| AMBASSADOR'S JOURNAL |
| Bhutan's Success |
| WHO Goodwill Ambassador Yohei Sasakawa's travels take him to Jordan, India and the “land of the thunder dragon,” Bhutan, which achieved elimination in 1997. |
JORDAN
When I visited Jordan in May, I contacted the local WHO office and the Jordanian Ministry of Health ahead of time, and asked them to look into the leprosy situation for me. I learned from this several things: leprosy was eliminated from the kingdom long ago; there is virtually no evidence that it was endemic; and nobody knows anything about the disease today. There was a hospital on the west bank of the River Jordan, but this was destroyed in 1967 at the time of the Six-Day War. There may be some hidden cases, but since leprosy does not exist in government records, there is no way of finding out. Given that leprosy is described in the Old Testament and Jordan is not far from Christ's birthplace, it's hard to comprehend that no records of the disease exist today. |
INDIA
On June 4 and 5, I was in New Delhi to attend a National Consultation Workshop on Advocacy Strategies for the Elimination of Leprosy. Held under the auspices of the India-headquartered International Leprosy Union, the workshop focused particularly on what role the media can play in leprosy elimination, and was attended by government, NGO, and media representatives, as well as people cured of the disease. I used the occasion to suggest to those present that we 1) come up with a concrete plan on how to use the media, 2) consider putting cured persons at the center of elimination activities, and 3) promote not just medical integration but social integration. I urged them to treat discrimination against cured persons and their families as a human rights problem, and reported that I am working to have the UN Commission on Human Rights take up the issue.
As there is a separate report on the Delhi proceedings elsewhere in this issue, let me here just bring up two more important points.
First, I was delighted to hear Dr. G.P. Dhillon, the deputy director general (leprosy) for India's Ministry of Health and Family Welfare, say that the prevalence rate in India as of March 31, 2004, had dropped to 2.44 cases per 10,000 population. Of course, this is at the national level. There are still two states where the prevalence rate is above 5 per 10,000, and nine more states where it is between 2 and 5, so the need for still greater efforts at elimination remains unchanged. To make progress toward elimination and remove stigma, widespread PR activities will be required to see that correct information about the disease reaches everyone. This is not just a task for organizations and individuals specializing in leprosy; it needs to involve people and organizations in every sector of society. Again, it is not only a question of medical integration, but social integration as well. The role the media can play in disseminating the right messages about leprosy is enormous - and how to involve the media in doing this was, of course, one of the main themes of this gathering.
In response to my remarks, Dr. S.D. Gokhale, the ILU president, proposed involving cured persons in a systematic and organized way as spokespersons to bring about an attitudinal change regarding the disease and so work toward elimination and the end of discrimination. Nothing carries more weight than the statements of cured persons. Until now, they have led a hidden existence. It is very important that we now ask them to assume a social role in making efforts for elimination and ending discrimination, and I look forward to seeing real progress in this area. |
 |
BHUTAN
From India I traveled on to the Kingdom of Bhutan. Bhutan is about the same size as Switzerland, and has a population of about 700,000. A mountainous country, it nestles in the Himalayas between China and India and is known by its people as “the land of the thunder dragon.” About 80% of the population work the land. The national religion is Tibetan Buddhism.
Bhutan began fighting leprosy in the 1950s, mainly under the patronage of the royal family, and it wasn't until the 1960s that the government began elimination activities in earnest. In 1962, the royal family invited The Leprosy Mission to Bhutan, following which the government and the NGO joined forces to tackle the disease. Thanks to the effectiveness of MDT, which was introduced to Bhutan in 1982, the country achieved elimination in 1997 and by 2003 the number of cases had dropped from 4,000 in 1966 to just 18. |
| Health Minister Dr. Jigmi Singay (left) in conversation with Yohei Sasakawa |
According to Health Minister Dr. Jigmi Singay, the driving force behind Bhutan's success was the powerful political commitment from the king down and the devoted efforts of health workers.
The role of religious figures has also had a big impact. A Buddhist priest who came down with leprosy meditated, attained enlightenment, was treated and cured, then traveled from village to village telling people about the disease.
Currently, about 10 designated staff work in the leprosy area, but the government program is to integrate treatment into the general healthcare system as the goal shifts from elimination in the direction of eradication. |
| Bhutan began fighting leprosy in the 1950s, mainly through the efforts of the royal family. |
| Bhutan: 80% of people work the land |
The national hospital at Gidakom, built originally as a leprosy hospital and once the main focus of elimination activities, is now a general hospital. Nearby is a dwelling-cum-workshop for cured persons, where I met a married couple earning a living making handicrafts.
However, stigma is deep-rooted, and there is a widespread fear that those who contract leprosy will suffer deformity. There is also a belief that “unlucky people get leprosy.”
For Bhutan, the challenge will be to sustain its successes. For that, ongoing monitoring and surveys are important, as well as an integrated approach to the rehabilitation of those who have suffered from the disease.
With free healthcare and education for all, Bhutan has a national policy that the king has expressed as Gross National Happiness (GNH). It derives from the belief that the collective happiness of the people is the most important indicator of national well-being, and is based on a set of strategies for creating an environment in which people have the best chance of finding happiness.
These involve equitable and sustainable development, conserving the fragile Himalayan environment essential to Bhutan's survival, preserving the best aspects of its culture while carefully choosing what to bring in from the outside, and creating good governance. While it is difficult to put happiness into figures, reducing the infant mortality rate and raising per capita income are two ways that it can be measured. To maintain Bhutan's identity, both men and women are required to wear national dress in public. The role of the extended family, which acts as a social safety net, is also something to which Bhutanese attach much importance.
In Prime Minister Jigme Y. Thinley's words, GNH is a way of developing society that focuses on the human dimension, creating the conditions in which individuals can find happiness, reminding them that material wealth is not everything and that there needs to be a balance between the material and the spiritual. Listening to his explanation, I felt his words served as a warning, and that Bhutan has raised an issue that everyone should consider. But I wonder to what extent those of us who have grown accustomed to affluence will be able to change the way we live, and rethink our values. |
|
