Leprosy:

[sdanyaro]

Source: By Tony Nwankwo
               Vanguard Newspaper
               Tuesday, November 12, 2002

LEPROSY (Hansen's Disease), a chronic, infectious disease that primarily affects the skin, mucous membranes and nerves, is not staging a comeback. Actually, the disease is caused by a rod-shaped bacillus, Mycobacterium leprae, which is similar to the bacillus that causes tuberculosis. It is much less common nowadays. From medical records, less than five per cent (about 10 million) of the world's population is susceptible. Leprosy is perhaps the least infectious of all known contagious diseases to the effect that newly diagnosed patients are seldom isolated. A leprosy vaccine is also currently under development. But that is all that can be said to be good about leprosy. Much of what the disease truly represents remains essentially bad. To Nigerians generally, leprosy, a disease of stigma, rejection and extreme poverty is bad news. Till date, the nation remains one of the few countries in the world where the disease can still be traced.

Leprosy is classified, according to symptoms and histopathology (abnormalities of tissue cells affected by the disease), as lepromatous, a generalized form; tuberculoid, a localized form; or dimorphous (borderline), a form between tuberculoid and lepromatous. Strong resistance to the disease is shown by the development of the tuberculoid form. Lack of resistance to the organism results in the lepromatous form, in which the disease attacks not only the peripheral nerves but also the skin, the extremities, the mucous membranes, and the eyes.

At the Yadakunya Leprosy Hospital, arguably the largest hospital for leprosy patients in the country, between 100 and 120 lepers are on admission at any point in time. Located on the outskirt of the ancient city of Kano, the 183-bed institution is a regular beehive of activities as it attends to hundreds of out-patients. This year alone, about 5,000 to 6,000 new leprosy patients have been discovered.

Monday, October 28, 2002, will remain evergreen in the minds of patients, staff of the sprawling institution following the symbolic presentation of a cheque of Euro 8,863.57 Euro cents by the Netherlands Leprosy Relief (NLR). Said Henk R. Plomp, NLR Representative in Nigeria, the amount was a charity donation to leprosy patients in Nigeria, from pupils of Laurentius School, Breda, in the Netherlands.

Making the presentation to the Medical Officer in-charge of the hospital, Dr. Tahir Dahiru, also Medical Adviser to the Netherlands Leprosy Relief, Plomp said although the donation was intended for leprosy patients across the country, the bulk was being given to Yadakunya because of the amount of work to be carried out in the hospital. According to Plomp, the35-year-old organization operates in 13 States in the country and has been supportive in providing transport and giving funds for maintenance of the vehicles. "Our experience has shown that providing the vehicles alone is not enough. If you give a vehicle, soon you will discover that it is in dis-repair, so you have to give funds for maintenance and for fueling. We are doing that for 13 States in the country", he said.

With assistance of the MOH , NLR has overhauled and resuscitated the giant generator that it now provides electricity for the hospital, rehabilitated the boreholes, long abandoned since its construction by the military administratin of Rtd. Col. Oneya. NLR has also provided drugs and machinery for construction and repairs of artificial limbs and other vital ancillary appliances for leprosy patients. It has equally trained staff who operate and maintain these equipment.

According to Dahiru, leprosy is contracted through droplet inhalation. What I mean here is somebody who has any form of leprosy when he sneezes or coughs out, the droplets from him can be inhaled by apparently healthy individual who now, depending on his level of exposure to micro bacterium may or may not contract the disease.

The minimum incubation period for leprosy takes about two years or even more than that. And the first clinical identification is usually a very light pigmented skin region which gets lighter than the surrounding skin. This can undergo spontaneous healing on its own. About 75 per cent of this stage will heal on its own without any treatment. The remaining 25 per cent now will decide to progress further and fall into one of the two classes we have at the moment. This lightly pigmented skin is usually lighter in the surrounding skin, and if you touch it with a gentle touch, using cotton wool, most often, the patient doesn't feel. Then as time goes on, the nerves too become involved. But the easily identified is the lighter skin region that doesn’t feel at all.

"In Africa, we have more of embitation (MB). What we mean by MB is multi-bacillary disease. The MB is due to the classification we adopt at the moment. The World Health Organisation (WHO) gave us a classification procedure. They classify leprosy into posit-bacillary and multi-bacillary. Posit bacillary stands for less number of bacilli in the body of that particular individual. A multi-bacilli, refers to active bacilli in that individual. What it means here, if you take a skin smear (that is a procedure we do in the laboratory), you take a skin smear from that particular individual, scrape a certain extent, then examine this under the microscope. If you see a bacilli at all, that patient qualifies to be a multi-bacilli patient. If there is none after scanning many marked skin, you don't see anything, the patient is classified as posit bacilli.

"But then, we have a problem. Our laboratories are not often reliable. But then we need to treat this patient because the classification into posit and multi helps you to treat the patient, and posit patients are treated for six months while multi bacillary patients are treated for one year. The WHO then came up with an advice. They say, okay, you count the number of skin diseases on this individual, if the patient has more than five skin lesions on his body, about six or above of these skin diseases, qualifies to be a multi-bacillary patient. Five and below five is posit-bacillary. Then again, in some instances with only one or two skin region, but you have multi-nerve too, which will be incorporated into classification procedure. So, anybody with five skin lesions or below five, and one only marginal nerve involvement, the person is posit-bacillary.

But if there is, for example, two skin lesions, but he has two and above nerve involvement, despite the fact that the nerve infected person has only two skin lesions, he is qualified to be classified as multi-bacillary patient. At the same time, if he has six and above with many nerve lesions, he is multi-bacillary. If he has six and above with only one emerging nerve involvement, he is still multi bacillary because of the number of skin lesions. So, going by this classification, we have more of the multi bacillary patients than posit bacillary.

"Usually, the public awareness campaign is what matters. If the public is aware, any light pigmented skin, is a suspect for leprosy until proven otherwise. That will go a long way to helping people to come forward for examination. The import of this is that any light pigmented skin area, that is lighter than the normal skin and and impervious to touch should give cause for concern. "Even if you feel it, it could be, you just come forward for final classification. The health workers are trained, they should be able to tell you if it is leprosy or not. As soon as you suspect you have the symptoms, doctors may not be the first to contact. You go to the nearest health centre."

In Nigeria, leprosy drugs are given in every Primary Health Care (PHC) clinic, including Kano State. There are also trained staff who examine the patient properly before coming up with the diagnosis.

"The people you see, the majority of them are not leprosy patients, When you say leprosy patients, these are the people who have the active disease, who are currently on treatment or trying to commence on treatment. The people begging for alms are people who have had leprosy in those days, what they are suffering for at the moment is the consequence of the disease. They are no longer a problem. Their only problem to society is that they go about begging because of disabilities and deformities they have."

The hospital staff try to manage the lepers' disabilities and deformities. These disabilities and deformities are the result of the nerve damage they had as a result of the disease. Usually, nerve damage is considered irreversible if it stays longer than six months.

Source: By Tony Nwankwo
               Vanguard Newspaper
               Tuesday, November 12, 2002

[Anonymous]

Not until I read up about Leprosy, ppl have brainwashed me since when I was a lil kid in2 thinkin havin Nono & Fura + Fish= Leprosy, ???

[Modibbo]

LOL, Think of all that you have missed!!!!!!.


Modibbo

[Blaqueen]

LOL, Think of all that you have missed!!!!!!.
Modibbo

eeeeeeeeeewwwwwwwwwwww........ but thats even sicker than leprosy itself... ugh.. nono and fish??????? tirrrrrrrrr....

[Anonymous]

Blaqueen I completely gotta agree with you.