Recent cases highlight a need to familiarize private practices with early signs of the disease.

　

In Madagascar, leprosy is not just a disease found in remote areas; it affects people in towns as well.
　We recently identified about 20 new cases in the capital, Antananarivo. All were detected by health workers at public health centers. Most cases involved people who had previously been seen by private doctors, but had not been diagnosed with leprosy. By the time they were seen by public health workers, their symptoms were fairly advanced, resulting in a late diagnosis.
　Most people living in towns prefer to consult private doctors because they believe the quality of a free consultation at a PHC is not as good as at a private practice, where they have to pay.
　It is therefore important to ensure that private doctors are made familiar with the early signs of leprosy, so that they do not mistake them for some other dermatologic condition.
　Strengthening collaboration between the public and private health sectors in this way, in addition to the usual detection activities carried out in endemic and remote areas, will help improve case detection and reduce the rate of disabilities.
　To this end, we organized a sensitization meeting for private doctors in Antananarivo toward the end of last year, where we showed many slides and photographs of actual leprosy cases and explained the different symptoms.
　Doctors were invited to refer suspected cases to a PHC (where MDT and trained health workers are available) for diagnosis and cure. The cooperation of private doctors will ensure that people with leprosy receive proper treatment, since at present only PHCs and some private centers are allowed to register patients and dispense MDT.
　Similar meetings to sensitize doctors will be carried out in the provincial capitals of the remaining five out of Madagascar's six provinces during this year.
　Overall, the progress made since the implementation of the leprosy elimination program in Madagascar has been encouraging (the country's PR at the end of June 2004 was 2.93/10,000). However, more effort is still required, mostly to improve the quality of diagnosis ― we found a 40% error rate during field visits ― and to ensure better follow-up of patients during treatment.
　In short, we need to address the problem of misdiagnosis, and improve our strategy for following patients on MDT, in order to reach the elimination goal.

　

The International Leprosy Union (ILU) was founded in Bombay in 1986 to provide a global forum for bringing together leprosy organizations in developing countries and coordinating their work. While there were already international organizations for donor agencies, there were practically none for recipients, who often found that donors decided the plan of work to be followed without regard to the cultural specificity or ethnic requirements of the local community. One of the goals of the ILU, therefore, was to give developing countries a voice and sensitize donors to their needs.
　Initially, the ILU had membership in about 15 countries in Africa and Asia. Its chairman, Dr. S.D. Gokhale, was taken on as a consultant by WHO and traveled to Nepal, Bangladesh, the Philippines and elsewhere to report on the work of NGOs there. In response to evolving needs, the ILU now concentrates primarily on India.
　In supporting the cause of leprosy elimination, the ILU sees leprosy not just as a medical problem but also as a social one, and has always endeavored to give a human face to the elimination strategy. Its vision is of a world free of leprosy and of the socio-economic discrimination it attracts.
　To achieve these goals, ILU's priorities today include urging media to play a greater role, encouraging the involvement of the non-leprosy sector, drawing attention to neglected groups such as women and children, and doing a study on assistive devices that help in the rehabilitation of those with disabilities.
　In particular, ILU champions the role of cured persons in speaking out, seeing this as a way to help to change the psyche of those affected by leprosy as well the perceptions of the community at large.

　

Dr. Monique
Vololoarinosinjatovo