Foreword
YO Yuasa
Executive & Medical Director
Sasakawa Memorial Health Foundation, Tokyo, Japan
The original Atlas of Leprosy was developed in 1981 in close collaboration with Dr R. S. Guinto and his colleagues of the Leonard Wood Memorial Laboratory, Cebu, Philippines. The initial 230 copies, in a larger prototype format, were practically handmade, but the response was so favorable that we decided to produce the Atlas in a regular printed format in 1983. Our intention was to supply a collection of high quality pictures of leprosy, both clinical and histopathological, primarily for doctors and senior paramedical workers to aid their training activities, in addition to its use as reference material. As a teaching aid we also produced a colour slide version. Little did we expect, at the outset, the subsequent overwhelming and continuous demand, even up to today, resulting in 38,000 English copies, as well as 23,000 copies in six other languages - a 'best seller' on leprosy, though practically all are given out gratis.
The global leprosy scene was changing quite rapidly, almost concurrently with the publication of the original Atlas in 1981. Starting with the historic Chemotherapy Study Group Meeting in October that year, multidrug therapy (MDT) has been primarily instrumental in this remarkable change. The 1991 World Health Assembly resolution on the 'Elimination of leprosy, as a public health problem' further accelerated that process. The 122 leprosy-endemic countries of the mid 80's are likely to come down to around 15 by the end of this year. WHO is now embarking on a 'Final Push', so that by the end of 2005, there should be no more leprosy-endemic countries left in the world, meaning that no country will have more than one case in 10,000 of the population. That will indeed be a great accomplishment.
However, for those deeply involved in leprosy work, such an achievement only signifies reaching an interim goal or a milestone, however significant it may be. Our final goal is 'A World Without Leprosy', in which every single new case (and new cases will undoubtedly keep arising) has been diagnosed and put on to MDT as quickly as possible. With reduced caseload, such basic leprosy control activities are likely to be handled, not by specialized vertical services, but general health services personnel.
This new Atlas, as the subtitle on the cover indicates, aims to assist frontline health workers, both the peripheral general health workers as well as village health volunteers, to carry out case finding as effectively as possible. Unlike the original Atlas, in which the pictures were all from the Philippines with relatively light coloured skin, this new Atlas has pictures mostly from India and Bangladesh, an area which will continue to have nearly 800% of the global caseload. Our intention is to produce enough copies of the Atlas to equip every peripheral health facility of that immense area with one copy, probably requiring 200,000 copies or more.
Dr Colin McDougall, an eminent leprosy specialist, has kindly accepted the responsibility of producing this volume. My name appears on the cover, primarily to take a full responsibility in choosing pictures or making statements, on which he had some doubts with regard to appropriateness in this volume.
The original Atlas was intended to strengthen leprosy control activities, at a time when no end point of our efforts was in sight. This new Atlas is meant to serve until the end of our efforts. Ambitious? Yes, but not, I hope, altogether unrealistic.
