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WHO Goodwill Ambassador's Newsletter For The Elimination Of Leprosy

AMBASSADOR’S JOURNAL: African Sojourn

The Goodwill Ambassador visits Ethiopia and makes his first visit to Chad.

ETHIOPIA (July 12-17)

In July I traveled to Ethiopia. The main purpose of my visit was to speak at a symposium to commemorate the work of the late Nobel Prize-winning agronomist Dr. Norman Borlaug. However, I also made time to update myself on the leprosy situation.

On July 13, I went to the WHO office in Addis Ababa, where I was briefed by Dr. Fatoumata Nafo-Traor・ the country representative. She pointed out that the annual number of new cases has remained constant at around 4,000 for more than 10 years, an indication that transmission is ongoing. Of new cases, around 7% have grade 2 disability.

The next day, I called on Health Minister Dr. Tewodros Adhano. Accompanying me were Leulseged Berhane, the president of ENAPAL (Ethiopia National Association of People Affected by Leprosy), and Menberu Adane Yihune, ENAPAL's managing director. The minister told me that leprosy remains a priority and stressed his commitment to raising awareness and promoting social rehabilitation. The ministry is working closely with ENAPAL on such issues as housing and microfinance.

From the health ministry I travelled to ALERT, the All-Africa Leprosy, Tuberculosis and Rehabilitation Center in the suburbs of Addis Ababa. Established in 1965, ALERT has played a major role as a training center for leprosy personnel and as a specialist facility for diagnosis, treatment, surgery, ophthalmology and rehabilitation. Today the hospital and its training functions are overseen by the Ethiopian government.

ENAPAL's headquarters are located in the compound of ALERT. Formed in 1966 to protect the rights of people affected by leprosy, promote awareness about the disease, and support economic and social self-reliance, ENAPAL now has a presence in eight out of Ethiopia's nine regional states and has 63 branches nationwide.

ENAPAL has started a number of income-generating projects in the vicinity of the hospital, where a large self-settled colony of people affected by leprosy and others has formed. I visited some of these projects, which include weaving, embroidery and edible oil milling, and was impressed by what I saw.

Leprosy was once a serious problem in Ethiopia. Today the situation is much improved. The commitment of the health minister, the important contribution of key partners such as the German Leprosy Relief & TB Association, and the positive work being done by ENAPAL, lead me to think that the country is moving in the right direction.

Embroidery worker at an ENALAP project in Addis Ababa
Embroidery worker at an ENALAP project in Addis Ababa

CHAD (July 18-21)

After Ethiopia, I made my first ever visit to Chad. Chad eliminated leprosy as a public health problem in 1997. However, in parts of the country, the prevalence rate of the disease remains high, especially near the border with Sudan.

I arrived in the capital, N'Djamena, on July 18, where I was met at the airport by Health Minister Dr. Toupta Boguena, WHO country representative Dr. Saidou P. Barry, and Dr. Landrey Bide, the WHO's leprosy point man in Africa. Paying a call on the health minister the next day, I learned that she had experience of the disease in her family. She told me that her father had been orphaned as a young child, and was raised by an aunt who had leprosy.

Next I went to a meeting with Assaid Gamar Sileck, the vice-president of National Assembly. In response to my request for his support in tackling the disease, he promised he would look into setting up a committee on leprosy. I was also fortunate to be able to meet Prime Minister Nadingar, who was busy preparing for an important regional summit.

Back at the health ministry, I was briefed by Dr. Moussa Djibrine Mihimit, the national coordinator for leprosy. He told me that in 2009, the number of new cases reported dropped to 484, or a prevalence rate of just 0.54 per 10,000 population. However, in the east and south of the country, there are still four regions where the prevalence rate remains between 1 and 2.75. Of concern are the high percentage of new cases with grade 2 disability (17%) and the high proportion of children among new cases (9%). Other challenges include political instability in some regions, the difficulty of monitoring nomadic tribes, and a lack of resources. (Indeed, 90% of the operating costs of the health ministry's leprosy program are borne by the Fondation Raoul Follereau.)

Dr. Toupta Boguena, Chad's health minister
Dr. Toupta Boguena, Chad's health minister

On July 20 I flew to Abéché Ouaddai Region, about 700 km to the east of N'Djamena. Around 300,000 refugees have fled here from Darfur in neighboring Sudan. They include a large number of people affected by leprosy. In addition, people with leprosy cross over from Sudan to seek treatment.

After paying a courtesy call on the governor, I visited the regional hospital. In the grounds, people affected by leprosy and their families have formed a colony totaling 436 people. They live in simple huts made of mud walls with thatched roofs like pointed hats, clustered together in a narrow area. There is a plan to relocate them to an area 7 kilometers away. There is no water at the site, so a proposal to drill a well is now under consideration. Another drawback is its distance from the market. I had an opportunity to see the site afterward, and it seemed to be in the middle of nowhere. It appeared unsuited to its intended purpose and I rather felt it would result in the community's isolation.

The Goodwill Ambassador meets with residents of a colony by the regional hospital in Abéché
The Goodwill Ambassador meets with residents of a colony by the regional hospital in Abéché

Back in N'Djamena, I visited Habbéna district. About 30 years ago, a health center specializing in leprosy was set up here, and a colony of people affected by the disease formed. Habbéna means "abandoned land," but as the community becomes increasingly mixed, I was told it has also come to mean "we love them" when the word is pronounced differently. Today the population of 980 people includes 89 people affected by leprosy.

After Habbéna, my next stop was CARK (Centre d'Appareillage et de Rehabilitation de Kabalaye) in N'Djamena. This is a facility run by a Catholic NGO that manufactures artificial limbs, crutches and other aids for victims of war, accident and disease, and also offers physical rehabilitation. CARK works in association with the government's national leprosy program.

In the afternoon I visited Koundoul, about 20 kilometers south of N'Djamena. This is the site of a local NGO called ASALT, set up with support from the Fondation Raoul Follereau. ASALT helps people recovered from leprosy to become self-reliant. People living in Habbéna district come here by bus and farm 20 hectares of land and raise sheep. They consume for themselves nearly everything they produce and sell the rest. In the future, I understand ASALT would like to establish an agricultural study center here.

Artificial limbs on display at CARK.
Artificial limbs on display at CARK.

My time in Chad reminded me that the road to achieving a world without leprosy is a long one, and that to achieve this goal requires continued application and perseverance. The elimination of leprosy as a public health problem is only a milestone. Sustaining this achievement, further reducing the number of new cases, diagnosing them before disability occurs and ensuring that those who are cured can take their place in society are the challenges that Chad and all endemic countries face.