Multi-dimensional and integrated approach needed to eliminate leprosy

Today, we are conferring International Gandhi Award-2017 on two outstanding personalities, Dr M D Gupte and Dr Atul Shah, for their selfless and humanitarian services in the cause of elimination of leprosy and in alleviating the suffering of leprosy-affected patients.

Leprosy has been prevalent in our country since a very long time. References to this disease date back to our ancient medical literature of Sushruta, Charaka and Vagabhatta around 500 BC. But very little was known about the disease and there was no treatment for it till the 1950's. Lack of knowledge and treatment coupled with the visible deformities caused by leprosy has made it a dreaded disease in the eyes of the people. This in turn led to lot of fear, superstition and stigma to be associated with this disease. This fear and social stigma resulted in social discrimination, deprivation of a place in the society and social boycott of persons affected by leprosy.

The mythological and historical evidence tells us that there was social acceptance of leprosy patients in the societal stream. Samrat Ashok and Bouddha King Upatis constructed “Arogyashalas” and “Punyashalas” for them. This practice was not followed by other rulers and the patients started creating self- settled colonies of their own. However, this did not last long because of misconceptions about the disease. Patients suffered from social ostracism and became outcastes. They were isolated from the society at large and became destitutes.

Even at such times when leprosy was looked down upon by the society and leprosy-affected people were victimized, Gandhiji had a special concern for them. In South Africa as well as in India, Gandhiji provided care and support to leprosy-affected persons. Parchure Shastri, the great Sanskrit scholar who was afflicted by leprosy, was provided shelter and nursing care in Sewagram Ashram by Gandhiji, demonstrating that the fears about leprosy were unfounded and that there was a greater need to care for the leprosy-affected persons.

Writing in 'Harijan' in November 1947, Gandhiji said "Leprosy work is not merely medical relief; it is transforming the frustration in life into the joy of dedication, personal ambition into selfless service. If you can change the life of a patient or change his values of life, you can change village and the country.”

Gandhiji took keen interest in leprosy patients and leprosy work even when there was no specific cure for leprosy in those days. Gandhiji was also aware that isolation of leprosy-affected persons in separate colonies was no solution to the problem. When Prof Jagadisan requested him in 1945 to inaugurate the building of the Kasturba Kustha Nilayam, Gandhiji replied, "Get someone to open it but I shall come to close it," thus suggesting that separate leprosy colonies were not a solution to the problem. In his view, the leprosy-affected patients should be integrated with rather than be isolated from society.

In most endemic countries, leprosy control has improved significantly due to national and sub-national campaigns and due to focused strategies to treat it as a public health problem. This has been possible due to the availability of effective multiple drug treatment to cure the disease, access to technology for early diagnosis, prevention and repair of deformities, as well as increased awareness in society about leprosy.

I am glad that the Gandhi Memorial Leprosy Foundation which was established in the 1950s has done pioneering work to eradicate the disease and to erase the stigma associated with leprosy. At a time when patients of leprosy were abhorred and socially isolated, the Foundation worked to provide succor, treatment, rehabilitation and ensure integration of leprosy patients into the social mainstream.

In 2012-13, India recorded 83,000 leprosy cases with a prevalence of 0.68 per 10,000 population.
I am happy to note that until 1st April 2012, 33 States and Union Territories had attained the levels of leprosy elimination of less than 1 case per 10,000 population. As many as 542 districts out of 640 had also achieved elimination by March 2012.

Nevertheless, it is a cause of concern that new cases continue to occur and high-burden pockets of the disease do exist. The State of Chhattisgarh and the Union Territory of Dadra and Nagar Haveli still have a prevalence rate between 2 and 4 per 10,000 population. Bihar, Maharashtra and West Bengal, which had achieved elimination earlier, have now shown slight increases in prevalence of leprosy in the current year. I understand that 209 high endemic districts have been identified in 2012-13 which need our concerted efforts.

The need of the hour is to intensify our efforts towards early detection of leprosy cases, provide equitable access to appropriate treatment and provide integrated leprosy services. There is also a need to empower those who have been socially discriminated through advocacy and information dissemination.

Over the years, the scourge of leprosy has remained a blot on humanity. More than the medical condition, the social stigma attached to the disease is a cause for concern. Ignorance about the treatability of the disease coupled with perpetuation of myths often leads to ostracism of persons afflicted with leprosy and causes considerable distress to persons suffering from the disease.

Social challenges remain for leprosy but the United Nations has now passed a resolution on discrimination against people affected by leprosy and efforts are being made to repeal laws that prevent people affected by leprosy, a curable disease, from participating in society.

The major challenge lies in sustaining leprosy control activities after achieving the year 2000 target of reduced registered prevalence of leprosy. Each year around 2,50,000 new cases are detected, almost 60 per cent of which are in India.

Health care workers, therefore, need to remain aware of the possible diagnosis of leprosy in patients presenting with skin lesions or sensory change.Those in primary health care, as well as specialist services need to be aware and trained in the diagnosis and management of leprosy.

Awareness in the community in general is also essential to promote early detection. Approaches to reducing stigma are important to prevent patients from hiding the diagnosis.

Prevention of disability in those with nerve function impairment and rehabilitation within the community are important challenges. There is also a need to conduct research on the development of diagnostic tests and new vaccines.

The latest WHO Expert Committee has set the challenge to reduce the rate of new patients with disability due to leprosy to 1 in a million by 2020 -a challenge that needs sustained early case detection and prevention of disability. Elimination requires a multi – dimensional and integrated approach.

On this occasion, I urge all stakeholders to come together and make concerted efforts for the total eradication of leprosy. I also wish the Gandhi Memorial Leprosy Foundation and all those involved in this mission all success in their endeavors.

Today, we recognized the dedicated work of an exceptional individual who made a great contribution for global elimination of leprosy and a leprosy institution which provided rehabilitation services of highest quality to leprosy-affected persons. We have honoured them with International Gandhi Award 2017.

I wish that the dedicated efforts of these and other eminent persons and institutions will continue so that the needs of leprosy-cured persons are properly and adequately addressed in the post-leprosy elimination period and the goal of leprosy eradication is achieved soon.

Jai Hind!

By: M Venkaiah Naidu
(Writer is Hon’ble Vice President of India)