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WHO Goodwill Ambassador's Newsletter For The Elimination Of Leprosy

AMBASSADOR’S JOURNAL: On-the-Ground Realities

The Goodwill Ambassador sees at first hand the difficulties for leprosy control in two African countries.

Talking with members of the Utale 2 community in Balaka district.

MALAWI (July 13-16)

When I met Malawi's health minister, Dr. David Mphande, in Geneva in May, he told me the country's leprosy control program faced a number of challenges. Many of these can be traced to a shortage of funds, equipment and personnel, which makes monitoring and supervision of the program difficult. Therefore, I traveled to Malawi to help raise awareness of the disease among political leaders and the public.

Malawi, which reported 321 new cases of leprosy in 2010, achieved the WHO's target of eliminating leprosy as a public health problem in 1994. It has maintained a prevalence rate of less than 1 case per 10,000 population since then. However, case numbers at the national level and in some districts have been fluctuating, and four out of its 26 districts have yet to achieve elimination.

During my stay I traveled to Balaka district, about 230 kilometers southeast of the capital Lilongwe. My destination was Utale 2 village, a community of people affected by leprosy. Its origins trace back to 1946, when missionaries established a leprosy sanatorium there. At one time there were five such facilities in the country; now there is only this one, which serves as a health clinic and rehabilitation center.

When I visited, there were 34 persons affected by leprosy living in the rehabilitation center, and 43 more living nearby. They are cared for by Father Francis Kachere, who with the support of the Catholic Church looks after their essential needs. The younger people I met showed few signs of disability, but that was not true of the older generation. Among the latter was a lady who told me she had fled from the civil war in Mozambique after being abandoned by her family. With nowhere else to turn, Utale 2 had become her home.

At a joint press conference with the health minister, I said I was visiting because of my concern that leprosy was being neglected. I asked the media to dispel outdated images of the disease and stress that it is curable. Dr. Mphande said he would like bring the number of new cases down to zero. He wanted to strengthen the leprosy program and scale up its capability, emphasizing early diagnosis and treatment. There is work to do.

Prime Minister Touadera

Health Minister Mandabada


The Central African Republic is another country that has achieved the WHO's interim goal of eliminating leprosy as a public health problem, but where the prevalence rate of the disease is showing a tendency to rise. Given the strains on the health care system imposed by civil war, poverty and other factors over the years, perhaps this should come as no surprise.

In 2010, the Central African Republic reported 235 new cases of leprosy. The prevalence rate of the disease is 0.52 per 10,000 people. Four of the country's prefectures have yet to achieve elimination - Ombella-M'Poko and Lobaye to the southwest of the capital, and Vakaga and Haute-Kotto to the northeast. FAIRMED, a Swiss-based NGO, plays an important role in supporting the national leprosy program.

Health Minister Jean Michel Mandababa, 41, is enthusiastic and determined. He accompanied me on a field visit to Kaka village in Lobaye Prefecture. The area is home to pygmies, who lead a semi-nomadic existence in the surrounding forests. There are quite a few cases of leprosy among them.

When I arrived, young and old alike welcomed me with dancing. I met about 50 people affected by leprosy. Many appeared to have disabilities, but few seemed to be taking care of their wounds or injuries. Belgian nuns who began providing medical services to this village about one year ago said that when they first arrived, they were shocked at the conditions they found.

Pygmies in Lobaye Prefecture. They face many challenges from leprosy.

I don't think I have seen a health center without MDT before.

One man I spoke with told me of his sadness at contracting leprosy and how his spirits worsened as disability set in. He requested appropriate footwear. There was certainly a need for it, to prevent further disability, even though it is customary for people to move around barefoot. Life for these people looked very hard indeed.

In the capital, Bangui, I was able to have a number of meetings with key officials to discuss leprosy, including Prime Minister Faustin Archange Touadera, the speaker of parliament, and the social affairs minister. All took a genuine interest in my mission and expressed a desire to tackle issues related to leprosy in their country

I also visited the offices of the UN and exchanged opinions with Margaret Aderinsola Vogt, a human rights expert. She mentioned the place of sorcery in the Central African Republic and various human rights issues the country was grappling with. People with leprosy and those with disabilities, for example, are thought to be cursed. In some cases, they have been killed as a result. Having seen media coverage of my visit, she said that images of me mingling with people affected by leprosy would have an impact on helping to reduce stigma.

During my stay I visited a health center in Darama district, about 24 km from the capital. It also serves as one of five leprosy clinics in the country. There were said to be eight outpatients under treatment. However, there appeared to be no MDT and patient records were incomplete as a result of staff fleeing because of civil unrest. I don't think I have seen a health center before without MDT. It seemed to symbolize how this country's health program has become sidelined.

On my last evening I attended a reception at which the prime minister and most of the Cabinet, together with representatives of international organizations, were present. The government presented me with an award for my leprosy work. However, I like to think of it as an award for everyone involved in this effort.

Images of people with disability unchecked and a health center with no MDT denoted for me the fact that health services are not reaching the people and places they need to. At the same time, I was gratified to meet so many of the country's leaders and encouraged to hear their desire to tackle leprosy-related issues. I hope that my visit will prove the catalyst for closer cooperation between the WHO and the health ministry and that the government will press ahead with reducing the prevalence of the disease in the four prefectures where it is endemic. Where there is a will, there is as way.