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WHO Goodwill Ambassador's Newsletter For The Elimination Of Leprosy

AMBASSADOR’S JOURNAL: A Week in Africa

Following a visit to Ghana, the Goodwill Ambassador heads to Mozambique to attend a partners' meeting in Maputo.

With IDEA Ghana's president, Kofi Nyarko
With IDEA Ghana's president, Kofi Nyarko

GHANA (March 8-10)

In March, I was invited to Ghana to speak at the Hideyo Noguchi Africa Prize Memorial Symposium, named after the late Japanese bacteriologist who died in Ghana in 1928 while researching a vaccine for yellow fever. During my brief stay, I took the opportunity to update myself on the leprosy situation there.

Ghana has a leprosy prevalence rate (PR) of 0.29 per 10,000 population. At the end of 2009, there were 636 registered cases of the disease, with 580 new cases discovered during the course of the year. Of Ghana's 10 administrative regions, the Upper West Region has the highest PR (1.19). In the country as a whole, there are 10 high-endemic districts with a PR of between 1.0 and 4.69.

Greeting residents of Ankaful Camp
Greeting residents of Ankaful Camp

On March 8, I travelled from the capital Accra to Ankaful, near the Cape Coast. I was accompanied by Kofi Nyarko, the energetic president of IDEA Ghana, part of the IDEA network of organizations of and for people affected by leprosy. Kofi, who teaches at a school for children with disabilities in Ankaful, is working tirelessly to bring about an end to stigma and discrimination in his country.

My first stop was Ankaful Hospital. The hospital was a focal point of the government's leprosy program until the second half of the 1980s, when the program was decentralized. Today it serves as a general hospital but still has wards marked "Hansen's disease." Next I visited nearby Ankaful Camp, which came into being when people with leprosy first started coming to the hospital for treatment. The camp is home to about 68 families, although not all are affected by leprosy. Of the few people who have jobs, most work at the hospital or at a rehabilitation center known as Ahotokurom, which was started by American Franciscans in the 1970s. According to Kofi, people living in Ankaful Camp today do not face discrimination from the wider community.

The next day, I travelled to the Volta Region to visit the Ho Polyclinic. The polyclinic started out as a leprosarium, founded by missionaries in 1926. About 100 people affected by leprosy, clinic staff and other well-wishers were on hand to greet me. I was told that there are a number of people affected by leprosy living close to the former leprosarium who have been unable to return to their families because of stigmatization. As was the case in Ankaful, few people have work and most are receiving food support from the Catholic Church. On a positive note, the government of Ghana has registered all persons affected by leprosy under the national health insurance scheme, so that they can access health care without payment for services received.

Scene from the partners' meeting in Maputo
Scene from the partners' meeting in Maputo

MOZAMBIQUE (March 11-12)

From Ghana I traveled via South Africa to Mozambique. This was my fifth visit to the country since 2005, when I began making regular visits in support of its leprosy elimination activities. Mozambique reached the WHO's elimination target of less than 1 case per 10,000 population at the national level in 2007. At the time, Health Minister Dr. Ivo Garrido said there would be no cause for celebration until this goal was reached at the state level too. This was duly achieved at the end of the following year.

After arriving in the capital, Maputo, I had meetings in the afternoon with Prime Minister Aires Ali, who assumed the post in January, and Vice President of the Assembly of the Republic Lucas Chomera. Accompanying me were Dr. El Hadi Benzerroug, the WHO's Mozambique representative, and Dr. Landry Bide of the WHO Regional Office for Africa. I congratulated the country's leaders on Mozambique's achievement of elimination and sought their cooperation in further reducing the number of cases of the disease. Later I met with former President Joaquin Chissano, whom I have known for many years through the Sasakawa Global 2000 Project to increase agricultural output.

On March 12 there was a partners' meeting at the Ministry of Health attended by representatives from six NGOs involved in leprosy work as well as ministry and WHO officials. From the NGO side were Dr. Charles Phaff, Netherlands Leprosy Relief; Ms. Genama Salvetti, AIFO; Dr. Jean Marie Nyambe, Damien Foundation; Mr. Candido Raphael, LEPRA UK; Mrs. Farida Gulamo, ADEMO; and Mr. Chamada Abibo, ALEMO - the latter having traveled from the very north of the country to attend.

Following the meeting, Health Minister Garrido gave a briefing on the current leprosy situation in the country in the presence of some 10 reporters from newspapers and TV. I learned that while leprosy has been eliminated as a public health problem in every state, the prevalence rate remains above 1 per 10,000 population in inland areas in a number of states. However, Mozambique is aiming to achieve elimination in every district while halving the number of patients in each district. Dr. Garrido said he would continue to lead these activities and carry on holding an annual meeting of all those concerned with leprosy work.

Concerning the situation in the north of the country, where there are still many cases, he said, "We cannot deal with leprosy simply as a problem of the poor. There must be a reason why certain areas have a high number of patients. We must analyze the situation and take appropriate steps."

In looking at Mozambique's achievement in eliminating leprosy as a public health problem, it is clear that political commitment has been most important. Soon after assuming his post, Health Minister Garrido indicated what must be done. He put the appropriate policies in place and, thanks to the determined efforts of the ministry, the WHO, and all the partners involved, achieved the desired result. I commend all who made this possible, despite limited manpower and funds, by dint of their persistent, patient work.

But the fight against leprosy is by no means over. As has been seen in other countries when elimination has been achieved and the number of leprosy cases declines, there is the very real fear that as leprosy comes to assume the status of a rare disease, medical workers become less aware of it, resulting in delayed diagnosis and treatment. Therefore, there must be no slackening off. Until the disease is completely eradicated, until the very last patient is treated and cured, appropriate diagnosis and treatment services must be sustained. To do this, the health services must continue to train health care workers to recognize and correctly diagnose leprosy.

Socio-economic inclusion is another key item that remains on the agenda.

The socio-economic inclusion of people affected by leprosy is another key item that remains on the agenda. In terms of discrimination against people affected by leprosy, Mozambique is no exception. In towns and cities especially, there are said to be many affected persons whose only recourse is to beg as they can't find jobs. Given Mozambique's economic situation, it is difficult to call for work for every affected person; but at the very least, people capable of working should not be denied the opportunity on the grounds that they once had leprosy.

Until the day comes when not just the disease but also the associated discrimination are eradicated and Mozambique is truly free of leprosy, the health ministry, the WHO and all NGOs involved must continue to work together closely. I intend to play my part and look forward to visiting Mozambique again in support of these efforts.

Leprosy FACT

Of 538 new cases reported in Ghana in 2009, 16 (2.7%) presented with Grade 2 disability, and 34 (6.07%) new cases were children.