Leprosy
mailing list – December 28th, 2005
Ccn:
all.
From: G Warren, Sidney, Australia.
Dear Salvatore,
Congratulations
to Dr Ganapati from Mumbai on the paper on Urban Leprosy Control (Ganapati R LML
–December 6th, 2005).
The 5
case histories that he gives are typical of my experience with WHO
consultants. They will
not accept patients as leprosy patients who do not fit in with a very
restrictive form of diagnosis by clinical signs. I have had several patients
turned down with typical lunar palsy because there is no definite
skin lesion. As for turning a patient down after he has had the
deformity successfully treated because he does not then (after
treatment) show all the signs the WHO wants. Can’t they
recognize when a case is well treated and accept that it was leprosy!
One,
to me, typical diffuse lepromatous leprosy (Common in the Chinese
patients but not so commonly reported in Indians, but I have
seen it, I wonder how often it does occur!) in whom we found skin
smears of 5 plus on the ear lobes (which did not look bad) was
declared as “non leprosy” because there was no obvious skin
lesion. The fact was
that the whole patient was one big skin lesion, which could have been
proven if we had had the facilities of biopsy which were not available
in that area. But we had a reliable skin smear technician
who did marvelous work and we certainly could rely on his skin smear
results.
In
quite a number of situations I have had to take and stain the smear
myself (fortunately I learnt to do it in the 1960s) in order to
be sure of the diagnosis; as WHO does not encourage this as a
routine and there are getting fewer and fewer technicians who are
reliable, and even less being trained.
There are very few Western countries where skin smears can be
relied upon. The
technicians can do TB bacilli smears – but leprosy? I assume they
try to do them the same way as the TB ones!
There
in nothing quite like a well done series of smears to show the
progress towards healing in severe LL patients. Please do not stop training
technicians in Leprosy Skin Smears.
I know that in the programs completely funded by WHO
agents it may be “illegal” to do a smear as Dr Ganapati reports. Fortunately some programs
stand on their own feet or on other charities and can do what is
best for all the patients, not just those who fit into WHO categories.
I have seen many teenagers in S E Asia with primary persistent
neuritic leprosy who have presented with an ulnar palsy to be turned
away. If left untreated
in a year or two they will have multiple palsies that will not be
reversible.
I am
afraid that the WHO Mindset on Elimination has done as much
against the whole program of containing leprosy as for it. Is there any way we workers
can combat this “head in the sand attitude”. We need to keep up the “go
and look for cases” attitude unless we want the disease to
suddenly increase in 5-10 years time!
Keep
up the good work,
Grace Warren
