Leprosy spreads in Indian cities
In 2005 India declared leprosy eradicated, but in the last three years, doctors and associations has seen an alarming increase in the number of new cases in the city of Mumbai. Now, that all eyes and resources are directed towards other diseases, the bacteria Mycobacterium leprae is again free to spread in the slums and cramped alleyways.
A dead rat lies smeared on the street. The flies swarm in their hundreds around it and sits on the red, fresh meat. Not many yards from the carcass runs the open sewers through Dharavi slum. The stench is sweet and caustic, gets stuck in the nose and tears your throat.
Next to the dark murky water, the buildings stand close. Each reaching up two floors, their tin plates meet next doors tin plates and from the top floors dark openings ladder reaches out over the canal and down to the busy road. Out there naked toddlers, adolescents and adults mill around and between cars, carts and waste. Tall stacks of refuse are located on the canal bank and stop the waters flow. It has been thrown out of windows from Dharavi endless rows of shanty houses.
Not many places on earth inhabitants live as close as in Dharavi, Asia's largest slum. Located in the middle of Mumbai it spreads out over an area of 1.72 sq km and is home to no fewer than 600,000 people. Not that anyone knows exactly how many people live here, but it is the best guess the people of Bombay Leprosy Project can provide. They have worked here for 29 years, during which time they have fought to have leprosy among the district's poor under control. In December 2005, the Indian government declared the disease eliminated, but instead of celebrating the victory, the workload has risen, says leader Dr V V Pai and his staff. Disease is rampant in Dharavi’s dark and smelly alleys as the rubbish, poor living conditions and poor hygiene continues to bring out new cases.
"Since the disease was declared eliminated, resources were taken from the control of leprosy and given to other areas such as HIV and tuberculosis. The problem is there still are pockets in India where leprosy is rife, and therefore we see in these years a resurgence of the disease again. It will continue if no funds become available to us so we can continue the fight, "says Dr Pai.
The organisation is housed in a backyard in the neighborhood Chunabhatti not far from Dharavi. Along the road there are women selling vegetables or flowers, while the children play on the same parched land between the ramshackle buildings, such as dogs, cows and men use as a public toilet. The smell from the surrounding piles of waste are lingering due to the breeze, but nobody here seems to notice it anymore. Nor in the backyard, where a group of young doctors has taken place in a tent of black plastic. In drawings of leprosy symptoms attend to the patients in spite of the disease accompanying stigma has crept in here, giving advice and handing out medicine.
"Actually, public and private hospitals take care of leprosy patients on an equal footing with everyone else, because the disease is no longer something special. We have also tried to train staff in the surrounding area, but they're so overworked already, so we still have clinics around Mumbai and the suburbs. Especially in the slums however, we see a steady increase in the number of new cases, and it's worrisome, "Dr. Pai sighs before he inspects some great dry and discolored spots on a young man’s arm and elbow. That it is leprosy, the doctor is not in doubt about.
The tent in the backyard and clinics around the city is today what the association can afford. In the past they had carried out several surveys in the Mumbai slums to find the new cases and create awareness about the disease. In the slums with their hot and damp houses, it is indeed perfect conditions for the bacterium Mycobacterium leprae that causes leprosy, explains Dr. Pai as he shows around between Dharavis ramshackle houses. The poor here have no access to clean water, bathrooms or toilets, and since most do not get nutritious diet, then hits the disease more often here than elsewhere.
"Only five percent of all people are susceptible to disease. But it affects mostly the poor, because they live close together, and where there is dirt and unhygienic. But even here lives the stigma, "he says resignedly.
And this is precisely what keeps the disease alive. As long as infectious patients walk around in the slums without wanting a doctor, the disease will continue to be transmitted and make patients deformed. Dr. Pai sees it as the projects’s primary task to help those, who think they have the disease. For it is curable, and even very easy to stop.
Since 1995, a medical combination of drugs consisting of rifampicin, dapsone and clofazimine - also known as multidrug treatment or MDT - been available free from the World Health Organization, and it is effective. In milder cases, patients take one pill every day for six months while the progressive ones need to swallow them in 12. In spite of the simplified treatment and the fact that the disease is no longer infectious after taking the first pill, a heavy shadow still hang over those who have physical deformities after leprosy, explains Dr. Pai.
"Those are really scarred after the disease ends up in the leprosy colonies. There are four in Mumbai and four more in the suburbs. But once you have ended there, there is no turning back. And often the kids don’t either”
The social implications of the disease are therefore difficult to handle for those it affects and their families, as neighbors, friends and acquaintances denounce them. But there are bright spots, says Dr. Pai, before he pulls a worn curtain into a small street clinic to side.
Inside sits Devicharan Verma and his daughter. A large festering wounds on the 42-year-old man's right foot is being cleaned, and he gives a little sigh, because cotton ball has stuck in the open wound. The nerves in the foot are so damaged due to leprosy that it is not as bad as it seems, says Devicharan low while he moves around in the uncomfortable chair. And the alternative is that the foot at a time to be amputated, he knows.
Dr. Pai is an optimist. For the mere fact that Devicharan is here today with a family means, that they take care of him and he can get help. He is not ostracized like many others and by being open about the disease, it might get others in the same situation to come to the clinic. It is what is needed if the residents of Dharavi and its surroundings must be freed from leprosy and India really will eradicate the disease, says Dr. Pai, before he again wanders out into the narrow streets outside.
Facts: Leprosy in India
According to World Health Organization, in 2008 India was the country in the world with the highest number of new leprosy cases. With nearly 140,000 new cases of the disease the country far ahead of Brazil and Indonesia, who in the same year had respectively 39,000 and 17,500 new cases. Official figures show that the number of leprosy nationally is below one per 10,000, but in pockets like Dharavi and others the figure is closer to four or five per 10,000, says Bombay Leprosy Project.
It is the bacterium Mycobacterium leprae that causes leprosy. However, it is not the bacterium that causes the fingers and toes to "fall off". Instead, it is the damage in the body where the nerves are harmed, that causes amputations and bone injuries. Leprosy is treated with a mixture of rifampicin, dapsone and clofazimine - also known as multidrug treatment or MDT.
Facts: Bombay Leprosy Project
The association was founded in 1976 by Dr. Ganapati and aims to eradicate leprosy. More than 30,000 patients are cured over the last three decades at clinics of BLP. Worst is the situation in pockets in the city slums and rural areas outside Mumbai, where up to three out of every 1000 inhabitants have severe deformities as a result of the disease. For more information, see: www.bombayleprosy.org
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By Anna Klitgaard - writes from India