Leprosy Mailing List – October 31, 2016
Ref.: (LML) A day on the ground |
From: Joel Almeida, Mumbay and London
Dear Pieter,
What active case-finding is like on the ground:
An infectious case lies buried like a needle in a haystack of transient, self-limiting cases. Skin smears allow such patients to be identified. Many have no signs other than subtle induration of the skin.
One untreated patient with polar lepromatous leprosy can shed more M. leprae than do hundreds of thousands of patients with self-limiting disease.
Polar lepromatous patients may be previously untreated, or re-infected after release from MDT. It is a serious error to deny them skin smears, or anti-microbial treatment. This error is sufficient to defeat leprosy control efforts, including chemoprophylaxis.
Trained and skilled leprosy workers are indispensable. Especially for detecting and treating the silent neuritis which causes 85% of permanent nerve damage in South Asian populations. As many as 90% of patients regain nerve function with anti-inflammatory treatment: if, and only if, nerve damage is detected promptly. It is a serious error to deprive patients of mobile, trained and skilled leprosy workers.
It is good that we are discarding past errors to launch a new era of leprosy control. One based on close acquaintance with clues from the ground, and greater respect for the nerves of individual patients.
This new era enables us to rebuild timely access to high-quality leprosy services. We have been destroyers of services for long enough. Now we can become builders once again. That's how we will succeed.
Joel Almeida
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << editorlml@gmail.com
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