On the dusty planes of Nepal under the shadow of Mount Everest small communities of farmers struggle to survive off the land. They live precarious lives with basic living conditions, little education, and minimal healthcare. In addition to these hardships, an illness of biblical shame stalks the weak and vulnerable. This is leprosy, a disease that remains a huge global health issue.
Many in the developed world believe leprosy no longer exists. They equate the disease with historical film footage of shuffling, voiceless corpses shrouded in muslin, loosing digits as they move. It comes as a surprise that over 12 million people are affected, many of them children. The bacillus, Mycobacterium leprae, causes leprosy. It multiplies slowly in the human host, often resulting in a prolonged incubation period of five years or more. The chronic granulating infection affects the skin, peripheral nerves and eyes.
Unlike polio, it causes both muscle paralysis and sensory loss. The combination of paralysis and insensate limbs means that recurrent trauma and infection lead to ulceration and erosion of hands and feet. Loss of sensation and paralysis of eyelids causes blindness. De-pigmented skin patches, deformed limbs and a collapsed nose and coarsened features leave onlookers in no doubt about the diagnosis.
Along with their functional consequences, these stigmata of disease cause considerable distress and prejudice. Families can go to great lengths to hide afflicted relatives from public view.
Leprosy is easily treatable
The treatment for leprosy has been freely available from the WHO for many years. Multidrug therapy renders a patient no longer infective within a month and continues for 6 to 12 months for full treatment. However, established sensory loss and paralysis cannot be reversed.
It is for these problems that physical therapy and surgery can help to restore form and function. For example, this might enable a farmer with a paralyzed hand to return to work or correct a child’s claw hand so that she can feed herself and marry in the future.
