Anti Leprosy Campaign
Of all the diseases that continue
to plague humanity, leprosy has the most notorious history as a cause of
deformity, disability, loathing and fear. From ancient times until the recent
past, the disease was considered both highly contagious and impossible to cure.
Victims were universally shunned, their physical suffering compounded by the
misery of being treated as social outcasts. Even at the medical level the sole
option for control was the isolation of patients in colonies or leprosaria.
The history of leprosy in Sri Lanka
dates back to Dutch colonial times. The
Dutch started the Leprosy Asylum at Hendala in 1701
to imprison the leprosy sufferers for life. Though Dapsone monotherapy
was started in late 1940,s segregation was the main mode of control carried out
till the early 1970s.
During the last two decades, Sri
Lanka has made much progress in eliminating leprosy. The introduction and
expansion of Multi Drug Therapy (MDT) in 1982, an effective chemotherapy of
short term duration and the launching of the awareness campaign; the Social
Marketing Campaign in 1990 to educate the general public about earl signs of
leprosy and to dispel misconceptions surrounding the disease, have resulted in
the achievement of the leprosy elimination target in 1995 at the national level.
This is five years ahead of the targeted year 2000, set by WHO.
The field programme of leprosy is
jointly funded by the Sri Lanka Emmaus leprosy control Project and Novartis
Foundation for Sustainable Development (NFSD) from Switzerland and
World Health Organisation. The Social Marketing Campaign, Training of
health workers of the island on integration and field monitoring activities
including the Management Information System
are solely funded by NFSD
The final phase of leprosy in Sri Lanka - integration of leprosy
services to the General Health Services - was
started in 2001 after two years of planning and strengthening of the
infrastructure for integration. Following objectives have been achieved in the
initial stage.
1.
Medical
officers, registered Medical practitioners , Pharmacists and Dispensers of the
country were trained on leprosy and on the new role them under integration.
2.
All
health institutions of Sri Lanka were provided with adequate stock of MDT
blister packs (Leprosy drugs) - Before integration,it was available only with
the leprosy clinic conducted by ALC and some of the skin clinic of the teaching
hospitals.
3.
Regional
epidemiologists (RE) were on trained monitoring and evaluation of the programme
at district level. They are assisted by the PHII/Leprosy.
For this, existed forms for
data collection were simplified and
user freindly software on Leprosy management information system was provided to
REs. MOHs were trained on epidemiological assessment.
4.
Public
awareenss campaign was launched to inform
the availability of leprosy drugs in health instituitions and also dispel the
misconception of leprosy
New case detection increased after
integration.. At the end of the second year
after integration (2002) , slight decline was observed. The new case detection
rate edropped from 1.2/100,000 (2001)
to 1.16/100,000 in 2002. Percentage of multi bacillary patients remained same as
the previous year. Deformity rate has come down indicating patients are detected
in the early stages respectively. However, traditionally endemic areas like
western and Eastern Provinces , child rate has increased indicating that
transmission is still continuing. ( See Tables)
1.
Training
programmes for MOOH on epidemiological assessment were completed in all
districts except in the Northern province. In addition to the MOOH, Programme
Assistants and Senior PHII attached to the MOH offices were trained.
2.
A
team consisting of a Novartis Consultant, D/ALC, MO/CLC visited five districts
to review the programme at field level.
3.
Patients’
satisfaction surveys were done in three districts.
4.
Review
meetings with REE (Quarterly) and PHII/Leprosy (Monthly) were held on regularly
(WHO)
5.
Review
meetings in Southern, North-East, Wayamba, North-Central and Western provinces
were held with the regional health administrators (WHO)
5.
Training
programmes were conducted for General Practitioners in Colombo Municipality.
6.
Deformity
registers of ex-patients with deformities were updated. Services were provided
to patients with deformities in Galle, Matara, Kurunegala, Gampaha and Colombo
Districts under the guidance from Dr.Atul Shah and Mrs. Neela Shah, visiting
Novartis Consultants form India.
7.
Sevices
for patients with deformities were integrated with GHS.
60% of physiotherapists of the were trained on management of hand and
foot deformities during the visits of Dr. Atul Shah. Three programmes have
already been completed. Attendance at these seminars wre 100%. The trained
physiotherapists provide services not only to leprosy patients but others with
hand and foot deformities.
9.
Preliminary
steps to integrate MDT distribution into GHS were taken by the end of July. DDG/LS
and D/MSD have taken steps to send circulars with regard to integration of MDT
distribution. The names of 4 types of MDT blister packs will appear in the
annual derugestimate booksin 2003.
10.
Six papers on integration of leprosy in Sri Lanka were
presented at International Leprosy Congress, held in Brazil. Director/ALC, was
invited as a panellist at the
symposium held on integration.
The two Leprosy Hospitals at
Hendala and Mantivu and the Central Leprosy Clinic (Room 21,National Hospital
Sri Lanka) function under the administration of the Anti Leprosy Campaign (ALC).
This clinics is the main referral centre for patients with complications and for
those who need rehabilitation. It also functions as the main operational centre
for field activities. Maintenance of the register of leprosy patients,
dissemination of leprosy statistics and other information are carried out by the
CLC.
Admission to the two Leprosy
Hospitals has been completely stopped since the introduction of MDT in 1982.
However, patients who have been admitted two decades ago still remain in these
hospitals. The Government policy as practised in other countries is to look
after the ex-patients for the rest of their life as they
have been admitted against their will. There are only 11 patients at LH,
Mantivu and 40 patients at LH, Hendala. Discussions are going
on as to the transfer of staff and patients of LH, Mantivu. Lepers’
Ordinance (1901) is to be repealed soon and the clauses related toleave for
leprosy patients in the Establishment code are to be deleted. Preliminary
measures were taken on this regard.