Discovering Nepal, Discovering Leprosy
Anna at the sign to the hospital
Mention leprosy to most people and they think of an ancient disease, one associated with biblical times, something highly contagious and rather mysterious, and not a condition affecting many in today’s modern world. This is not the case. Leprosy, although first described as early as 600 BC is still prevalent and posing a public health problem in countries as diverse as Brazil and India, Mozambique and Madagascar. The World Health Organisation has an ongoing programme aimed at disease eradication. Although this has reduced the burden of disease, significant progress is still required before the world can be declared free of leprosy. (1)
I spent my medical elective in Nepal, working in the Terai - the flat, agricultural district of the country with the highest prevalence of leprosy. I worked in the Lalgadh Leprosy Services Centre, one of three leprosy referral hospitals in the country. The hospital is funded by the Nepal Leprosy Trust, a UK based charity, which made it fairly easy to organise the placement.
Government public health education poster about the importance of drug treatment for leprosy
During my placement I was able to learn about leprosy in a first-hand setting. Having never seen a patient with leprosy before I arrived it was a steep learning curve, but after some helpful tuition from the doctors, a bit of reading in my spare time, and of course seeing patients I felt more familiar with what I was dealing with.
The hospital served a very large catchment area, some people travelling for days by foot or donkey to seek medical advice. When patients arrive at the hospital, they wait to be ‘screened’ - a process designed to pick out those with leprosy from the rest. Because the initial sign of leprosy often involves the skin, I also saw many weird and wonderful dermatological conditions.
Once identified as probable cases, patients saw a member of the medical team for diagnosis and treatment options. This rather cursory consultation often took place in a hot and crowded room, with queues of people waiting impatiently to be seen. The opportunity to see physiotherapists, pharmacists and podiatrists was offered; every newly-diagnosed patient left the hospital with a free pair of shoes to limit the damage done to the feet as nerve function declines. The free multi drug treatment cures leprosy if taken correctly, but requires a daily commitment to take tablets for at least six months.
The inpatient department served those with the severest disabilities, infections or adverse drug reactions. Amputations were commonly carried out, often without anaesthetic, as the nerve damage meant pain wasn’t an issue for most patients! The hospital is also well known for its work on reducing the stigma of a diagnosis of leprosy, and I had the chance to carry out a research project in this area.
Overall, my elective was fantastic. The sights and sounds of a new country - Nepal is definitely worth exploring - the friendliness of the people and the chance to have a totally new medical experience combined to form a great two months, and I can’t wait to go back.
Anna Shore
FY1 House Officer
Leeds
UK
annashore@gmail.com
Thanks to St Francis Leprosy Guild and LEPRA for financial assistance with the elective.
[1] http://www.who.int/mediacentre/factsheets/fs101/en/index.html
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