HEALTH: The ancient scourge returns

Meet Manang Rosa, whose family lives in a small bamboo house north of the town of Bansalan, Davao del Sur, about five kilometers away from the poblacion along one of the dykes that leads to the rice fields.

It’s Sunday and only four o’clock in the morning, but she’s already awake.  She has to prepare breakfast for her two sons and a daughter.  As she pulls her body across the split bamboo floor, her swollen legs and toeless feet are dragged behind like dead wood.

Manang Rosa lifts the boiling pot of rice from the fire with her bare hands and a large red blister readily appears, but she does not even notice it, she feels no pain.  She’s only in the fortieth year of her life.

An hour later, she calls everyone for breakfast.  One by one, they go to the table where the prepared foods are ready for eating.  Each one reaches for a spoon while Manang Rosa just lowers her head. Eight small stumps have taken the place of her fingers and once manicured nails.

After eating their breakfast, the father and the three children head towards the rice field for the harvest along the same path that their grandfather had walked years ago.  But Manang Rosa will remain at home, years ago she had come to face the reality that she will never harvest rice again.

As she sits in the window watching them leave, she prays that their fate will be different from her own.

Manang Rosa has leprosy and she’s not alone.  Although the ancient scourge is no longer a public health threat, it has not been completely eradicated from this part of the world.  In fact, more than 1,000 Filipinos still get infected with the disease each year, according to the Department of Health (DOH).

In Davao Region, leprosy cases go up by 39.2%: from 125 cases in 2016 to 174 cases last year.  Of those reported in 2017, 110 cases were new, the Davao Leprosy Control Program of the health department disclosed.

Davao Region is composed of five provinces: Davao del Sur, Davao del Norte, Davao Oriental, Davao Occidental and Compostela Valley.  Davao del Sur (from which Manang Rosa comes from) has been singled out as having the most number of new cases: 19.  In comparison, other provinces reported from as low as five cases to as high as eight cases.

Leprosy is endemic in the Philippines.  Although it is a curable disease, it still remains one of those diseases people don’t talk about.  As a matter of fact, misconceptions and false beliefs about leprosy still abound.

For instance, there are those who believe that leprosy is the result of eating chicken together with squash.  While this is not true, many families still never serve chicken and squash at the same time while dining.

Many think that living in close contact with lepers is dangerous since the disease can easily be transmitted from one person to another.  That is why many insist on confining the lepers together in one area, believing that this is the best preventive measure.

Unlike other diseases, leprosy is not hereditary.  The misconception of being a hereditary disease is may be due to the fact that young children get leprosy if their mother had the disease.  After all, the infectious mother breast-feed and sleep with her child, thus close intimate skin to skin contact takes place and, over a period of time, the disease may be transmitted from mother to child.

From ancient times and in virtually every culture, leprosy has evoked particular images of horror and fascination.  For no other illness have people been buried alive, burnt at stake, or given last rites for the dead before being expelled from walled cities with a bell and candle.  “For ages, leprosy remained a disease without hope,” one health official said.

The disease is as old as Biblical times.  In both the Old and New Testaments, leprosy was considered a punishment from God for sin.  The victim was said to be in a state of tsara’ath, or defilement.  This Hebrew term was later translated as lepros, from which the word “leprosy” came.

The bacteria responsible for the disease wasn’t identified until 1873. In one of his studies, Dr. Gerhard Henrik Armauer Hansen discovered the bacillus Mycobacterium leprae under the skin of his patients.  Finally, leprosy entered the realm of scientific scrutiny and was now called as Hansen’s disease.

“For want of anything better, since leprosy was now recognized as a communicable disease, communities went on isolating patients and continued to treat them with oil of chaulmoogra,” Prof. Michael F. Lechat, of the Catholic University of Louvain in Belgium, reported.  “It was a dark chapter in the history of leprosy.”

Like the other ancient scourge, tuberculosis, leprosy is transmitted through the air:  “inhalation of droplet from coughing and sneezing of untreated leprosy patient,” the health department said.

Generally, it is transmitted through close personal contact.  A casual contact with a leper will not lead to leprosy but a prolonged exposure may make a healthy person susceptible.  In addition, old age contributes to one’s susceptibility.

Fortunately, leprosy is slow to develop.  These are the signs and symptoms, according to the health department: long standing skin lesions that do not disappear with ordinary treatment, loss of feeling or numbness on the skin, loss of sweating and hair growth over the skin lesions, and thickened and/or painful nerves in the neck, forearm, near elbow and the back of the knees.

The Geneva-based World Health Organization (WHO) says that those diagnosed with leprosy usually feel self-pity, resentment, no sense of belongingness, feeling of rejection, isolation, and detachment.  Other behavioral reactions include frustration and depression, strong feeling of guilt, and repulsive and rebellious.

Lepers usually undergo a denial stage, which includes resistance to treatment even after learning that they have leprosy.  They also resort to divine intervention, pleading to God that He takes the disease away.  Most patients go through the “crying or anger stage” once they have confirmed that they could not escape treatment.  They feel deep sense of hopelessness, and many tend to be suicidal since they feel they are society’s outcasts.

After going through these emotional upheavals, the lepers usually go experience the stage of reconciliation, which involves acceptance, forgiveness and openness to others.

Until 1950, leprosy had no cure.  Then, Dapsone came into use.  Although the drug acted very slowly, it was at first effective, but after many years it was found that patients failed to respond because the leprosy germs developed resistance to it.

Fortunately, new and more potent drugs became available and the answer to drug resistance was found to be the treatment of patients with a combination of drugs.  This led to the WHO recommendations on standard treatment of leprosy through multidrug therapy (MDT) in 1981.

MDT involves the use of three drugs – Rifampicin, Lamprene, and Dapsone – against the more serious form of the disease, and two drugs against the less serious form.

“The global effort to eliminate leprosy as a public health burden has been successful over the years: from 5.2 million in 1995 to 213,036 at the end of 2008,” the WHO said, adding that the disease was eliminated in 119 countries out of 122 countries where it was considered a public health problem

In the Philippines, the establishment of the National Leprosy Control Program in 1985 brought the prevalence rate of the disease to 7.2 per 10,000 population.  Currently, the prevalence rate is further down to 0.31per 10,000 population.

Aside from Davao del Sur, among those with high prevalence rate of leprosy in the Philippines include the following: Ilocos Sur (Candon City, San Juan, Tagudin), Tarlac City, Nueva Ecija (Lupao), Metro Manila, Cebu City, General Santos City, Lamitan City, and Marawi City.

Government health officials urged Filipinos to help eliminate leprosy completely in the country.  Those who suspect they have been infected to immediately go to a government clinic or hospital.

“You don’t need to go to a sanitarium,” Dr. Francesca Gajete, a government health official during the Aquino administration, was quoted as saying Philippine Daily Inquirer.  “You can be treated as an out-patient.  The medicine is free and after just a day of treatment, you are no longer infectious.”

The MDT treatment, however, lasts 6 months for less serious form and 24 months for more serious form.  At the end of those periods, the cure is complete.

“A person may be completely cured but, if there has been severe damage to the limbs, that damage cannot always be put right,” argues John Bland, of WHO’s action program for the elimination of leprosy.  “So there will be a long-term need for rehabilitation and treatment for people disabled by the disease.”

In many parts of the world, those who are already cured from the disease may also have a struggle to reintegrate themselves into their communities.  A major problem attached with leprosy is its stigma.  Sometimes, this can be more threatening and troublesome than the medical implications of the disease.  The stigma dates back to Biblical times, people were cast out of society, draped in black with a bell around their neck, and proclaimed “dead from this day forth,” if they were thought to have leprosy.

Of course, this is no longer practiced, but in many cases the negative attitudes which still persist towards leprosy can be just as detrimental.  As one health official explains, “Once a leper, always a leper.  You lose your job, you lose your name, and you lose your self-worth.”