Leprosy in NepalLeprosy, also known as Hansen’s Disease, is caused by bacteria called Mycobacterium Leprae which is related to the bacteria that causes tuberculosis. The disease is mildly infectious and is most prevalent in places with higher levels of poverty. Due to issues like overcrowding and malnutrition that many people living in poverty face, people’s immune systems can be compromised, making them less able to fight the bacteria.

Leprosy is curable and, if treated early, it will not cause any long-term health issues. According to The Leprosy Mission, around 200,000 people worldwide are diagnosed with leprosy each year.

Although the overall prevalence of leprosy in Nepal fell below one case in 10,000 of its entire population in 2009, there are still areas in Southern Nepal where its prevalence is much higher due to its proximity to Northern India. Nepal was still among the top ten countries affected by leprosy in 2021.

How Leprosy Affects People

If left untreated, leprosy can cause nerve damage, leading to a loss of sensation in the hands, feet and face. Due to this loss of sensation, people with untreated leprosy are less likely to notice pain from injuries such as burns and cuts, which can then lead to infections. Nerve damage to the face can also cause difficulty with blinking and can lead to eye damage and even blindness.

Due to myths and superstitions, there is a great amount of fear and stigma surrounding leprosy in many cultures. Those suffering from the disease are often isolated from their families and communities, and many lose their jobs and even their homes because of this.

Heal Nepal

Although leprosy is curable, especially when treated early, it can be very difficult to diagnose. The Leprosy Mission works with medical researchers to discover new treatments for leprosy and develops campaigns in countries affected by leprosy to help educate people about the disease. They also work with governments worldwide to ensure medical staff are educated, reducing misdiagnosis and preventing leprosy from developing.

The Leprosy Mission aims for zero transmission of leprosy worldwide and is working to improve education on how to end the transmission of leprosy in Nepal through its Heal Nepal program. Heal Nepal works with local communities and health services in 11 different districts of Nepal to educate local communities about leprosy, raising awareness of its symptoms and treatment. They also train health workers on leprosy diagnostics and encourage the early treatment of leprosy, and emphasize that it is not infectious when treated.

These efforts have significantly reduced waiting times for referrals and have allowed for a more efficient provision of leprosy treatment to patients, which has decreased the number of serious health complications in people with leprosy in Nepal. The program also provides patients suffering from more advanced cases with reconstructive surgery when necessary.

How Heal Nepal Is Supporting People with Leprosy in Nepal

Heal Nepal has recruited numerous female volunteers and trained them to identify leprosy, and due to their efforts, more than 170 new leprosy patients have been identified and given treatment. This has lowered the levels of the disease and prevented many people from developing lifelong disabilities that can occur as a result of untreated leprosy.

Along with readily available and highly effective treatments such as multi-drug therapy (the World Health Organization’s recommended treatment for leprosy), there have been many medical breakthroughs within the past decade that are helping people with disabilities caused by leprosy. “Clawed hands” or foot-drops caused by leprosy-related nerve damage can now be restored with surgery and physiotherapy, and reconstructive surgery can also restore eyelid muscles, allowing people to blink again. People with nerve-damaged hands and feet are also encouraged to check daily for any cuts or burns and to soak their hands and feet regularly to make them softer, which helps prevent further injuries which could cause disability. Protective shoes and mobility aids have also been made available to those who need them, improving their quality of life and allowing them to be more independent.

Not only do Heal Nepal and The Leprosy Mission help those with leprosy on a physical level, but these programs also help with the social aspects of having leprosy and work to end the stigma and fear surrounding leprosy by educating people in communities where leprosy is common. They also offer counseling and support groups to help people with leprosy feel less alone and help them cope with the negative social aspects of having the disease.

Overall, The Leprosy Mission’s Heal Nepal campaign has helped reduce transmission of leprosy by identifying and diagnosing the disease early on. This has allowed people with the disease to be treated and cured and allowed many people to return to a normal standard of life. For those with more advanced cases, their quality of life has also been improved with more advanced medical and social care.

– Molly Wallace
Photo: Flickr

Leprosy in India
In addition to widespread poverty and striking inequality, India has the highest number of leprosy cases in the world, with more than 120,000 cases in 2019. Although the disease is curable, leprosy has been neglected by the Indian government since it was considered to be eliminated in 2005. The government reallocated resources that once maintained health services, trained professionals and prioritized curing leprosy. The resurgence of the disease was met with a limited government response. Today, the government does not detect approximately 50% of new leprosy cases. As a result, leprosy in India remains a significant health crisis.

The Disease of Poverty

Despite the country’s soaring GDP, India is home to one of the highest populations of the world’s poor, with more than 300 million people living in poverty. 70% of the country’s population lives in rural areas and does not reap the benefits of India’s urban wealth. Leprosy, a “disease of poverty,” disproportionately affects India’s rural poor. Lepra has since emerged to combat the detrimental effects leprosy has on those diagnosed with the disease. The organization aims to prevent, treat and reduce stigma around leprosy in the communities it serves.

3 Ways Leprosy Affects India’s Rural Poor:

  1. In India that discriminate against people affected by leprosy. For example, leprosy is deemed an adequate reason for divorce, and people with visible leprosy are legally prevented from forms of public transport such as trains. Additionally, people with leprosy face tremendous social stigma and are often ostracized from their communities due to lack of awareness about the disease.
  2. India’s rural population has limited access to healthcare. Rural populations have fewer health facilities available to them despite higher rates of diseases in these communities. These deficiencies in diagnostic facilities and trained professionals leaves many leprosy cases undiagnosed.
  3. People in poor, rural areas are more likely to contract leprosy due to malnutrition and living conditions. Although more than 90% of people are naturally immune to leprosy and the disease is not easily transmitted, those with immune systems weakened by other illnesses, malnutrition or poor living conditions are more likely to contract the disease. India’s malnutrition rates are higher in rural areas than in urban areas. Poor hygiene and sanitation in rural areas coupled with malnutrition make these populations more likely to contract diseases such as leprosy.

Lepra: The Good News

Lepra was founded in Hyderabad, India in 1989 as a partner of Lepra UK. The organization began by supporting the implementation of the Indian government’s National Leprosy Eradication Programme. Lepra has since expanded dramatically, now working in 156 districts in 9 states. Lepra caters its leprosy response to the different districts it serves. However, its core programs focus on detecting new cases, disability prevention and care, empowerment and inclusion. The organization prioritizes vulnerable, poor populations such as women, children and those living in slums.

Since its founding, Lepra has treated more than 565,000 affected individuals, provided disability care for more than 95,000 people, and produced specialized protective footwear for more than 250,000 people. Lepra organizes multiple projects in each of the 9 states it serves. It also offers services to combat lymphatic filariasis, tuberculosis, HIV/AIDS and eye issues.

In Delhi, Lepra’s West Delhi Referral Centre conducts screenings and surveys in schools and regularly follows up with the families of infected children until they are cured. The project also informs people affected by leprosy of their rights and engages in community outreach to reduce prejudice against those affected by the disease.

Moving Forward

Since rural poor populations are most affected by leprosy, it is essential that the Indian government invest in health facilities, train professionals to address the disease in poor regions and reform the laws discriminating against people with leprosy. Lepra’s programs and projects pave the way for leprosy to be eliminated in India and for those affected by leprosy to gain societal acceptance.

– Melina Stavropoulos
Photo: Unsplash

Brazil’s Fight Against Leprosy
When people think of leprosy, they may think of an extinct disease; a Biblical sickness that has long lived in the past. This could not be further from the truth, as leprosy or Hansen’s disease affects millions of poverty-stricken individuals throughout the world.  One of the largest concentrations of leprosy in the world is in Brazil, which combined with India and Indonesia, accounts for 81 percent of all leprosy cases worldwide. Here is some information about Brazil‘s fight against leprosy.

What is Leprosy?

While leprosy is a debilitating disease that has existed for centuries, there is a myriad of misconceptions about how it spreads and functions due to its ancient status. Leprosy is an infectious disease that the pathogen, Mycobacterium leprae, causes. It affects the skin, eyes, peripheral nerves and upper respiratory tract of its victims. Common symptoms are skin lesions, often accompanied by sensory deprivation and weakness of muscles near the afflicted area.

People currently do not know how leprosy spreads, but physical contact with an infected person or creature was the predominant theory for a long time. Recently, the theory that leprosy spreads through respiratory routes (i.e. coughing and sneezing) has been gaining traction. Leprosy infection can happen regardless of age, but 20 percent of registered cases occur before a child turns 10. While leprosy is just as likely to infect boys as girls, adult rates for leprosy show a different story. In fact, leprosy is twice as prevalent among adult males than it is among females.

If a person with leprosy does not receive treatment, it will often lead to blindness, loss of extremities (i.e. fingers and toes) and arthritis. Leprosy has crippled 1 to 2 million people across the globe. There is hope, however, as leprosy is curable with antibiotics and if a person receives treatment early enough, they can expect a full recovery with little to no complications.

Poverty and Leprosy

Poverty and leprosy go hand in hand. Wherever there is leprosy, poverty is sure to follow. There are a plethora of reasons why poverty and leprosy often co-exist, and one of the main reasons is that those with leprosy and unable to receive a cure will very often find themselves unable to work due to the crippling disabilities of the disease. Once the serious disabilities from leprosy settle in, sufferers are hard-pressed to survive, let alone work to make enough money to afford proper treatment. This subsequently traps them in a brutal cycle of poverty, unemployment and social pariah status.

However, there are many NGOs working to eradicate leprosy by taking on poverty as well.  One such NGO is the No Leprosy Remains group (NLR), which has been working towards the complete elimination of Hansen’s disease in Brazil since 1994. As of 2017, NLR’s main mission is to achieve a 90 percent decrease in the number of people needing treatment for neglected tropical diseases (leprosy being one of them). To reach this goal, NLR has enacted the PEP++ plan to preemptively treat over 600,000 people and reach a 50 percent reduction in new leprosy cases compared to its starting year.

Why Brazil?

Brazil’s fight against leprosy has been a tumultuous one; with Brazil contributing to 93 percent of all leprosy cases in the Americas in 2018. One can attribute Brazil’s status as a hotspot for leprosy to the fact that it is a very large country with many remote areas in hard to reach places, leading to difficulties in diagnosing people with leprosy, let alone curing it.

However, there is one cause of leprosy that is entirely unique to Brazil, the armadillo. In Brazil, testing determined that 62 percent of nine-banded armadillos were hosts to Mycobacterium leprae. Furthermore, Brazilians who ingested nine-banded armadillo meat on a regular basis had higher concentrations of leprosy antibodies in their bloodstream. This is problematic given that armadillo meat is a common source of protein for Brazilians in lower socioeconomic areas where food is not as plentiful. To counteract this, NLR’s PEP++ program has a focus on community education that aims to teach about the social impact of leprosy as well as techniques and knowledge that are vital to curbing this disease.

The Future of Brazil’s Fight Against Leprosy

Brazil is making headway in its fight against leprosy.  The Brazilian government has been tackling the threat of leprosy with renewed vigor since 2003 and has shown remarkable improvement in the treatment and diagnosis of this disease. The Brazilian government, with the help of NLR and the World Health Organization, should meet PEP++’s 2030 end goal of a 90 percent reduction in leprosy cases annually.

– Ryan Holman
Photo: Flickr