Health ministers outline the various challenges leprosy still poses.
The Goodwill Ambassador met with a number of health ministers or their representatives on the sidelines of the 67th World Health Assembly for an update on leprosy control activities in their countries. Their comments are summarized below.
You have a special place in our hearts for visiting our country at a very difficult time [in 2003] and going to the countryside to see the challenges we faced in implementing the program. We will never forget.
Leprosy remains a preoccupation. The situation is under control at the provincial level, but in some municipalities is not where we would like it to be. Now we have a clearer picture because we are setting up a program to municipalize public health. This will allow us to put more human resources into the field and give us greater control and supervision. We also have a team of Cuban doctors, nurses and epidemiologists helping us in 70 municipalities.
The drugs for treating leprosy are available free of charge, so we have a responsibility to do our best to fight the disease. We are working with the minister of social welfare and rehabilitation to tackle discrimination. But our main focus is the national program of dermatology and the training of young doctors and nurses to recognize the main dermatological diseases. If they have queries, they can send pictures via smart phone or iPad to professors and this is increasing the opportunities for early case-finding and for improving the prognosis for patients.
I have recently been to the island of Culion to inspect the recovery efforts from Typhoon Yolanda six months ago. I also visited the leprosy museum and archives supported by Sasakawa Memorial Health Foundation. In the Philippines, leprosy is not a serious problem, but it is still a problem. The number of new cases has remained unchanged for the past three to four years. Prominent dermatologists tell me that some cases are not being diagnosed right away by general practitioners because they don't recognize the symptoms, so this is something we need to look at.
Over the past four to five years, case numbers have remained the same. I have informed President Thein Sein that although we have eliminated leprosy as a public health problem, we are still finding some 3,000 new cases annually. The president knows about the situation and says he will support us in bringing down that number.
During 2013, I enjoyed productive discussions with senior figures working in leprosy for many years and received invaluable suggestions and recommendations. One issue is the future direction of the Yenanthar Leprosy Hospital in Mandalay. Is it to be a treatment center, a training center, a rehabilitation center or a combination of all three? And should it be a leprosy hospital or a general hospital that also takes care of patients with leprosy? I will take the experts’ advice.
Another challenge is the social rehabilitation of people cured of leprosy, as they are not always accepted by society or even by their own families. There are 1,000 acres of land in Mandalay that were given to people affected by leprosy some 20 to 30 years ago; they can work the land themselves or rent it out to other farmers. Currently, the government is in dispute with the farmers the land was originally taken from and we are looking to find a solution. The future direction of the hospital depends on how we resolve the issue.
We believe the Bangkok Declaration [signed following last year’s International Leprosy Summit in July], is an important tool for countries not to forget leprosy. It is totally unacceptable that in 2014 a person suffers from this disease and the possibility of disability.
Last week, Brazil finalized the data for 2013. All the indicators showed improvement, except for the incidence of leprosy in children under 15. The reason for this is the campaign to de-worm schoolchildren and exam them for leprosy. The campaign, which is about to begin again, involves not only the ministry of health but the ministry of education, churches, NGOs and other stakeholders.
Out of several million schoolchildren who examined themselves, 250,000 reported something. Of these, 3,000 were sent to see a doctor for further examination. Out of this number, 300 were newly diagnosed with leprosy. What is good about the campaign is that children talk about leprosy with their families. It’s important to take a family approach.
We are moving forward. In Brazil, leprosy is again on the table. It is a priority. Our new minister of health, Dr. Arthur Chioro, has the same commitment to leprosy as his predecessor.
In July, Brazil is hosting this year’s meeting of heads of state of the BRICS nations (Brazil, Russia, India, China and South Africa). Following that meeting, there will be a meeting of BRICS health ministers. The focus will be on neglected tropical diseases — with an emphasis on leprosy.
The low prevalence rate makes case detection a challenge. Because health workers don’t see many patients with leprosy, they are losing experience of diagnosing cases. There is a need for more education to improve case detection. At the same time, there is also a need to build up the capacity of communities so that they recognize the symptoms and visit clinics. This dual approach is how we will achieve control of leprosy: through intervention on the part of health services and through intervention on the part of the community. Another important area is to support those with disabilities — and those who make the crutches and other tools that people with disabilities need in their daily lives.
Leprosy is a very big challenge, but your support has made a difference to our efforts. The problem is now significantly reduced. If we can mobilize the resources, it will be possible to make even further progress. We know the areas where leprosy remains; we just need the resources to mount a campaign.
Mozambique has made great progress in recent years. The economy is growing; the quality of life is improving; the fight against poverty is gathering pace. We want to use the country’s natural resources to improve the quality of life. I spent some time in Japan in the 1980s; I learned a lot and improved my technical capacity as a doctor. I will do my best to see that young health professionals go to Japan to be exposed to a professional environment, so as to improve services in Mozambique. I am working with colleagues to revamp the country’s leprosy program and create a new roadmap. We still need your support; together, we can beat leprosy.
China has made strides in prevention and control. The rate of infection is now low, but we still see new cases — around 900 in 2013. The government attaches great importance to raising awareness of leprosy, promoting treatment and eliminating discrimination. Every World Leprosy Day, the health minister participates in events. However, there is still a long way to go to root out discrimination.