Zambia's former national leprosy center has living reminders of its past role.
|Dr. Jombo Namushi|
Quiet-spoken Dr. Jombo Namushi, 32 , is the medical officer at Liteta Hospital in Chibombo District, about 80 kilometers north of the Zambian capital, Lusaka. The hospital was founded in 1959 as a national tuberculosis center for then-Northern Rhodesia. Four years later, it became the national leprosy hospital and training center, functioning in this capacity until 1993, when it was converted into a district hospital under nationwide health reforms.
The hospital sees an average of two to four new cases of leprosy a year, according to Dr. Namushi. As of the beginning of July, there were seven patients receiving multidrug therapy on an outpatient basis. In addition, there are 13 people affected by leprosy living in the nearby "invalid compound." A further 22 affected persons live in the surrounding villages.
Up until 1993, anyone in Zambia diagnosed with leprosy was sent to Liteta for treatment. Since then, it has been health ministry policy to treat new cases close to their homes to make treatment more accessible and to reduce the stigma attached to the disease. Because the name Liteta remains associated with leprosy, however, some patients still come from other parts of the country to be cured.
"The health reforms had a positive impact. Patients can now be treated anywhere."
"The health reforms had a positive impact," said Dr. Namushi. "Patients can now receive treatment anywhere. Centralized treatment is what led to the social dislocation of the people you find here." He cites the example of Minison Shamwata, 73, who had to leave behind his family in Southern Province when he came for treatment in 1971 and remains in the invalid compound 38 years later.
Dr. Namushi says that although discrimination still exists, it is nowhere near the level it was at in the past. The integration of leprosy services into the general health services has made a difference, and the public has a better understanding of the disease. "A lot of people today understand that leprosy is a treatable disease and not something you get just from a handshake," he says. For its part, Liteta Hospital places any leprosy-related inpatients together with other patients.
That said, Dr. Namushi admits that he still encounters negative comments from time to time. "People say, 'Oh, you come from Liteta. I hope you won't infect us.' While most don't really mean it, a few probably do," he says. Ignorance is part of the reason, as well as biblical representations of leprosy as an unclean disease. "Zambia is a Christian nation. People read the Bible. In biblical times, a person with leprosy would be abandoned in the bush or the mountains," he says.
Lack of Resources
In its dealings with leprosy today, most of the challenges the hospital faces are resourcebased and relate primarily to the presence of people affected by leprosy living in the invalid compound. Dr. Namushi lists a few of the issues. Water-related infrastructure is inadequate and water must be rationed, making it harder for those with wounds to practice self-care. There is a lack of shoe-making equipment to provide those living in the compound with appropriate footwear, which ideally should be made on site to their specifications. Laundry equipment is old and not functioning. Toilets are some distance from the compound, and the walk there can exacerbate injuries, particularly at night, because there is no electrification. Keeping the toilet area clean is yet another challenge. The residents have taken this task upon themselves, in spite of their disabilities, because the hospital can't afford to pay for a cleaner.
"Developing countries encounter a lot of problems," Dr. Namushi says. "You just try to make do with what you have to sustain the services."
On a positive note, the local community now has a police post. "The police told us that if we wanted a police post, then we would have to provide them with accommodation. As the only houses available were in the invalid compound, in the beginning they didn't like the idea," recalls Dr. Namushi. "Eventually, though, they came to accept it." Now several policemen and various other workers live in the compound among people affected by leprosy . and in this way a few more bricks in the wall of discrimination have been removed.
Among communicable diseases, leprosy is a leading cause of permanent physical disability. Timely diagnosis and treatment of cases, before nerve damage has occurred, is the most effective way of preventing disabilities due to leprosy. The disease and its associated deformities are responsible for social stigma and discrimination against patients and their families in many societies. (From the WHO's Enhanced Global Strategy for Further Reducing the Disease Burden due to Leprosy)