Kathmandu's new government seems committed to the cause of moving beyond the milestone of leprosy elimination.
NEPAL (DECEMBER 3-7)
My trip to Nepal at the end of the year left me with feelings of guarded optimism that it will now come to grips with eliminating leprosy as a public health problem. Nepal is one of the three countries yet to pass this interim goal. It has been through some difficult times in recent years, but the new government seems to be taking things in hand.
During my trip, I met with Minister of Health and Population Dr. Girirajmani Pokharel, one of the few members of the previous Cabinet to have retained his job. The minister told me that "in the new republic, there should be no place for leprosy," and gave his commitment to seeing Nepal achieve elimination in 2009.
His words were echoed by Prime Minister Pushpa Kamal Dahal (Prachanda), with whom I had an audience later the same day. Prachanda told me, "We are trying to build a new Nepal, and we want to build a Nepal without leprosy."
One of the health minister's most positive steps was to appoint Dr. Garib Das Thakur as chief of the Leprosy Control Division of the Department of Health Services. This appointment took effect just two weeks before my arrival. Under Dr. Thakur, the program will be both field-oriented and action-oriented, and I believe he will make an important contribution to the leprosy control program.
With Prime Minister Prachanda in Kathmandu
The WHO's representative in Nepal, Dr. Alexander Andjaparidze, is working closely with Dr. Thakur and also expressed confidence that the elimination program is getting back on track. He told me that special teams had been formed to conduct a three-month trial in three districts where the leprosy prevalence rate is high. If these trials prove successful, then this approach will be extended to other districts.
Leprosy prevalence rates stand at less than 1 per 10,000 in 49 of Nepal's 75 districts. In the remaining 26 districts, it is higher than 3 per 10,000 in just 3. By region, the PR is above 1 in all five of Nepal's official regions. Two regions, however - the Eastern Development Region (EDR) and the Central Development Region - yield 63% of the nation's new cases. More than 80% are from the low-lying Terai belt bordering India.
"The prime minister told me, 'We are trying to build a new Nepal... without leprosy.'"
For this reason, visiting districts in the Terai belt was the main purpose of my trip to Nepal this time.
Volunteer health workers at Mangalbari PHC
On December 3, I flew to Jhapa District for a briefing by the district public health officer. Next, I attended the opening ceremony of a women's empowerment workshop organized by IDEA Nepal. Some 25 women affected by leprosy took part in the event, the sixth of its kind run by IDEA Nepal. In the afternoon, I called at a leprosy clinic located within a Primary Health Center (PHC) in Gauriganj.
The following morning, I visited Mangalbari PHC, in Morang District. This health center currently has 28 patients under treatment for leprosy. I was able to meet some of them, along with some 50 female volunteer health workers serving the local community.
Following that, I was briefed by the Morang District public health officer, and attended street theatre designed to raise leprosy awareness. The specially arranged performance took place in the forecourt of a hospital that included a regional leprosy clinic - my next stop.
A courtesy call on Lalgadh Leprosy Services Center
Street theater in Dhanusha District
At the hospital, I was given an overview of the situation by EDR Regional Director of Health Dr. Naresh Pratap K.C. Apparently, quite a few patients come from India, and this was borne out when I met a woman from neighboring Bihar who had brought her 10-year-old daughter to Nepal for treatment. However, I understand that while the health authorities treat patients from India, they do not include them in Nepal's case register.
After flying back to Kathmandu, I returned the next day to the Terai, this time to Dhanusha District. The first event on my itinerary was another performance of street theatre. I have seen many such performances in my time, but this was one of the best. Two or three hundred people encircled the actors, who skillfully played out a tale of diagnosis, rejection, understanding and acceptance. I believe activities such as these are a highly effective way of reaching people with information about the disease, and judging from the enthusiastic reaction of the onlookers, they will not soon forget the message that leprosy is a curable disease.
After a brief stop at Dhalkebar Health Post, I proceeded to Lalgadh Leprosy Services Center, built and run by the Nepal Leprosy Trust. Time constraints kept my visit short, but it was enough for me to form a very favorable impression of a well-run facility staffed by a dedicated and caring team.
The center is situated in neat, campus - like surroundings, and is composed of several different buildings. It has 52 beds and serves as a referral hospital for the surrounding four districts, handling leprosy reaction and other difficult cases. In addition to providing medical services, it also trains government health workers and volunteers, supports self - care groups and conducts awareness campaigns among the general population. Indeed, the Center was responsible for organizing the street drama that I so enjoyed earlier in the day.
During this trip to Nepal, I was very impressed by a suggestion that the WHO's Dr. Andjaparidze made to the health minister for breaking down stigma. He suggested that patients who have been cured of leprosy should receive a 'treatment completed' certificate bearing the minister's signature. I thought this was an excellent idea, and I will be interested to see what comes of it.
We have come a long way, and are at a stage of final effort to eliminate leprosy from Nepal. Let me take this opportunity to thank the thousands of dedicated health and community-level workers for their contribution. In Health and Population Minister Sri Girirajmani Pokharel, Nepal has a committed leader to achieve this goal, and the goal is within our reach.
- Dr. Alexander Anjaparidze, WHO Representative in Nepal (excerpted from his 2009 World Leprosy Day Message)