| INTERVIEW |
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Interview with Prof. Upendra Devkta, M .D., Health Minister, Nepal
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| The following conversation took place on February 7, during the Third GAEL Meeting in Yangon. |
Special Ambassador Sasakawa:Your Excellency, please tell me about the current state of the leprosy elimination effort in Nepal.
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Upendra Devkta:First, I would like to commend those
countries that have achieved, in a very short amount of time, the target set by
the World Health Organization for the elimination of leprosy; for example, Myanmar.
While we applaud that, I would like to say the leprosy elimination program in
Nepal is also on the right track. We might not have been able to drastically reduce
the curve, but there is steady progress in terms of case reduction. At the moment,
we have somewhere around 3.4 per 10,000. We should be able to make the target
on time. There have been both good points and a few shortcomings as well in our
leprosy elimination program. The good points are that (A) we have a good network
of institutions. Under the ministry there are about 30,000 staff members, so we
don't need to recruit other people. The second point, (B), is integration. We
have integrated our health-care system, so the same peripheral health worker who
gives drugs for tuberculosis is going to give anti-leprosy drugs as well.
So we are integrated in terms of manpower and integrated in terms of programs. We don't
have any of this "I'm a TB man, I don't give leprosy drugs," or "I'm a polio man.
I don't give leprosy drugs." Our leprosy, polio and TB all are integrated at the
delivery point. This is a good strategy to cure the disease, and we believe that
is the way to go.
Otherwise, if we were not consolidated, you would have the kind
of situation where the staff would eliminate a lot of the cases and then in the
future forget how to take care of the few new cases that came in. You would be
left with nobody who knew how to treat leprosy. But if you integrate the health
services, then there will always be people who can treat it.
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Special Ambassador Yohei Sasakawa (right) with Nepal Health Minister Upendra Devkta.
(c)Photo by Natsuko Tominaga
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Now, the reason why the figures are still not as respectable as I would like - maybe I would have been happy if it had been 1.5 or 1.75, or something like that - the reason for that is that there is a lot of social stigma attached to this. And second, we have very difficult geographic terrain. Although institutions are there, people have to travel long distances to get to the health centers. I think that these are the two major problems. I don't think we have a problem with drug supply.
What we think we should be doing is, of course, continuing our current mass campaign to remove stigma. I think that we need to intensify our case-detection campaign, especially in heavily endemic areas. Finally, to enhance public awareness, we need to have more training for the people - especially journalists and other media people.
S:I understand that the logistics for the treatment of patients are successfully managed, but the problem is how to get patients to come for the treatment, come to the health center and take medication. One reason is the strong stigma. In West Bengal, India, I learned that there used to be a strong stigma but that now almost 90 percent of people come for treatment. What are needed are thorough publicity activities so that people become aware of availability of treatment. Those people who come late for treatment usually have deformities. We need to get them to come in sooer.
D:Publicity is already there but again we need to intensify. A lot of things have been achieved in a very short period of time. It is significant that the Nepalese prevalence rate has gone down from 70 to 3.4 in 15 years. That's not insignificant, but we still need to intensify our activities. What I have seen happen is that the leprosy patients have come to have absolute confidence. They are no longer stigmatized. In my own experience as a neurosurgeon, leprosy patients used to be very shy. This happens no more. They openly talk about the disease. Now they come forward. They say, "I am cured, I've taken treatment for this." Mass education takes time but it really is a very significant and steady process. I think we should be able to accelerate it a bit. But I do know that we have a saying: "When the pot is boiling, you don't need to heat it a lot."
Our education program is very well planned and the mass media campaign is very regular. Every day, people see the television and come to the health centers, knowing that leprosy is curable. The message is very clear. The Nepalese believe that you are reborn 8.4 million times. In the past, they said that if you did something very sinful in a past life, you would be born with leprosy. But today, that is thought of as nothing but a story. This is a very positive change in terms of cultural education. We will, however, definitely intensify our efforts. We will do case detection campaigns targeted especially at bad areas, and our regular case detection programs need a bit of focus, but we should be able to handle that. I would like to invite you to see some of the areas where leprosy is still endemic. The deformity rate is gradually decreasing. Surgeons in leprosaria are highly qualified and even non-leprosy patients are seeking their treatment as well, as they do not mind entering those facilities. Leprosy patients don't mind being called leprosy patients. So in other words, it is not a problem.
S:Wonderful. Looking at the high endemic figures of the past, we can see that what you have accomplished is significant. But the final mile in a 100-mile journey is most difficult.
D:One thing I would like to add is that for the leprosy elimination campaign, we need to translate things into local languages. Messages are very effective in mass education if they are translated into local languages.
S:If we look at the Indian and Mozambique examples,
they have the same kind of language issues. Even if you do campaigns through TV
and newspapers, they may not effectively reach the local people as we want them
to. In these places, they have been using school children to give short plays
or sing songs.
D:That reminds me of our own mass media campaign. We have been using a very popular star to sing songs on TV.
S:That's an excellent idea. Now, if I may change the topic, some people say that due to political turmoil in your country, it is difficult to make leprosy elimination activities effective. They say that we should wait until order is restored before really trying to work on the leprosy campaign there.
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D:This is a very ignorant opinion. Today, 90 percent of health institutions are active. Even in the areas controlled by Maoist groups, health activities are continuing. Medical supplies are regularly provided in these areas. In the past, people were concerned that supplying these kind of medicines to the countryside would make the Maoists stronger. But when I became minister, I said that what rebels need are surgeons who can heal wounds, or fix broken bones. These services are today available only in the cities, which the Maoists do not control. Leprosy supplies are not going to make the Maoists any stronger and so why should we stop the supply lines? TB tablets or leprosy tablets or aspirin are not going to make the Maoists any stronger. Now the lines are open.
S:NGOs' involvement is important and in Nepal we understand many NGOs are active. However, we have heard there was a certain period when NGOs were kicked out of the country. What do you think of the future of collaboration with NGOs?
D:We work with NGOs to intensify elimination activities. They can carry on as long as they like. But we have got our own mechanisms. I think that in the leprosy sector, we have achieved an excellent symbiosis. It has not been the policy of the government to kick out leprosy-related NGOs. They are not troublemakers. Of course, there are other NGOs creating a lot of trouble. Sometimes with them, we are not sure who is in the driver's seat - them or the government. Again though, I have nothing but appreciation for what the leprosy NGOs have done.
S:In closing, what do you think of this GAEL meeting?
D:I think it is helpful. No doubt about it. Extremely helpful to come to a global consensus. One point that I would like to make is that while the sharing of success stories is good, it is sometimes more helpful to share failure stories. You sometimes learn more from the failures of others. In future meetings of GAEL, it will be good if we have a session in which we can listen to failure stories.
S:Good point. I'm sure we can all benefit from it. Thank you for talking with us. |
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