KARACHI : Marie Adelaide Leprosy Centre (MALC) to mark 61st World Leprosy Day 2014 organized a Press Briefing today at the MALC Centre, Karachi. Dr. Ruth Pfau, Founder Member of MALC, Mr. Mervyn F. Lobo, Chief Executive Officer, MALC, Dr. Mutaher Zia, Leprosy Specialist-MALC and Dr. Ali Murtaza, Director Training Blindness Control & Community Development, MALC addressed the Press Briefing.
Every year, the last Sunday of January, the World Leprosy Day is observed all over the world, which brings about the feeling of love and togetherness with the Patients affected by Leprosy.
January 2014 marks a significant milestone in the continuing fight against Leprosy in Pakistan. This year sees the beginning of the Leprosy Elimination National Strategy for further reducing the disease burden due to Leprosy.
Leprosy work started in 1956, in a Leper colony at Karachi, in a makeshift shed built by the Leprosy patients themselves, under the guidance of late Mexican Sister, Bernice Vargas. In 1960, a young, enthusiastic and ambitious lady doctor; Dr. Ruth Pfau joined hands with Sister Vargas to alleviate the miseries of patients suffering from Leprosy. From this small beginning, she embarked on developing the National Leprosy Control Programme in Pakistan and established 156 Leprosy control centres all over the country, including Azad Jammu & Kashmir and Gilgit-Baltistan. In the years 1965 to 1971, Provincial Leprosy Control Programmes were integrated into the National Leprosy Control Programme. In 1984, WHO introduced Multi Drug Therapy (MDT), which had a strong impact on the treatment results and led to control over the Leprosy bacillus.
MALC is assisting the provincial health departments in running the Leprosy Control Programme. Together with the Department of Health (DoH) of the respective provinces, as Private Public Partnership, the Programme, under a unique unwritten arrangement between the two partners, led to the control of Leprosy in 1996, four years ahead of the WHO target of the year 2000. After controlling Leprosy, the Programme has moved into its second phase, of Leprosy elimination.
With control of Leprosy in the country achieved, MALC added other health disciplines like Tuberculosis and Blindness control to its forte of Leprosy to optimize its capacities. Since MALC is the only NGO responsible for Leprosy in Pakistan, excluding Punjab and parts of Hazara division, where a sister organization - “Aid to Leprosy Patient” is working. MALC takes it as a moral obligation to ensure that the Leprosy services are continued till we achieve elimination and finally eradication.
The elimination phase means that the present activities like treatment of new cases (300-400 annually), prevention and treatment of deformities, awareness and rehabilitation through socio-economical support and capacity building will have to be sustained.
The priority areas in the Leprosy elimination Programme are; early case detection, case holding and consequently, the prevention of disabilities. Still a significant number of cases do not seek treatment or seek treatment late, partly due to socio-cultural beliefs and stigma about Leprosy. There is a need to address this issue seriously to reduce stigma and promote community acceptance of Leprosy patients.
The goals of the Leprosy elimination are to increase community awareness and participation; improve the capacity of general health workers in diagnosis and treatment; and detect cases that have remained undetected in the community and cure them by providing free access to Multi-drug Therapy.
MALC has already identified the priority areas and since 1996, all provinces have implemented the Leprosy elimination campaign with the aim of intensifying elimination activities at the grass-root level. Overall, the elimination has been successful, as could be seen by the marked decline in the national prevalence of Leprosy.
However, a significant number of cases still remain undetected or are detected late partly due to their delay in seeking treatment. Despite a marked change in the knowledge and attitude of the common man for Leprosy, it is still one of the less known diseases not only among general public but also health professionals. This lack of awareness is resulting in the patients either being diagnosed very late or not at all. Late case detection may result in deformities, which could have been prevented with timely treatment. In addition, the risk of transmission in a community increases as the infection pool is maintained longer than necessary. Leprosy stigma has been found to be a major factor leading to the delay in patients seeking treatment. Due to prolonged and variable incubation period of 3 to 40 years, Leprosy surveillance in the country is needed for another few decades.
Policies:
There is a broad consensus on the need to integrate Leprosy services into the general health system. WHO and other International Anti-Leprosy Associations see this as the most realistic strategy to sustain cost-effective Leprosy services. Following the recommendations, the major thrust of MALC's efforts will also focus on integrating Leprosy into the general health services, to ensure availability of diagnostic and treatment facilities in all primary health centres, to enable patients to be treated as close as possible to their homes. The following steps will be taken:
Field clinics with a low Leprosy caseload over the last few years would be integrated into the General Health Services. The Leprosy staff will be merged into the general health set-up.
MALC will maintain its presence in areas with a higher Leprosy prevalence and supervise the necessary work in Government controlled clinics through district resource teams, comprising of medico-social workers.
Integration means that day-to-day patient management will be done by general health staff, therefore they would be provided basic knowledge and skills about Leprosy and its management, and field procedures including recording and reporting. The skills of the general health workers will however be limited mainly to suspecting Leprosy and referral of complicated cases to District Resource Team.
Uninterrupted supply of anti-leprosy drugs will be guaranteed.
Coordination with Federal and Provincial governments will be continued, ensuring that the governments must make a commitment to sustain Leprosy control activities and the General Health Service infrastructure must function adequately, providing same quality care services to Leprosy patients and their family members.
To prevent the occurrence of new disabilities and to prevent worsening of existing disabilities, WHO-introduced strategy of Community-Based Rehabilitation (CBR) will be implemented to enhance the quality of life for people with Leprosy-related disabilities through community initiatives. CBR programme will also include general disabled patients especially children, but also senior citizens.
Supervision and logistical support will be maintained throughout the process of integration. The integration process will be monitored, using simple and useful indicators.