Pilot project in the Philippines shows the important role schoolchildren can play.
The Philippine Leprosy Mission is running a threeyear pilot project called PILA to identify approaches for screening, detecting and diagnosing skin diseases, including leprosy. Dra. Ma. Gemma C. Cabanos, PLM's executive director, explains how it works.
What is PILA and why was it started?
PLM-Initiated Leprosy Activities, or PILA, was one of the Philippine Leprosy Mission's initial responses to the WHO's global strategy for 2006-2010. It is designed to implement strategies that have proven effective in improving the coverage of immunization and nutrition programs in the Philippines.
How does the project work?
The PILA project works in partnership with two institutions that are basic to every community: schools and health care units. Elementary and high school students campaign for skin health and prescreen their respective household members, using an observation guide and reporting sheets. School authorities collect the data and submit it to health authorities. These reports are supplemented by the skin survey or preliminary screening for skin problems undertaken by barangay* health workers among households with no elementary or high schoolchildren, and also among institutions. People found to have skin lesions are then advised to visit the local government unit-run rural health unit or health center, where schedules of screening for common skin diseases by trained medical officers have been pre-arranged. This is when suspect or clinically-diagnosed leprosy lesions can be identified and confirmed.
Where is PILA being carried out?
In Ilocos Norte, in the northern tip of the country, where relatively high case-detection and prevalence rates are reported. Currently, eight cities and municipalities are implementing PILA, and projects will be implemented in four more municipalities in Ilocos Norte this year. The goal is to cover all 23 municipalities and use the lessons learnt to motivate other provinces to apply the strategies.
Are you pleased with the results to date?
Using dermatology as the entry point for finding all kinds of skin problems is a very effective way of finding hidden cases of leprosy. The communtiy develops a heightened awareness of skin problems, which increases voluntary reporting. Community members are now regularly seeking consultation at rural health units, even on days that were not scheduled for PILA activities.
What lessons does the PILA project have for other countries?
The control of leprosy is not the sole responsibility of health ministries or departments. The public and private sector must participate in increasing the awareness of skin health and services. The PILA project has also demonstrated that schoolchildren and volunteer health workers are effective in prescreening of household members and community members with skin problems.
What is the level of awareness of leprosy in the Philippines today?
Awareness is low and a great majority of the population is misinformed about the disease. IEC for leprosy needs to be stepped up to educate the people in order to improve their attitudes and behavior toward persons affected by leprosy. People who are ignorant of the disease generally avoid persons with leprosy, especially those with deformities, for fear that they will get the disease themselves. This is also observed among health workers because many lack the knowledge and skills to recognize the signs and symptoms and manage the disease and its complications.
School for skincare: boy with observation guide (left), hands-on instruction (right)
INTERVIEWEE: Dra. Ma. Gemma C. Cabanos
Dra. Ma. Gemma C. Cabanos is executive director of the Philippine Leprosy Mission.
* The smallest political unit into which cities and municipalities in the Philippines are divided.