Background: Leprosy

Sick people need a place in society

Wielding a mattock becomes an acrobatic performance, pounding grain in a mortar a game of skill, and threading yarn on a spool a new challenge.

In many parts of the world, leprosy has been a stigmatising disease and remained so even in 2006. Fear and ignorance still prevent sick people from finding medical help before visible disabilities start to appear. People with disfigured hands or feet are rejected and outcast, whole families often lose their livelihoods.

Practical aid through micro-credits

But it does not have to be like this. The vicious circle of disease and poverty can be broken if people with leprosy are given a chance. This is where

socio-economic rehabilitation comes in. This DAHW programme has become increasingly important in recent years.

Of course, the village community has to participate; positive experiences help. In 2006 the DAHW helped about 75,000 leprosy patients and their families to receive education, to build a small house, and to earn their own living. Micro-credits helped them to buy a cow or open a market stall. Others found work in a weaving mill.

Is the disease retreating?

The number of newly diagnosed cases of leprosy has fallen in recent years by one third: from more than 760,000 worldwide in 2001 to 259,017 in 2006.

However, the leprosy figures from Ethiopia and Sierra Leone had not been available to the World Health Organization (WHO) when these figures were published. In 2006, 94 percent of all new cases of leprosy occurred in only 15 countries, in nine of which DAHW supports programmes. India reported most number of cases by far (139,252, a decrease of 22,235), followed by Brazil (44,436, an increase of 6,026).

The reasons for the decrease are disputed, because it is largely based on the falling figures in India, while the trend in other parts of the world has been less marked or even indicates the opposite, such as in Brazil. For the people affected, their physical problems are often overshadowed by social marginalisation and emotional suffering. It is estimated that more than three million people have disabilities caused by leprosy.

There is no reason to relax efforts: long-term and sustainable success only can be secured if comprehensive and medically sound leprosy control is maintained in the affected countries. This includes the training of medical staff, even in places where leprosy cases are clearly declining.

As long as patients only present themselves for treatment when they have visible disabilities, as long as children contract leprosy, and as long as the disease leads to social rejection, DAHW will do everything it can, together with other leprosy relief organisations, governmental health services and WHO, to ensure that patients have access to timely medical treatment. Simultaneously, it will also continue to care for people who are living with disabilities.

Drop in severe cases: in Nepal for example

Despite his difigured hand, this former leprosy patient is a skilful basket-weaver. Photo: DAHW / Jürgen Hammelehle

Only twelve years ago, 17 percent of the new leprosy patients in the Himalayan country of Nepal were already visibly disabled when they presented for treatment. “It’s the stigma which disables people, not the disease,” explains Karen Baxter of the International Nepal Fellowship (INF), an association which DAHW has been supporting for more than 30 years. “Since the introduction of regular radio broadcasts informing listeners that leprosy is curable, there have been, thankfully, fewer people with handicaps than a few years ago.” The statistics confirm the effectiveness of anti-leprosy work, indicating that the proportion with disabilities has fallen to about 3 percent.

The disease rate nevertheless indicates clearly that leprosy is far from having been conquered. Green Pastures Hospital, which is active as a referral hospital in the western region of the country, has seen about the same number of new patients for many years. The hospital is able to treat many of those diagnosed at a very early stage as outpatients.

Severe cases, by contrast, may develop damage such as a “claw hand” through nerve damage. A sensitivity test determines which fingers are affected; physiotherapy, and possibly surgery, restore to the hand as much flexibility as possible.

Education helps to integrate people

After treatment, micro-credits can provide additional help. A little more than € 200 is enough to build a simple little house. And in self-help groups, patients, former patients and their families help each other to grow vegetables for their own consumption.

Suresh Makato bougt a rickshwa with a micro-credit which enables him to pay for his family′s keep. Photo: DAHW / Jürgen Hammelehle

A new spirit has come to village communities in many places as a result of DAHW’s efforts to provide education. In Nepal, fewer and fewer people with leprosy are being marginalised, and only a few have to be treated as inpatients. The majority of the patients carry on their normal life while they are being treated.

Leprosy has thus become a disease like any other. The stigma is constantly decreasing.