Leprosy
Mailing List – December 3rd, 2006
Ref.: “How
valid are any of these figures?”
From: Ryan
T J., Al Wakeel Y., Oxford, UK
Dear
Salvatore,
I
have noted the question posed by several of your correspondents “How
valid are any of these figures?”
One
reason for writing to you is that reliable figures are very hard to
come by. May be it should
in itself be a field for study, and hopefully the following comments
will indicate why. It
must be a major concern that there are clearly large numbers of new
cases of leprosy that never become National statistics.
Dr
Yasir Al Wakeel and I have collected the following data in India. I would welcome opinion on
their accuracy because if true the answer to the question “How
accurate?” must be “Not at All!” The Government sector is not
attractive and it is likely in my view that a majority of persons
affected by leprosy will think twice and may well choose an
alternative.
Number
of public Hospitals
17,000
Number
of primary health centres
24,000
Percentage
adequately staffed
38%
(This
consequently is reflected in short consultations, in uncompassionate
and unwelcoming surroundings)
India
lies at 171st place out of 175 for health spending
0.2%
0f the population have health insurance.
24%
of villagers cannot afford health care.
I
agree with Dr Baniprasad and spoke about this at the 2006 Annual
meeting of the Association of Dermatology Venereology and Leprosy in
Hyderabad and found a high level of agreement about the following.
The
Dermatology Private Sector
The
Indian Association of Dermatology Venereology and Leprosy which
provides a full training, examination accreditation and CME in leprosy
has a Membership of 4000. There
are lesser qualified (diplomatists) Dermatologists in the order of
6000. My impression is
that the private sector is quite generous to the poor and skin camps
are commonly done with no charge.
The last one I attended picked up 4 new cases of leprosy and
did refer to he National programme but did not make sure that they
attended.
Leprosy
new cases detected annually per dermatologist very approximately are
24 to 240. The average
number of such cases referred to the National programme is unclear but
many are not referred and of those that are, an instruction to report
is usually done verbally to a bemused patient, and few are confirmed
as registered.
Indian
Systems of Medicine (Ayurveda, Siddha and Unani)
Ayurveda
is the most popular system of health.
There are over 600,000 practitioners that have had 6 years
training in up to 300 colleges or 26 universities. Almost 8000 students graduate
each year. Many take a further 2years course in postgraduate medicine
inclusive of Biomedicine. In
addition there are more than 6000 ayurvedic, 346 Siddha and 375 Unani
pharmacies.
The
skin signs of leprosy are of less interest to these practitioners than
the constitution of their clients.
Therapy for imbalances may alter immunosurveillance and be of
benefit to the control of leprosy.
Postgraduates will usually diagnose leprosy. Referral to the National
programme will usually be delayed or will not happen. The number of
new cases of leprosy seen each year is unknown but I would guess it is
large.
Non-governmental
organisations
The
society for participatory research in Asia states that there are 1.2
million NGOs in India. One
study of 12,265 NGOs found 91.5% in the social sector of which 52%
were for rural development. In
1991 there were 250 concerned with leprosy but recent figures for
“leprosy centres” records 700! Questioning several of these it is
clear that many new cases are never referred to the National Programme. Furthermore some well known
centres receive patients from far distances and refer them back to
their home district without having a system for confirming
registration. I have
noted that several NGOs purchase MDT “to avoid bureaucracy”.
Our
full report of our findings and our plea for integrated approaches can
be found on
<< http://www.leprosyhistory.org/englishbulletin/discussion.htm >>
<<
http://www.leprosyhistory.org/english/englishhome.htm
>>
Best
regards,
Terence
J Ryan and Yasir Al Wakeel
