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WHO Goodwill Ambassador's Newsletter For The Elimination Of Leprosy

AMBASSADOR’S JOURNAL: Dateline Dhaka

The Goodwill Ambassador travels to Bangladesh, a country with a five-year national plan to further reduce the burden of leprosy.

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Partners examine the five-year plan.

BANGLADESH (April 11-16)

In April I visited Bangladesh, a country that reported about 4,000 new cases of leprosy in 2011. It achieved the WHO's goal of eliminating leprosy as a public health problem in 1998 and has a five-year national plan to reduce the disease burden further.

On the day following my arrival in the capital, Dhaka, I called on Minister of Health and Family Welfare Prof. A.F. Ruhal Haque. He recalled the days when Bangladesh had a very high number of cases of leprosy, but said the situation today was much different thanks to the measures that had been taken. He told me his ministry is working closely with the WHO and partners to ensure that leprosy control is sustained. He also pointed to the repeal of the archaic "Lepers Act," which formalized discrimination against people affected by the disease and allowed for anyone with leprosy to be forcibly incarcerated.

In the afternoon I attended a partners meeting at the offices of the National Leprosy Elimination Program (NLEP). Taking part were The Leprosy Mission International - Bangladesh (TLMI-B), Damien Foundation, LEPRA Bangladesh, Rangpur Dinajpur Rural Service (RDRS), Health, Education and Economic Development (HEED) Bangladesh, Dhanjiuri Leprosy Center, PIME Sisters, the Salvation Army and the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b). Together with the government and the WHO, the partners have formed the Leprosy and TB Coordinating Committee (LTCC), which meets to coordinate leprosy and TB policy in Bangladesh.

After opening remarks from Dr. A.K.M Ali Ashraf, Assistant Director (Leprosy), NLEP, there was a presentation about the current situation in Bangladesh from Dr. Safir Uddin Ahmed, Deputy Program Manager (Leprosy). This was followed by a presentation of the five-year national strategy for 2011-2015. This strategy has been developed in consultation with partners, NGOs and the WHO, to enhance efforts to achieve and sustain the goal of a leprosy-free Bangladesh.

Based on the principles and guidelines laid down in the WHO's global strategy, it proposes introducing a national target of reducing the rate of new cases with grade-2 disability per 100,000 population by at least 35% by the end of 2015, compared to the baseline at the end of 2010. In addition, it promotes the greater involvement of persons affected by leprosy in leprosy control services.

At the meeting, NGOs gave a brief overview of their activities. TLMI-B, for example, is carrying out rural health and community-based rehabilitation in 15 districts and runs the Coordination for Advocacy and Networking (CAN) project to promote and protect the human rights of people affected by leprosy. It is also involved in some very significant research into leprosy, including new diagnostic tools for early detection of leprosy in the field.

I told the meeting that Bangladesh's achievement of the WHO's elimination target at a relatively early stage was a credit to the government, the WHO but above all to the NGOs who work so tirelessly to control the disease. I welcomed the national five-year plan and hoped it would be successful in tackling the challenges Bangladesh still faces. I also noted my appreciation of the efforts that resulted in the repeal of the 1898 Lepers Act last year.

The five-year strategy aims to enhance efforts to achieve a leprosy-free Bangladesh.

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Patients and a member of staff (standing) at the Salvation Army clinic.

On April 13, I visited a leprosy clinic run by the Salvation Army in Mirpur, a subdistrict of Dhaka. This well-run clinic provides multidrug therapy and offers a wide range of services, including ulcer treatment, counseling and footwear; runs skin camps; and refers cases for reconstructive surgery. That day, those calling at the clinic included Abdul (picture on the cover), who is receiving treatment for leprosy reaction.

From the clinic I moved on to a saree factory in the handloom weaving area known as Mirpur Banarasi Palli. The factory is run by a person affected by leprosy. It was started with a loan he received from his self-help group - a group supported by TLMI-B. The factory now employs 40 people, including non-leprosy affected. The factory shop sells around 1,000 sarees a month.

Next I called at the home of a person affected by leprosy in the Bashbari area of Mohammadpur. A self-help group mentored by TLMI-B meets here. Through buying and selling fish and vegetables, members make a monthly contribution to a bank account the group has opened. This sum is used for loans to members.

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At work in the saree factory

On April 14, the day that marked the Bengali New Year, I travelled six hours by road to Srimangal, a tea-growing region in Sylhet Division in the northeast of the country. The next morning I was briefed by HEED Bangladesh about its activities in the area.

HEED was established in 1974 to promote national development through improving the socio-economic position of the disadvantaged and underprivileged. In 1976 it discovered and began treating cases of leprosy in the tea plantations. Over the years it has provided inpatient and outpatient services, including ulcer care, reconstructive surgery and physiotherapy, as well as supplying footwear and offering skills training. It has also sought to educate the public about leprosy through such means as puppet plays and folk songs.

In recent years, however, because of funding difficulties, its work has largely been confined to dispensing drugs. HEED Bangladesh's president is Pastor Anwar Hossain. "Pray for Bangladesh and people affected by leprosy," he said. "And let us join forces to work on their behalf."

After the meeting, I visited a HEED clinic, a hospital run by a tea estate and a government hospital for TB and leprosy. At the Chatlapur Tea Estate Hospital about 20 people affected by leprosy had gathered. Among the people I met were a basket maker; a woman who works as a seamstress after receiving HEED skills training; a tea estate worker; and a young girl being treated for the disease.

I came away from this visit to Bangladesh with a renewed awareness of the important role that NGOs play at the grassroots level, and of how essential to a nation's leprosy strategy for there to be a solid partnership between the government, the WHO and NGOs. It is also important that people affected by leprosy become more involved in leprosy control activities and make their voices heard. I hope to see this happening more in Bangladesh and I shall be following its progress closely.