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WHO Goodwill Ambassador's Newsletter For The Elimination Of Leprosy

REPORT: Building Bridges

Astrakhan meeting aims to bring Russia, Central Asia into the global picture.

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Conference participants from Central Asia

Leprosy has been endemic to parts of Russia and Central Asia, but in recent years there have been almost no reports of new cases from former Soviet countries. To gain a better picture of the situation, an international conference was held in the southwest Russian city of Astrakhan on June 29.

The occasion was the first visit to the Leprosy Training and Research Institute by Goodwill Ambassador Yohei Sasakawa. Through his visit, Sasakawa was seeking to learn more about the status of leprosy in the region and to link the work of leprologists there with global efforts to tackle the disease.

Taking part were experts from Russia, Kazakhstan, Turkmenistan, Tajikistan and Karakalpakstan, an autonomous republic within Uzbekistan. Representing the WHO's Global Leprosy Program was its team leader, Dr. Sumana Barua.

Also present was Dr. Romana Drabik, a German physician who has built up extensive knowledge of the disease in Russia and the Commonwealth of Independent States (CIS) over the past two decades. "Through the connections being made at this conference, our work for leprosy patients will improve," she said.

Country presentations confirmed that new cases of leprosy have been in decline. Dr. Victor Duyko, the director of the Astrakhan institute and Russia's top leprologist, reported no new cases of the disease in Russia in 2011, and only nine since 2001. As of January 1 there were 382 patients registered - although in Russia and the CIS, anyone diagnosed with leprosy remains registered for life, even after they have been cured.

"We have made progress. We see only a few new cases. But we still have work to do," said Dr. Duyko, who added that despite the break-up of the Soviet Union, his institute confers regularly with counterparts in former Soviet states.

Where numbers were concerned, it was a similar picture in other countries. Kazakhstan, for example, has 524 'patients' as of 2012, but has detected only four new cases since 2001. In Karakalpakstan, where men were not allowed to serve in the Soviet army between 1952 and 1962 because of the incidence of leprosy among them, there are 315 registered 'patients' but no new cases since 2007.

But as presenters made clear, there is more to the story. The possibility of undetected cases is real, and there are concerns about the circumstances of people affected by the disease.

In Tajikistan, which shares a 1,400-kilometer border with Afghanistan, the presence of some 25,000 migrants from that country is seen as a potential source of hidden cases; so too are difficult-to-access areas of the Pamir Mountains. In Turkmenistan, meanwhile, where there were also no reports of new cases, the situation for its 63 registered patients was described as "difficult" following the closure of the country's only leprosarium early in the last decade.

Additional information supplied by Dr. Drabik based on past visits to CIS countries indicated the sometimes desperate plight of people affected by leprosy and her suspicions that cases were going undetected.

'HOW CAN WE HELP?'

Dr. Barua reported on the activities of the Global Leprosy Program and invited participants to tell him how the WHO can support their national programs. He stressed the need to improve data collection and capacity building, saying, "We need to know where cases of leprosy might still exist."

He paid tribute to the important research that has taken place in Astrakhan in the past and hoped there would be a way to collaborate with the institute - including bringing it into the drug resistance surveillance program.

One practical step agreed on was for WHO documentation to be translated into Russian, including the current global strategy for leprosy for 2011-2015 and its accompanying operational guidelines. Discussions are also now taking place on conducting training courses on leprosy at the institute.

Other presentations included ones on research and international cooperation; on medical rehabilitation, including an introduction to Russian "liquid bandages" for ulcer care developed by military surgeons; and on new skin lesion treatments made possible by the biodiversity of the Astrakhan region.

Commenting on the significance of the visit by the Goodwill Ambassador and the Global Leprosy Program team leader, Dr. Drabik said, "It is very important for the institute, for Russia and for the CIS to be engaging with the WHO at this level. This is a historic moment for leprosy in these countries.