Rise in leprosy cases calls for early detection and awareness

by Randima Attygalle

“I often talk about leprosy in terms of a motorcycle. The front wheel represents curing the disease and the rear wheel symbolizes ending discrimination. Only when both wheels are turning at the same time will we make progress toward our destination of a leprosy-free world,” remarked Yohei Sasakawa, WHO Goodwill Ambassador for Leprosy Elimination marking this year’s World Leprosy Day on January 31.

Sasakawa further noted that, ‘persons affected by leprosy continue to face discrimination, reinforced in some countries by outdated laws that make leprosy grounds for divorce, prevent people with the disease from participating in public life or place other restrictions on their activities.’ Women and children are particularly vulnerable to the social and economic consequences of the disease.

Although today a curable disease, leprosy was one of the most dreaded age-old diseases dating back to some of the oldest civilizations. It had ostracized those inflicted with it by their families and communities. Though many may think that leprosy is now a disease of the past, millions of people, according to the World Health Organization, still live with some form of a leprosy-induced disability.

As of 2019, Ant-Leprosy Campaign of Sri Lanka (ALC) records 1,660 new leprosy cases in the country, of which 38% is found in the Western Province. Among the new cases are 181 (10.9%) child cases and 679 (40.9%) female cases. Late presentations of 455 cases (27.4%) are also recorded. Annually, around 2,000 cases are diagnosed locally.

“We have been observing a rise in leprosy cases in the country over the past few years, notably in the Western Province,” says the Director of the Anti-Leprosy Campaign (ALC), Dr. Champa Aluthweera. The increase in case detection as well as lack of awareness about leprosy, have contributed to this, she says.

The Central Leprosy Clinic functioning under the ALC is located at Room number 12 at the National Hospital. This walk-in clinic provides comprehensive care including diagnosis, management, skin smear testing, physiotherapy services, counseling services and wound care. Patients are provided with needed splints and gutters, specially made shoes, ulcer care kits etc. The clinic is open on all five week days, headed by a Consultant Dermatologist. In addition to the central clinic, 91 District clinics also provide services.

Despite these facilities, difficulties in sustaining momentum and diagnostic interests among clinicians and delay in identifying patients still remains to be addressed, says Dr. Aluthweera. “The collaboration between the health sector and the non-health sector stakeholders remains minimal. The ownership of the situation at the regional level too remains very low,” says the physician who goes on to cite inadequate facilities at dermatology clinics to identify and treat patients, lack of counseling services and inadequate research conducted about the disease and transmission as other bottlenecks. “Advocacy and increased social awareness using all kinds of media including social media is urgent,” adds the ALC’s Director.

Also known as ‘Hansen’s disease’, leprosy is a chronic, progressive infection caused by the bacteria Mycobacterium leprae. A highly contagious disease, leprosy is transmitted via droplets from the nose and mouth. The disease mainly affects the skin, the peripheral nerves, mucosa of the upper respiratory tract, and the eyes. The skin symptoms of the disease include discoloured patches of skin, usually flat, that may be numb and look faded (lighter than the skin around), growths (nodules) on the skin, thick, stiff or dry skin, painless ulcers on the soles of feet, painless swelling or lumps on the face or earlobes and loss of eyebrows or eyelashes. Other symptoms include nosebleeds and stuffy nose. Leprosy symptoms could however mimic other skin conditions such as Diabetes Mellitus and Pityriasis Versicolar, locally known as aluham. Hence, proper investigation is required to rule out the condition.

Untreated leprosy can cause progressive and permanent damage to the skin, nerves, limbs, and eyes. The symptoms could occur within a year and in certain cases it may take as long as 20 years or even more for them to occur. Leprosy, is curable with multidrug therapy (MDT) today. “Despite this, the disease is fed by social stigma which needs to be dispelled,” says the physician who urges the public to seek early intervention through the facilities at state hospitals.

The Leprosy Hospital in Hendala built by the Dutch in 1708, then called the ‘Leper Asylum’ is one of the oldest of its kind in South Asia. The facility which almost fell into antiquity has been revived, says the ALC’s Director. “The hospital admits patients who cannot take the required drug treatment at home due to lack of family support. Residential care is still provided to them in Hendala.”

The second facility which was set up in Mantivu in the East in 1920 is today cash-strapped and does not function in the same capacity it used to, says Dr. Aluthweera. This, however, needs to be resurrected for wider reach, she adds.