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WHO Goodwill Ambassador's Newsletter For The Elimination Of Leprosy

AMBASSADOR’S JOURNAL: The Road from Rabat

Learning about Morocco’s leprosy elimination activities, sanatorium visits in Spain and Portugal and an appointment with the prime minister in India are among the Goodwill Ambassador’s recent activity highlights.

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At the National Leprosy Center, Casablanca

MOROCCO (October 26-30)

Visiting Morocco for the latest in a series of regional symposia on leprosy and human rights being organized by The Nippon Foundation gave me an opportunity to learn more about the leprosy situation in this North African nation.

With a population of 33 million, Morocco sees about 30-40 new cases of the disease annually. It achieved the WHO’s target of eliminating leprosy as a public health problem in 1991 and is now aiming to reduce the number of cases to zero by 2025. Its strategy is based on early detection and treatment, and the use of chemophrophylaxis to treat contacts of index cases to protect them from developing the disease. The health ministry began administering single-dose rifampicin to contacts from late 2012.

In Casablanca, I visited the National Leprosy Center, which was created in 1952 at Ain Chok Hospital. In the past, someone diagnosed with leprosy would be hospitalized here for three months. That requirement ceased with the decentralization of healthcare from 2006.

During its busiest period, the hospital had around 200 inpatients. Now, on average, there are between 8 and 16 inpatients, but only those with severe symptoms. It sees around 30 outpatients a month.

Taken on a tour of the facilities by Dr. Eddaoule Asma, who has worked here for three years, I was shown cabinets of patient records dating back to the opening of the center. Dr. Asma told me a very good database had been established by Dr. Rene Rollier, the French doctor who ran the center for many years.

I met with some of the inpatients and saw the work of an NGO based at the hospital, the Association for Reintegration through Tapestry, where people affected by leprosy are taught to make high-quality tapestries that they sell to provide an income for themselves and their families.

In days gone by, the hospital was home to people such as Naima Azzouzi, who heads a newly formed association of people affected by leprosy in Morocco. She lived here for 10 years after both her parents died, because she had nowhere else to go, along with others rejected by their families.

As patient numbers have declined, so budgets have been cut, leaving areas of the hospital unused and falling into disrepair. The lab has closed, with patients requiring biopsies referred to a nearby TB hospital. The operating theatre hasn’t been used since 2006. “As you can see, the hospital is very old. The government says it is going to renovate it, but who knows when?” Dr. Asma said.

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In Beni Bouhar

To see the situation in the field, I headed northeast from the capital, Rabat, toward the mountains of Chefchaouen Province. I was going to meet a nurse specializing in leprosy in one of the four endemic regions of Morocco where 60% of cases are found. For the past 36 years, Nurse Ramadani has been looking for new cases, tracing contacts and developing close ties with people in the region.

After meeting at a local health center that serves 48 villages and hamlets with a combined population of around 31,000 people, we traveled to the village of Beni Bouhar, 700 meters above sea level. It has a population of 230 and its inhabitants earn an income from olives, figs and mountain honey.

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Nurse Ramadani

After visiting the house of a man he had treated, we traveled by four-wheel-drive vehicle to the home of another of Nurse Ramadani’s former patients. There, he showed me how he took skin smears from Redouane el Moudeu and tested for anesthetic skin patches. The same tests were carried out on his family members and it was found that three of his younger brothers also had leprosy.

“I’m extremely happy at the progress we have made since I first started this work,” Ramadani told me. Showing that leprosy can be cured means people are more willing to talk about the disease and look for the signs in others, he said. “Visiting villages is a process of sensitization.”

SPAIN (October 30-November 2)

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A view of Fontilles and its wall

Set in wooded hills high above Spain’s Costa Blanca, Fontilles sanatorium has a history going back more than 100 years. It opened its doors on January 17, 1909, but its origins trace back to 1902, when two friends — a Jesuit Father and a lawyer — were moved to help those with leprosy who had been rejected by society.

One of the founders’ tasks was to build a wall around Fontilles, as local residents were fearful of inmates escaping. But the wall was never completed and nearby communities, which in any case had been a source of leprosy patients, came to appreciate the value of Fontilles as an employer.

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Some of the 35 remaining residents

Fontilles grew into a small village with its own facilities — a bakery, carpenter’s shop, blacksmith’s, printing office, bindery, shoemaker, hairdresser’s, a church, a theatre and even a bar. “It’s bigger than the Vatican,” Ramon Trenor, the president of the Fontilles Association, told me with a smile after I arrived by road from the city of Valencia.

In the past, the Valencia region was one of four focal points of leprosy in Spain, along with Andalusia, Galicia and the Canary Islands. Today there are only around 15 to 25 new cases registered each year; of these, 75% consist of immigrants from South America and Africa.

At its peak in the 1940s, there were 438 people affected by leprosy living in Fontilles; today there are just 35. After attending Mass, I had an opportunity to meet with some of them. Many have lived here for decades.

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Commemorative plate

Visiting the well-run laboratory, I heard from Pedro Torres, the head of the lab, that Fontilles receives about 65 referrals a year from major Spanish cities, of which nine or 10 cases prove to be leprosy. The lab also examines biopsy samples from abroad, as part of its international cooperation efforts.

Fontilles first began to work overseas in 1989, when it set up dispensaries in India. It now works on projects in Asia, Africa and Latin America relating to the treatment and cure of leprosy and other diseases of poverty, and also focuses on social rehabilitation. With decades of expertise to draw on, it also runs courses on leprosy for doctors and paramedics, and trains volunteers to work in leprosy overseas.

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One of the jewels in Fontilles’s crown is its library. The mostly Spanish-language books and journals are a valuable source of research material for the academics and scholars who visit. Fontilles also boasts a Spanish-language scientific journal on leprology, which marked 70 years of unbroken publication in November.

Not all of the Fontilles complex is devoted to leprosy these days. In addition to the sanatorium, there is a geriatric center specializing in the care of the elderly with different physical and psychological needs. There is also the Hospital Ferris, for patients needing to convalesce after surgery and for rehabilitation. Most recently, some rooms in the hospital have been made available to care for the terminally ill and those recovering from serious operations or injuries among the large expatriate population in the region.

Fontilles continues to make an important contribution to leprosy work in terms of diagnosis, training, research and care. I think there is much to be learned from Fontilles’ long and distinguished history and how it is adapting to society’s present and future needs.