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WHO Goodwill Ambassador's Newsletter For The Elimination Of Leprosy

AMBASSADOR’S JOURNAL: Visits to Africa, Europe and the U.S.

Field visits to Ethiopia and DR Congo, meetings with ministers at the World Health Assembly in Geneva and awareness-raising in New York.

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Residents of Tesfa Hiwot, Ethiopia

ETHIOPIA (APRIL 2-5)

This was my first visit since the regional symposium on leprosy and human rights held in Addis Ababa in September 2013. Ethiopia reported 4,374 new cases of leprosy that year, a figure more or less unchanged for the past decade. Of this total, children accounted for 13% and cases with Grade 2 (visible) disability for just over 10% — levels that indicate ongoing transmission and delays in diagnosis.

Ethiopia’s health ministry now has a plan to strengthen case detection, taking advantage of the special fund set up after the 2013 International Leprosy Summit in Bangkok. It has submitted a three-year project proposal that focuses on capacity building at the primary health care level, supporting the national leprosy program and boosting advocacy, communication and social mobilization.

Health Minister Dr. Kesete Admasu told me that the ministry had recently carried out mapping of high-endemic areas to find out where leprosy is concentrated, and would be focusing on these areas from now on. He also revealed that 5,000 nurses were being given an opportunity to learn about leprosy and would participate in elimination activities. In addition, he said the ministry would be enhancing its cooperation with the Ethiopian National Association of Persons Affected by Leprosy (ENAPAL) in aiming to reduce new cases to zero.

Founded in 1996, ENAPAL has gone from strength to strength. It now has a total of 63 branches in eight out of Ethiopia’s nine states. There are few other organizations of people affected by leprosy on this scale anywhere else in the world.

I met with ENAPAL leaders during my stay and visited two communities of people affected by leprosy to inspect a vegetable farm and a poultry farm begun with microloans provided by Sasakawa Memorial Health Foundation. Ethiopia faces many challenges in detecting and treating new cases and reintegrating those affected by the disease, but I believe it is moving in the right direction.

DEMOCRATIC REPUBLIC OF CONGO (APRIL 5-10)

The DR Congo eliminated leprosy as a public health problem in 2008 but still has hot spots of the disease in the country. The 3,744 new cases it recorded in 2013 was the second highest number in Africa after Ethiopia and the fifth highest in the world.

Dr. Mputu, the long-serving national program manager, told me there were eight provinces where the prevalence rate is more than 5 cases per 10,000 population. He said the health ministry is targeting these eight provinces for specially strengthened elimination activities and they will be making an all-out effort to find new cases.

The country has submitted a project proposal to the Bangkok special fund that targets increasing new-case detection by 50% in order to help break transmission of the disease. I told Dr. Mputu I thought this was a bold and necessary initiative.

Accompanied by Health Minister Dr. Felix Kabange Numbi Mukwampa, I called on National Assembly Speaker Dr. Aubin Minaku. Engaging with political leaders is important for raising awareness of leprosy. I asked the speaker to use his position to encourage parliamentarians to tell their constituents that leprosy is curable, treatment is free, and that discrimination has no place.

The next day, together with Dr. Kabange and Dr. Mputu, I flew to Equateur Province, one of the eight provinces where prevalence of the disease remains high. From the provincial capital Mbandaka we drove into jungle to visit communities that see cases of leprosy among the pygmy population.

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Heavy going in DR Congo’s Equateur Province

Our journey was hampered by torrential rain and several times we had to wait for repairs to bridges along our route. In the end, we were only able to reach the first of our two intended destinations, where I visited a health center and met two men from the Batwa tribe who were being treated for leprosy. The trip was a vivid illustration to me of the realities involved in delivering health care services to the remoter parts of the country.

On my final day in the country I met Dr. Victor Makwenge Kaput, the former health minister and now a National Assembly member. He said that although leprosy still stigmatizes, the public is coming to know that treatment is free and that it is possible for people who are diagnosed with leprosy to continue to live with their families. It was an encouraging note on which to end my trip.

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The Goodwill Ambassador in action in Tesfa Hiwot

SWITZERLAND (MAY19-22)

While in Geneva for the World Health Assembly to present this year’s Sasakawa Health Prize, awarded to Poland’s Childbirth with Dignity Foundation, I took the opportunity to meet with health ministers or their representatives from 11 countries: Brazil, China, Democratic Republic of Congo, India, Indonesia, Madagascar, Mozambique, Myanmar, South Sudan, Sudan and Tanzania.

In addition to discussing the leprosy situation with them, I wanted to encourage those that had not taken advantage of the Bangkok special fund to submit project proposals to strengthen case-finding activities. I also asked for their governments’ support for a follow-up resolution on elimination of discrimination against persons affected by leprosy that the Japanese government was planning to introduce at the 29th session of the Human Rights Council between June 15 and July 3. On both the medical and social fronts, we need to continue to devote ourselves to doing all we can to tackle the disease and the discrimination it causes.