If our knowledge about persons with grade 2 disability is limited, it is even more so for the persons with grade I disability, which means persons with loss of sensation in hands, feet and/or eyes, and thus who are potentially likely to progress to grade 2 disabilities. Looking at the data collected from ILEP supported projects, it seems that the numbers of persons with grade I and grade 2 disabilities could be roughly the same, but again we are talking more of guesses rather than real numbers.
How many persons are there in the World with leprosy related social handicap?
We all know that leprosy besides causing physical disability, also presents formidable social problems. While there is some attempt to estimate the number of persons with leprosy-related physical disabilities, there is almost no information about the social handicap caused by leprosy. Still, the situation in most of the endemic countries continues to be characterised with stigma and prejudice even though, early diagnosis of leprosy and it's treatment with MDT has helped in improving the situation, especially for persons who manage to avoid visible disabilities.
What are the future opportunities for promoting rehabilitation of persons with leprosy-related disabilities?
The present situation with a marked decrease in case-load in terms of provision of MDT and increasing integration with other health services, presents both positive and negative conditions for promoting improved responses to the rehabilitation needs of leprosy affected persons. Thus, vertical leprosy programmes with less work-load for control programme activities, can provide the possibility to devote more time to learn more about the rehabilitation needs and to intensify activities for teaching self-care. Leprosy control through primary health care and other integrated health programmes provide an opportunity for integrating rehabilitation activities with those for other non-leprosy disabilities.
At the same time, decreased political support and resource allocation for leprosy related activities, is already a reality in many countries and it is likely to get worse in the future. Health personnel in primary health care services may not be able to devote adequate time for control activities and rehabilitation may not be seen as part of their work.
Specific rehabilitation strategies and activities are needed for those persons who have no visible deformities (Grade 1) but only the loss of sensation in the extremities and/or eyes. Without regular and life-long care they are likely to develop complications and visible deformities.
Persons with visible deformities (Grade 2) need specific services for overcoming the disabling effects of these. Clear strategies and services are needed to make sure that their existing deformities do not worsen and they do not develop new deformities.
To have clear strategies and services for the two groups in the national leprosy programmes could be an ambitious undertaking.
