Campaign Aims at Leprosy Stigma, Awareness

For the past 10 years, Som Pak has spent most days hiding in his house in Banteay Meanchey province’s Svay Chek district, avoiding villagers who he says shun him and his family and refuse to give him work.

When he was 17, Som Pak contracted leprosy. The affliction was not treated in time, causing damage to his arms and legs and the loss of his fingers.

Now 49, Som Pak traveled to Kean Khlang National Rehabili­ta­tion Center in Phnom Penh last week for surgery on his disabled hands and feet.

“Even though I am not sick anymore, people are still very suspicious because of my appearance. I have tried to explain to them many times, but they will not believe me,” he said. “I worry about going back.”

Leprosy sufferers continue to battle stigma, despite a na­tional program that was launched by the government a decade ago to eliminate the disease and to educate the public.

Information is especially lacking in rural provinces, where populations still consider leprosy a highly contagious, mutilating and incurable disease, said Adelina Baltazar Green, a medical administrator at Kean Khlang.

“People in the countryside still think it’s very contagious. They refuse to help the lepers, who are sometimes even rejected by their own families,” she said.

Although the sickness is now considered “eliminated” in Cam­bo­dia, with fewer than one case per 10,000 people nationwide, experts point out the need to continue campaigning to stop stigmatization and, above all, to avoid the resurgence of the disease. This phenomenon was observed in Papua New Guinea, among other countries, where, after elimination, a lack of control led to a rebound in leprosy cases.

In this context, the government’s National Leprosy Program and the International Committee for the Order of Malta for Lepers’ Assistance—which technically and financially assists Cambodian authorities in their efforts to fight leprosy—chose 10 districts to which they will be travel this month, meeting village leaders and educating them about the disease and its clinical symptoms.

Leprosy is a chronic infection disease, caused by a bacteria called mycobacterium leprae, which transmits from human to human through sneezing or coughing. The disease generally incubates in the body for five to seven years before symptoms arise—which sometimes only appear after two or three decades.

The disease slowly leads to nerve damage, triggering a loss of sensation in limb extremities, but also affects the skin, the upper respiratory tract and the eyes.

If symptoms are not cured in time, they can lead to permanent disabilities such as muscle atrophy, foot dragging, a contraction of fingers called “claw hand,” and, in some severe cases, the loss of a limb.

But while the disease is commonly thought of as highly contagious, 95 percent of the population is immune to it, according to Stephen Griffiths, country medical coordinator for International Committee for the Order of Malta for Lepers’ Assistance. And for the five percent remaining, contagion is considered “low to moderate,” he said.

Although treatments have existed since the 1940s, multi-drug therapy—a combination of two or three antibiotics that was put in use in the 1980s—now cures patients in six to 12 months and interrupts transmission in 36 hours.

If taken during the early stages of symptoms, patients can recover without suffering any disabilities.

In 1998, Cambodia achieved its goal of “eliminating” leprosy, reaching one case per 10,000 population nationwide—a prevalence level at which the sickness is considered to die out. But “elimination does not mean eradication,” Griffiths said.

“It is clear that if neglected during a period, a serious reappearance of the disease in the population is possible.”

At the beginning of 2003, 588 leprosy patients were undergoing multi-drug therapy treatment and, between January and July, 299 new cases were detected.

While leprosy is considered eliminated in most provinces, Stung Treng, Rattanakkiri and Mondolkiri still have rates higher than one per 10,000 people.

During the 10th National Annual Conference on Leprosy, which took place in October, experts highlighted the necessity to maintain a solid “post elimination program.”

While men and women are as vulnerable to contagion, only 25 percent of patients recorded are females, suggesting many female cases have not yet been reported.

Finally, the report also suggests that “the drop in case finding in the first six months of this year may be related to pre-election activities in which many health workers were involved.”

During the conference, the NLP presented a $380,000 budget—$60,000 to $80,000 less than last year, according to Griffiths.

With Cambodia no longer being a priority, donors have started to turn to countries where leprosy has not yet been eliminated.

The World Food Program, which used to provide food for patients undergoing treatment, withdrew at the end of 2002, so did the Sasakawa Memorial Health Foundation.

In the next few weeks, Som Tok will return to his village, and he expects a similar reception from his neighbors as in the past.

“People over there know nothing of leprosy. I’ve never seen anyone come and tell them about it,” he said. (Additional reporting by Nhem Chea Bunly)


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