Leprosy
Mailing List – October 3rd, 2007
Ref.:
Management of leprosy reactions in low endemic areas
From: Ganapati
R., Mumbai, India
Dear Dr Noto,
My apologies to your readers
and to Dr P Vijayakumaran for my belated response to the latter’s
LML-September 3rd, 2007 on management of reactions in low endemic
areas.
I appreciate Dr
Vijayakumaran’s understanding of the epidemiology of clinical
complications in rural areas. What
I do not appreciate is the fact that he believes that the solution
rests (1) in the hands of the dwindling clan of “experts” and (2)
in the role of the Leprosy Mailing List (LML), which he expects to
provide information as a “primer in leprosy” to teach the basics
to all those not conversant with the elementary management of leprosy
in an “integrated” set-up.
As regards LML, Dr
Vijayakumaran may be correct. I
am open to correction. Perhaps
Dr Salvatore Noto may explain the exact objects of LMLs. I am under the impression that
LMLs have been proving to be an excellent medium to promote dialogue
among experts on challenging clinical and public health problems. Recent exchanges on
controversial (and not so controversial) issues by stalwarts like
Grace Warren, Terence Ryan, Ben Naafs, van Brakel, Hugh Cross and
Pannikar etc might have been found stimulating particularly by those
who are already experienced in leprosy.
Of course some elementary knowledge dished out by Noto might
have been found useful also by those not so conversant with the
subject, who are subscribers to Noto.
However much Dr Vijayakumaran may desire, the “Doctor in a
rural clinic” is not likely to be the one to have access to Noto.
As regards the incidence of
reactions in rural areas, Dr Vijayakumaran’s calculation may be
applicable to Projects where international NGOs have been efficiently
working, engaging knowledgeable doctors and field workers to assist
the national programmes. Not
so in areas without such assistance.
Recently in a rural population of 149,000 adopted by us we were
astonished to realize that the prevalence rate (PR) of visible
disabilities (grade 2) alone was about 19.1 per 10,000, where as the
PR of active leprosy (as reported by the government) was well below
one per 10,000. These are
villages where the “Survey, Education and Treatment Centres” and
“Leprosy Control Units”, fully manned by trained medical and
paramedical staff of the government were working under a “vertical
set-up”. These staff
who were administering MDT as a priority were made to believe that MDT
would take care of reactions and disabilities, most of such
complications occurring in patients while under MDT or after
completion of treatment. The
abnormal pool of deformities has arisen obviously from patients who
underwent reactions and neuritis (acute and silent) during the peak
period of MDT for more than two decades. A paper on this study is under
preparation.
Experienced leprologists,
scattered unevenly in a vast country like India who are becoming an
extinct species can hardly be expected to offer their clinical
expertise for problems arising in a varied manner of distribution due
to the cumulative neglect of such complications ever since MDT was
introduced in the country in 1982.
Nor can the Internet medium like the LML with its poor reach be
expected to offer a solution.
It is the duty of “public
heath planners” to prepare a pragmatic strategy based on commonsense
to face the gigantic challenge with deep implications of human rights.
With regards,
Dr R Ganapati
Director Emeritus, Bombay
Leprosy Project
