LESOTHO (JULY 31 - AUGUST 1)

 At the end of July I made my first visit to Lesotho, a landlocked country surrounded by South Africa. Lesotho achieved elimination some years ago, and with just seven new leprosy cases discovered last year, it is close to eradicating the disease altogether.

 Arriving in Maseru I headed straight for the office of Minister of Health and Social Welfare Dr. Motloheloa Phooko. The minister briefed me on Lesotho's progress in combating leprosy. He said that political commitment, human resources, free drug supply and community education had all played their part.

 Yet there are still areas of concern, including weak surveillance, the existence of social stigma and difficulties in tracing patients due to geographical factors. Speaking of the country's public health situation in general, the minister spoke of a number of challenges hampering health service delivery, especially at the primary healthcare level. He said the country needed to strengthen health centers and train new community health workers.

 During my stay, I paid a visit to the Botsabelo Leprosy Hospital. In 1976, there were over 1,000 people hospitalized here. Now there are just seven. I noticed most of the patients under treatment were suffering from disabilities, indicating that stigma may have prevented them from seeking treatment sooner.

 It was in Lesotho that I was first asked if I knew the story about the cassava tree:“If your cassava tree grows more than 1 meter tall, then you will get leprosy.” Myths about leprosy abound all over the world, and Lesotho is no different. The only way to counter these misconceptions is to inform, educate and communicate.

　

　

ANGOLA (AUGUST 2-5)

 Angola achieved the elimination target around the same time as India, at the end of December 2005. When I last visited three years ago, there were problems with the distribution of MDT, suggesting elimination could take some time. But thanks to collaboration between the government, the WHO and NGOs, Angola achieved elimination more quickly than I had thought possible. The prevalence rate now stands at 0.93 per 10,000 population.

 The main purpose of my visit was to attend a partners' meeting. Chaired by the health ministry, this takes place every year, attended by representatives from ILEP members and other NGOs. Topics ranged from the need to increase the number of health centers where proper diagnosis and treatment are carried out (there are still individual provinces where the PR is in excess of 5) to using books and magazines to spread correct information about leprosy to reinforcing collaboration between the private and public sectors.

 Dr. Luis Gomes Sambo, the WHO's regional director for Africa, also attended the meeting. A native of Angola, Dr. Sambo is delighted that his country has achieved elimination, and suggested Angola should serve as a model for other African states that have yet to achieve the goal.

　

　

 The next day I visited Funda, a community center for the rehabilitation of leprosy patients about 50 kilometers from the capital, Luanda. Here, residents engage in activities such as shoemaking and wheelchair manufacture, and sell their products to the country's remaining leprosy sanatoria. Today, only six sanatoria are left. The rest have been converted into general hospitals or old people's homes.

 Wherever possible, Angola actively encourages the reintegration of persons affected by leprosy into the local community, donating housing and providing assistance so that affected persons can live with their families. I was told that six families from Funda have received assistance and moved to the suburbs of Luanda, and that another five are set to follow.

 My field visits in Angola were organized with the help of ARPAL. This local NGO formed by leprosy-affected persons currently has a total of about 300 members in four cities. Not only does it help affected persons build homes, but it also offers them micro credit and campaigns for their human rights. In a show of government support for its activities, ARPAL's headquarters are in a building donated by the health ministry that was once used as a leprosy treatment center.

 I agree with Dr. Sambo that Angola can be a model for the rest of Africa. Amid the public health challenges posed by HIV/AIDS, TB, malaria and other diseases, the elimination of leprosy is a success story, and one that should be promoted.

　

MOZAMBIQUE (AUGUST 6-11)

　

 The final stop on my African journey was Mozambique, one of the countries yet to achieve elimination. Mozambique has a leprosy prevalence rate of 2.5 per 10,000 population, and the number of patients is especially high in the three northern provinces. Among these, Nampula Province has a prevalence rate of 6.3. Thus, strengthening elimination activities in the north of the country is an urgent task.

 To bring myself up to date, I headed straight to Nampula. The population of some 4 million is spread over a wide area, and over half live below the poverty line. Visiting a health post in Murrupula provided a stark picture of the challenges on the ground. In Mozambique, these health posts are responsible for the distribution of MDT at the local level, yet I learned that only 25% of the surrounding population lives within a 5-kilometer radius of the Murrupula post, so health service delivery is stretched thin.

 In the capital Maputo, I had meetings with President Armando Guebuza, Health Minister Ivo Garrido and President of the Assembleia da Republica Dr. Eduardo Mulembwe. I spoke of my visit to Nampula, and asked for their help in ensuring that budgets are approved in a timely fashion and that drug supplies flow smoothly. More work needs to be done on the distribution of MDT in Mozambique, and I hope the situation will have improved by the time of my next visit planned for April 2007.

 I thanked the president for giving a 15-minute radio address about leprosy on World Leprosy Day in January, a truly valuable contribution to raising awareness. I was heartened to learn that the national assembly is thinking of forming a task force on leprosy, and encouraged to hear Dr. Mulembwe say that every assembly member has a responsibility to spread correct information about the disease.

 Many of Mozambique's problems are caused by poverty, and unless poverty is eliminated, those problems will remain. The government is now focused on job creation and food supply, but I was assured that leprosy remains a public health priority. Health Minister Garrido said that Mozambique aims to achieve elimination by December 2008. However, I hope this will be possible sooner, and will do all I can to help Mozambique pass this milestone.

　

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Leprosy FACT