Poem Treung, Kompong Cham province – “No one wants to buy cake or ice cream from a leper,” Ing Sokmeng explained. That stigma is why many of the villagers in this former leper colony turn to collecting recyclables or charity to survive.
Ing Sokmeng, who makes a reasonable living driving a motorcycle-taxi and gathering bottles and cans, is missing half of his left foot. It was amputated to halt the spread of infection from a wound on the sole; because the bacteria that causes leprosy attacks the nerves, he couldn’t feel the injury to his foot or its eventual removal.
Fellow villager Him Ran, 38, moved to Poem Treung from Prey Veng province when she discovered that the discolored patches of skin on her body and face were symptoms of leprosy.
“I didn’t want to give my family a bad reputation, and so I ran away,” she said.
Although the physical scars linger, neither Him Ran nor Ing Sokmeng is currently infected with the Mycobacterium leprae microbe. Multiple drug therapy combining three medications cures the vast majority of leprosy infections.
According to World Health Organization statistics, there are almost 500 registered cases of leprosy in Cambodia, less than a third of the number two decades ago. However, new cases are still appearing-more than 300 were detected in Cambodia in 2008 alone, according to figures provided by the International Committee of the Order of Malta or CIOMAL.
In Poem Treung, a village of approximately 1,000, there are now only six people with active infections. That’s a stark contrast to 1996, when missionary Hai Joon Kim arrived in the so-called “leper village” as part of the Christian group Harvest Mission International.
“It was horrible, horrible,” Kim recounted. He estimated that 300 actively leprous people were living in Poem Treung 13 years ago. “Actually, they were just dying there,” he said.
Back then, lepers were confined within village limits by law, and visitors required written permission from government health authorities.
Although the social stigma remains firmly attached to the disease, researchers now know that leprosy is not highly contagious. It is most likely transmitted via droplets of mucus from the nose, according to the WHO. The bacterium multiplies very slowly, meaning that symptoms-usually numb, white patches of skin-can take up to 20 years to appear.
If left untreated, leprosy causes loss of feeling in the hands, feet and face, which means that lepers don’t care for their cuts and burns. Infections that start with surface wounds spread as far as the bone, and amputations are often necessary.
Clenched, claw-like hands and droopy feet are also hallmarks of leprosy. In many cases, the disease causes the body to reabsorb fingers and toes, leading to the stumpy hands and feet that many people associate with leprosy.
Dong Lein, one of the six remaining patient’s at Poem Treung’s clinic for active lepers, was not shy about displaying his stunted digits. He has suffered from leprosy for 52 years, and his infection is too far advanced to be cured.
“My hands and my legs are completely numb,” he said. “I cannot earn any money because of my disease.”
Others in the village have had more luck.
Lay Huot was given a microcredit loan by the Switzerland-based CIOMAL to start a recycling business. Now he makes enough to support his son, who attends university in Phnom Penh.
But recycling wouldn’t have been his first choice. “I couldn’t go to the rice fields, because I had lost my fingers and toes,” he recalled.
Socio-economic support is key to the recovery of leprosy patients, according to CIOMAL mission head in Cambodia Harald Schmid de Gruneck.
He estimated that his organization gave out more than 90 microcredit loans in 2008, allowing former lepers to launch small businesses and agricultural projects. The organization also sponsors patients to attend training courses in tailoring or mechanics.
Apart from a number of recyclers like Lay Huot, Poem Treung is home to two former patients who now make specialized shoes for lepers.
“The situation in Treung is encouraging,” Schmid de Gruneck said.
Workers from CIOMAL have collaborated with the Cambodian Ministry of Health on leprosy-related projects since 1983. The group helps the Ministry of Health screen for leprosy in remote villages, and distributes pamphlets and posters to educate villagers about the disease.
“The message we want to get out is that leprosy is curable, treatment is free and the earlier you diagnose the sickness, the less disability you will have,” Schmid de Gruneck said.
CIOMAL’s centerpiece is the Kien Khlang Rehabilitation Center in Phnom Penh, constructed in 2000. As of Wednesday, 32 patients were staying at the center, where they can receive treatment for their ulcers, undergo physiotherapy and have reconstructive surgery if necessary. Treatment, food and transportation to the clinic is offered free of charge.
Last year, the center conducted 1,109 outpatient consultations and uncovered 25 new cases of leprosy. But the majority of outpatients turned out to have non-leprous dermatological conditions, Schmid de Gruneck said.
“If it’s not leprosy, thank god,” he said.
One of the patients at the center, Heng, wears a prosthetic on his left leg; the limb has been amputated below the knee. Now 48, he’s suffered from leprosy since 1979, when lesions started appearing on his skin. He lost his leg and some fingers almost 10 years ago, when he was working in the rice paddies near his home in Kandal province’s Sa’ang district.
“My leg was speared by a sharp stick, but I did not feel any pain,” he said. “If I had information about this illness, I would have gotten medical treatment in time to keep my leg and fingers.”
Heng came to Kien Khlang soon after it opened.
“When I realized that I had this disease, I thought about committing suicide, but then I thought of my children and forgot that idea,” he said.
Now he said he enjoys the time he spends at the clinic. “People here are sweetly mothering me.”
So Visal, a physiotherapist at the clinic, said that much of the work at Kien Khlang is centered on teaching patients to lead normal lives once they return to their homes. They learn to care for their limbs and how to cook without burning themselves.
“Most of them live alone,” So Visal said. “They don’t know how to feed themselves.”
Two support workers hold regular self-care sessions with patients, showing them how to avoid injury. One of the workers is 20-year-old Nour Sreypov, who first came to Kien Khlang as a patient.
“The disease did not affect me strongly. I was just a little numb, but I could still work,” she said. Even so, her fingers eventually clenched into claws.
At Kien Khlang, she was cured of leprosy through multi-drug therapy, and learned to do daily exercises to relax her hands. Now she is nine months pregnant, and her hands look as healthy as ever.
Many patients are not as successful as Nour Sreypov, and return to Kien Khlang because they have injured themselves after neglecting their self-care routines, So Visal said.
Nevertheless, he added, “We receive them any time they want to come.”