Take in line steps for leprosy elimination in BD
Leprosy is one of the Neglected Tropical Diseases (NTDs). Leprosy is called the disease of the poor and the poorest as well. In Bangladesh, according to the Ministry of Health and Family Welfare, at present the total number of leprosy patients is around 3500.
In accord with the World Health Organization (WHO), if there are more than 1000 leprosy patients in a country, it is called an endemic country. On the other hand, the WHO declares, where there is more than 1(one) patient out of total population 10,000, that place or country is endemic. In 2016, in Bangladesh, Moulvibazar district got more than 1 (one) patient out of 10,000 people. So, considering the estimates of the WHO, Bangladesh is a leprosy-endemic country, and Moulvibazar is a leprosy-endemic district.
Around 3500 patients require hospitalized treatment of leprosy annually in Bangladesh. Among them around 600 patients get treatment from three specialized hospitals of the government. The rest of the around 3000 patients seek treatment from the NGO-managed specialized hospital (e.g. DBLM under TLMIB). But, it is a matter of great concern that some NGOs run hospitals are being closed due to shortage of funding. Therefore, the government should create opportunity to offer the treatment and health services to all those leprosy patients.
In fact, considering the negligence of the government of Bangladesh to eliminate leprosy, the health experts mentioned, is it leprosy elimination, or the leprosy project elimination? They observed that unfortunately, the government seems to eliminate the project of leprosy elimination instead of eliminating leprosy.
Because there are some remarkable problems were continued at the Director General (DG) Health Services office. For example, the post of project manager (PM) of Myco Bacterial Disease Control (MBDC) was vacant for a long time. The funding for TB and leprosy project was cancelled, and taken back by the World Health Organization (WHO) in 2015- 2016 financial year due to this.
As a result, the leprosy elimination project, and its important activities badly hampered, and the target beneficiaries were unnecessarily deprived from the government health services. Though the funding was recollected from the WHO after a series of communication by a new project manager, but this type of illogical problem must be immediately solved by the government.
Another big problem at the DG Health Office was, from 2014 to 2017 within the three years the director of MBDC changed/ transferred 10 times by the government ignoring the importance of leprosy project implementation timely. Frequently change of project personnel remarkably hampered the leprosy elimination programmes.
And finally the government became failure to make Bangladesh free from leprosy due to those unacceptable reasons among others. These types of grave situation must be controlled for the smooth functioning of the project activities.
To know about the status of the government health services for leprosy elimination, while contacted, Dr Rouseli Haq, Director Myco-Bacterial Disease Control (MBDC) & Line Director TB-Leprosy, said, "We are working very hard to reach the goal of leprosy elimination through different activities at the leprosy-endemic Maulvibazar district and other areas of the country. To cover the hard-to-reach areas, and to overcome the existing challenges of complications management to eliminate leprosy through removing social stigma, the government of Bangladesh is planning to give health services to the leprosy patients at the community clinics side by side.
It will help to reach the health services to the grassroots level leprosy patients, and will ensure inclusion of every one. In collaboration with the government, NGOs should work for leprosy elimination. GO-NGO collaboration is exists; it must be strengthened, and sustainably continued, Rouseli Haq urged.
Researches show that girls and women face more stigma due to leprosy. Women face even divorce, abandoned, other life-threatening worst situation, and get suicidal tendency. Girls and women face double burden of disease.
A coordinated and combined 'push' is required for mass awareness creation. Behaviour Change Communication (BCC) is an essential part of a comprehensive programme that includes different services like medical, social, psychological, and spiritual among others. In terms of advocacy, information dissemination through print, electronic, and social media must be effectively ensured to create mass awareness.
The Leprosy Mission International-Bangladesh (TLMIB) -- is a leading international organization -- has been working to eliminate leprosy in different districts of Bangladesh with the collaboration with the government. Jiptha Boiragee, Program Support Coordinator of TLMIB said, "Leprosy and TB Coordination Committee (LTCC) has been formed with GO-NGO representatives. Thanks to the Bangladesh government for initiating the coordination system. The LTCC coordination committee should take into account that holistic (total) leprosy service is inadequate in health system. For example, assistive device, ulcer care, complication management and human resource for new case finding issues should be addressed proactively, and properly".
Health staff of other program/section needs to be involved more in the field level for leprosy education, new case searching and refer to Upzila health point. Health Ministry needs special attention and support to ensure leprosy complication management service in GoB Medical Collage hospitals. We need to work with Department of Social Service (DSS) to ensure social and economically rehabilitation of leprosy affected people, specially, people with disabilities due to leprosy. Special Assistive Devices for people with leprosy disabilities are yet to add in disability service centre managing by DSS, Jiptha added.
The social stigma keeps the leprosy patients unexplored/ excluded, isolated from the family, society and the community. Considering the problems, the World Health Organization recommends 'Active Searching' for the leprosy patients so that no one is left behind.
In 1873, Physician Gerhard Armauer (G.A.) Hansen discovered the bacterial cause of this infectious, chronic mycobacterial disease, Leprosy. The term leprosy is taken from the Latin word Lepra, means Scaly. It is also called Hansen's disease that primarily affects the skin, the peripheral nerves, the mucosa of the upper respiratory tract, and the eyes.
Anyone can get leprosy. Leprosy is a curable disease with the use of multidrug therapy (MDT). To prevent leprosy ultimately lies in the early diagnosis and treatment of those individuals suspected or diagnosed as having leprosy, thereby preventing further transmission of the disease to others.
So let's work together to establish the truth among the people that leprosy is curable. Don't fear it; rather treat it immediately to eliminate leprosy.
Parvez Babul is a journalist and he can be reached at: firstname.lastname@example.org