LAOS(NOVEMBER 23)

 On a recent visit to Laos, I had the opportunity to visit Ban Somsanouk, a village about 130 kilometers north of the capital, Vientiane. It is one of several villages in Laos where people affected by leprosy live, but the only one where they are drawn from different ethnic groups. Ban Somsanouk has a population of 1,136. Of these, 165 are affected persons, of whom 109 have disabilities.

 While I got the impression that the affected persons live among the rest of the villagers, I understand the community is not entirely free from stigma. From what I was told, some people still think that leprosy is divine retribution and that the disease originates from within. Also, many of the leprosy-affected persons are severely disabled, and clearly at a disadvantage compared to their able-bodied neighbors.

 When I arrived, people turned out to give me a warm welcome. I told them that leprosy is curable, it is not God's punishment and that discrimination is fundamentally wrong. I also urged them to spread correct knowledge about the disease. Leprosy may no longer be a public health problem in Laos, but from a human rights perspective, it is clear that more needs to be done.

　

　

NEPAL(NOVEMBER 26-DECEMBER 2)

 My visit to Nepal took place against the backdrop of momentous political developments following the signing of a peace accord between the government and Maoist rebels signaling an end to a decade of conflict. Not unrelated, perhaps, Nepal is one of five major countries that have yet to pass the WHO's elimination milestone of reducing prevalence of leprosy to less than 1 case per 10,000 population at the national level.

 At present, PR stands at 1.65 and officials estimate that elimination could be achieved this year. One of my reasons for visiting at this time was to attend a WHO regional seminar on leprosy elimination designed to review progress and encourage greater efforts.

　

　

 The day before, I traveled south of the capital to Anandaban Leprosy Hospital. Founded in 1957 by The Leprosy Mission International, it is the biggest leprosy hospital in the country and the main leprosy referral hospital for Nepal's Central Development Region. Over the years, the hospital has helped thousands of people affected by leprosy and more recently has also been providing primary health care services to the local community as the number of leprosy cases lessens.

 The hospital's reputation for treating people with leprosy extends far and wide, and patients come from India, Tibet and Bhutan, as well as from Nepal. Sometimes they are referred to Anandaban at the border. On the day I visited, there were 69 leprosy in-patients, 9 general patients and 4 children or relatives accompanying the in-patients.

 Through offering outpatient services and operating a general ward, Anandaban Hospital is also helping to lessen stigma. Over time, it seems, the surrounding population is coming to see leprosy as just another disease.

 Another reason for visiting Anandaban was to attend the opening ceremony of the IDEA Nepal 4th General Assembly, which was being held in a packed meeting hall in the hospital grounds. IDEA, which stands for Integration, Dignity and Economic Advancement, has chapters in many countries, and is a self-help organization working for the social empowerment of people affected by leprosy. Dr. P.K. Gopal, the president of IDEA International, recalled how he had been present a few years earlier when IDEA Nepal was established. “There were just a handful of leprosyaffected persons and some medical staff. What a change!” he said.

 For my part, I told the assembled audience that there are two approaches to dealing with the issue of stigma and discrimination − a top-down approach and a bottom-up one. The top-down approach involves initiatives such as issuing last year's Global Appeal signed by world dignitaries, and seeking to have the United Nations issue guidelines to member nations.

 The bottom-up approach is a grass-roots effort. Some 135,000 people have been cured of leprosy in Nepal. I urged IDEA to encourage as many of them as possible to become members in order to mobilize support and help the organization grow. While self-help is the key, I also said there will be times when government assistance is required. For that partnership to be effective, the government must be fully informed about the situation of affected persons. Overall, I was very encouraged by what I saw and returned to Kathmandu with the feeling that IDEA Nepal is moving in the right direction.

 Organized by the WHO's South-East Asian Regional Office, the two-day seminar on leprosy elimination took stock of Nepal's position and the challenges it faces. A major barrier remains the health consequences of poverty. Nonetheless, Nepal is making progress in reaching out to people with leprosy, and I hope this conference will spur it closer to the elimination milestone. Lending their support and experience were several representatives from India's health ministry, and I understand they had productive discussions with their Nepali counterparts on how to deal more effectively with leprosy cases in their common border areas.

 For the last part of my visit to Nepal, I flew to Pokhara, where Dr. Iain Craighead took me around Green Pastures Hospital and Rehabilitation Center, a well-run facility in a lovely location set up in 1957 by the International Nepal Fellowship, a Christian mission. INF focuses on health and development in the West and Mid-West regions of Nepal for poor and marginalized peoples. Leprosy is one of INF's six core areas, among the others being TB and HIV/AIDS.

 Green Pastures was established as a leprosy hospital, but with the improvement in leprosy control services and the introduction of MDT, patient numbers have fallen so it has broadened its scope to help people with all kinds of disabilities.

 The hospital was once far from the town, but as Pokhara has expanded, Green Pastures is no longer the remote location it was, and this has helped to familiarize people with its work and reduce stigma toward those with the disease. In more remote areas, however, I understand that many still think of the disease as a curse and some people come directly to Green Pastures rather than to their local health center, because they don't want people in their area to know that they have leprosy.

 During my tour of the grounds I saw a safecooking class, visited a vocational training workshop where the emphasis is on making local products and includes three months in the local bazaar learning how to sell, and saw a training farm where patients learn how to grow food in a kitchen garden and raise animals including goats and rabbits. A total of 60 to 80 people train at the farm a year, usually in small groups.

 Green Pastures aims to get patients back living with their own families in their own communities, and does not encourage people to live in the residential unit. The community rehabilitation program is extremely successful, Dr. Craighead told me, and there has not been a new admission to the residential unit for over 10 years.

 While in Nepal, I had the opportunity to call on King Gyanendra at the royal palace. I explained my role as goodwill ambassador and my concerns about discrimination against people with the disease. I also called on Prime Minister Koirala and outlined my mission. Both expressed their support for the efforts being made to tackle leprosy and I am hopeful that we shall see further progress in due course.