increase the numbers and will work
against the "elimination" goal. The only way to "reach
the elimination goal at the national level as soon as possible" is not to detect the
patients. (Can I really believe the figures from India, reducing the
official detection by 55% in only three years?)
Patients come when they are
sick and they don't mind about statistics. They come when they need to do
so and when they trust in treatment facilities. (Why do have 18 million
Mozambicans less than 1.000 physicians but over 70,000 traditional
healers?) It is not that
we don't find the patients, the patients don't come to us.
No, friends in leprosy work,
let's finally stop with flash light actions. Only a constant programme with
a constantly good quality will build up trust and enable the patients
to come and to come early, the best POD action. Only a constant programme with
a constantly good quality will reduce, at the long term, the leprosy
burden and eradicate the disease – or do we still have autochthon
Leprosy or Malaria in Europe? It is the quality which makes the
winner, not the noise.
Kind regards,
Wolfgang Hippke
Mozambique
