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WHO Goodwill Ambassador's Newsletter For The Elimination Of Leprosy

OBITUARY: MDT’s Radical Protagonist

Dr. Yo Yuasa was at the forefront of the global fight against leprosy.

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Dr. Yo Yuasa

Dr. Yo Yuasa, who died on September 7 in Kyoto, Japan at the age of 90, served as executive and medical director of the Sasakawa Memorial Heath Foundation (SMHF) between 1975 and 2005 and as advisor until 2012. He was an influential proponent of multidrug therapy (MDT) and a driving force to eliminate leprosy as a public health problem.

Born into a distinguished family of educators and social activists, Dr. Yuasa grew up in Kyoto and Tokyo. His schooling was interrupted by World War II, when regular classes were suspended and many students were sent to work in factories or on farms, and by bouts of tuberculosis that confined him to a sanatorium. After the war, he traveled to the United States to study at Amherst College in Massachusetts, only for his TB to return a month before he was due to graduate in 1953.

He credited his experiences as a TB patient with his desire to become a doctor, as he felt that the doctors and nurses he encountered were “too healthy” and lacked sufficient understanding of what their patients wanted or needed.

ENCOUNTER WITH LEPROSY

His introduction to leprosy came at the age of 20 when, with two fellow TB patients from his sanatorium, he visited Nagashima Aiseien leprosarium in Japan’s Inland Sea to see what they could learn from leprosy patients about how they had been coping with the privations of war and its aftermath.

He would later return to Nagashima Aiseien in 1957, after the leader of the patients’ association he had befriended on his first visit asked him to teach English to pupils enrolled in the high school there. It was a decision that would shape the rest of his life.

While at Nagashima Aiseien, he was scouted by the organizing committee of the 7th International Leprosy Congress, which Japan had agree to host in 1958 at short notice after India pulled out. He worked as liaison between the Japanese Leprosy Association and International Leprosy Association and, after the congress was over, was given the formidable task of single-handedly publishing the proceedings. The job took almost one year and he spent countless hours working with typesetters and printers unfamiliar with English. But in poring over the proofs, he gained a thorough grounding in the disease, which decided him to pursue a career in leprosy.

Through the congress he had come to know the world’s leading leprologists. Two of them, Dr. E. Muir and Dr. J. Ross Innes, were graduates of Edinburgh University, and they now advised him to study medicine at their alma mater. With his bride, he set out for the United Kingdom, spending five years at Edinburgh and a further five working at a hospital in the south of England, rotating through the departments in the belief he would one day be working in a remote part of Africa where he would need to be capable of handling every kind of medical emergency. His education was completed with a year at the School of Tropical Medicine in Liverpool.

He credited his experiences as a TB patient with his desire to become a doctor.

Instead of going to Africa, however, he went to work in Nepal, sent to Anandaband Hospital by The Leprosy Mission via a year as medical officer in the Hay Lyn Chau leprosarium in Hong Kong. He had been interested to work in reconstructive surgery, but after seeing how many untreated cases of leprosy there were in the country, he felt there were more urgent tasks.

RETURN TO JAPAN

The opportunity to put a public health approach into practice came through a new foundation, SMHF. He was invited to one of SMHF’s early workshops in Tokyo as a delegate from Nepal, surprising the Japanese participants by how well this Nepali could speak their language. Learning that the foundation needed a medical director, he applied and was accepted, after first seeking advice from another of his mentors, Dr. Stanley Browne.

Under Dr. Yuasa’s guidance, SMHF worked closely with the national leprosy programs of endemic countries, helping to strengthen their activities, and formed alliances with all the key stakeholders in leprosy to put the disease on the global health agenda. This was at a time when known leprosy cases numbered in the millions and patients were developing resistance toward Dapsone, the drug that had been used since the war to treat the disease. He was part of the WHO Study Group that looked into alternatives to Dapsone and which led the WHO to recommend the introduction of MDT as the treatment of choice in 1982.

Dr. Yuasa became in his own words one of the drug regimen’s “most radical protagonists.” He believed it was a top priority to reach all cases as quickly as possible, working through the general health services, and he regarded the WHO’s program to eliminate leprosy as a public health problem, which he helped to inspire, as a politically effective goal.

DILIGENT, DISCIPLINED

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Dr. Yuasa addresses a workshop on chemotherapy of leprosy in Asia (1977)

Extremely diligent and conscious of his responsibilities to the foundation and to millions of people with leprosy, Dr. Yuasa was a disciplined worker and spent months of each year travelling. He filled many roles with distinction. He was a member of the ILEP Medical Commission between 1978 and 1992 and served the International Leprosy Association, first as secretary, and then as president for two terms between 1993 and 2002. He was also chairperson of the WHO Special Action Program for the Elimination of Leprosy steering committee from 1994 to 2002.

Among the awards and citations he received for his contributions to leprosy elimination, the ones he most cherished were the Damien-Dutton Award, which he received in 2002, and a certificate of appreciation from the American Leprosy Missions, which noted that he had gone about his work “Quietly, firmly, faithfully, brilliantly.”

Born and raised a Christian, he said that while his faith informed his work, he did not rely on miracles. “If there is a medical problem, then there is a medical way of dealing with it.”

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A book of Dr. Yuasa’s speeches and writings was published last year. It can be downloaded at www.smhf.or.jp/e/hansen/publications/

Over the years, he developed an interesting view of M.leprae, the causative agent in leprosy, querying whether humanity had a right to eradicate a bacillus it had not created, and whether it was even in humankind’s interests to do so, as it might teach us something useful as we come to learn more about it.

But he regarded delivering the cure for leprosy to all who need it as a moral imperative of public health policy and felt an obligation to address the stigma and discrimination. “We didn’t create M.leprae, he once said, “so in a way we are not responsible for it; but the problems associated with leprosy are a purely human creation, so it is our duty to deal with them.”

Dr. Yuasa was not entirely comfortable with slogan of the 15th International Leprosy Congress held in Beijing in 1998, over which he presided as ILA president—“Working toward a world without leprosy.” Three months earlier, speaking at a workshop in Manila, he was already voicing his reservations. Noting that the recent elimination program had made it possible to contemplate “the end point of our activities,” he commented:

“For me, that end point is best expressed as ‘a world without leprosy-related problems, both medical and social.’ It sounds rather mundane. It does not sound as glorious as ‘eradication of leprosy’ or even ‘a world without leprosy.’ But I believe it is a more honest expression of what we are likely to be able to achieve and, more importantly, we will have no excuse for not achieving it.” Dr Yo Yuasa 26 July 1926 – 7 September 2016