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WHO Goodwill Ambassador's Newsletter For The Elimination Of Leprosy

INTERVIEW: Taking Aim at Disability

Chhattisgarh’s state leprosy officer is on a mission to prevent Grade II deformity.

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What are the attributes of a state leprosy officer?

A state leprosy officer is a manager. But he must also be a doctor with good knowledge of how to examine a patient for leprosy, and how to analyze the data collected.

How much of your time is spent at your desk, and how much in the field?

I spend 10 days of each month in the field or in meetings. And two to three days training NMAs (non-medical assistants).

How big is your team?

We have a district leprosy officer (DLO) in all 27 districts, but they are all part-time DLOs. At block level we have NMAs, at sub-block level we have multipurpose workers (MPWs) and in the gram panchayat (villages) we have mitanins.

Why do you think there are so many cases of leprosy in Chhattisgarh?

I have only been state leprosy officer for a couple of months, but I think the program was neglected after India achieved elimination of leprosy as a public health problem at the national level in 2005. Prior to that, it was a priority-based program; after that, slackness set in. Now we are gearing up the program, there are campaigns and new cases are coming out. We have deformity cases. We have child cases. Hidden cases have always been there. It’s a problem.

Are you finding the hidden cases in a particular part of the state?

We are finding them all over, but they are mainly in nontribal areas. In tribal areas, the standard of living may be poorer, but houses are clean and set further apart. This may be a reason for less disease prevalence.

When you were offered the post of SLO, how did you feel about taking on this challenge?

I wanted to do this work because I saw the old cases of Grade II deformity. There is no way back from that deformity. There is a distance between a normal, healthy person and a person affected by leprosy. People think those with the disease are cursed. One of my motivations is to prevent Grade II disability. We see people residing in colonies and we see new patients going to reside in colonies. Why? It is because of Grade II deformity. If Grade II deformity is not there, the stigma will be less.

What is the key?

Early diagnosis. Finding the cases and starting treatment. We should be treating PB (paucibacilliary) cases so that they do not turn into MB (multibacilliary) cases. Already we are seeing some progress. In 2016, there were slightly more PB cases than MB cases in Chhattisgarh.

How important are mitanins to your work?

The mitanin is a voluntary health worker appointed from within her community. We give them training. We have 60,000 mitanins. They are the main strength of the state. We are the founder state of mitanins. In other states they are known as ASHA (Accredited Social Health Activists).

I wanted to do this work because I saw the old cases of Grade II deformity.

Do you see attitudes toward leprosy changing?

I had a conversation with a friend of mine from the education department, who asked me if there are cases of children affected by leprosy. When I answered yes, he said, ‘Then the students should be removed from school!’ I told him it is a child’s right to have an education and they should not be removed. They can be treated and they are not infectious. He accepted my explanation.

I was examining a case of leprosy. The patient told me that he had “kushta” (skin disease), not “kodha” (leprosy with Grade II deformity).

I know of a boy who was taken to the hospital by his mother and diagnosed with leprosy when he was 14. He was treated, but when the villagers came know this they advised her to send him to a leprosy colony. She refused. Some years later, his marriage was fixed. He told the girl that he had suffered from leprosy in the past. The girl’s parents didn’t want her to marry him, but she did anyway. Now they have children and are doing well.

PROFILE: Dr. M.R. Deshpande

Dr. M.R. Deshpande is the state leprosy officer for Chhattisgarh in central India. Chhattisgarh is among six of the country’s 34 states and Union Territories that currently have a disease prevalence rate of above 1 case per 10,000 population.