by Najma Sadeque
Published in Karachi DAWN in English 21 Jan 1983 Magazine page I
Two-thirds of the new cases that are being detected are of Afghan refugees—the impact of which was first felt in 1980. Today the infectivity has more than doubled.
In olden-day Europe a leper was bound to ring a bell when he went out into the street to warn off people that he was passing through so that they could make themselves scarce. Unkind as this may seem, one could not entirely blame society as then neither did people know that leprosy was curable nor were distinctions made between infectious and non-infectious\ varieties.
Until today, through the lifelong dedication of two women doctors — Dr. Pfau and Dr. Zarina Fazalboy — leprosy in Pakistan had been completely controlled. Not only had the awareness that, they promoted ceaselessly, diligently, paid off so that increasing numbers came forward voluntarily for treatment, the record-keeping of patient treatment and history is as prodigious and meticulously detailed as is the relentless watch on patients so that they do not interrupt or discontinue treatment for lack of self-interest or carelessness, a tendency that is often there.
If statistics show there are more cases at present than before, it is not that the incidence of leprosy among Pakistanis is rising hut because that more have been brought to attention more easily — they were always there.
However, that is not the only reason. There is every fear now that this happy trend may be reversed. In fact, a “sieve action” seems to have begun already — the more locals that are being cured, the more outsiders, carrying infectious leprosy, seem to be pouring in, in droves.
That in itself is not a matter of concern since these self-same doctors under the wing of the Marie Adelaide Leprosy Centre have such a highly-organised leprosy monitoring and treatment network going. But then, dealing with leprosy also depends on awareness and willingness to be treated. And that, unfortunately, from the wave of leprosy-afflicted patients crossing over our borders, is not really forthcoming.
With the coming of the Afghan refugees, cases started trickling down from Peshawar while others were detected in Quetta and Manghopir. In Baluchistan two-thirds of the new cases that were being detected were of these refugees. Previously infectivity accounted for about 24 per cent of the cases, now it is 56 percent: more than doubled. This uncountable trend of leprosy is a threat not only because of being infectious in kind but also because the leprosy attending health workers are being deterred in their task.
One would think that the job would be simplified since most refugees are ensconced in camps, more so because the; camp commandants are extremely cooperative. But the problem, and a very serious one at that, is that the inmates are not. Apart from the reluctance to admit to an illness that still cries “taboo!” although facilities for cure or control are available, keeping records and follow-up of treatment is almost impossible with those wont to answer to different identities at different times with multiple passports!
The doctors express the possibility and willingness to at least tend to the stable inmates — women, older and disabled men and children — but even this; is being resisted. The menfolk will not permit other than women to attend to their womenfolk, and there are scarcely any female leprosy health workers around available for the purpose.
Leprosy has more or less been a runaway problem in Afghanistan. There is a Leprosy Department there, largely on paper. In 1966-67, before there were such pressing political problems, the Afghan Government had requested Dr Pfau to train their personnel for the control of leprosy. Unfortunately the language barrier arose. The personnel offered spoke only Farsi, and even for on-the-job training the Pakistani trainers would have had to be able to speak Farsi too. The only way out was for the Afghan personnel to come with a working knowledge of English or Urdu or at least any of the local languages. But nothing transpired thereafter.
All Dr. Pfau managed was to impart basic training through lectures and demonstrations. The West German Government had started two clinics in Afghanistan but with the opening up of hostilities and the conditions constantly fraught with risk to life and limb, they had no option but to pull out.
Not that there is no solution. There are funds available. Funds that can establish hospitals where leprosy patients can be housed or quarantined until the disease is brought under control. But unfortunately donors are less concerned about the threat of leprosy than about the hands into which funds to fight it have to be delivered.
It is a job few others apart from missionaries will gladly take up, and an unhealthy paranoia towards missionaries continues to exist. — Even though leprosy control is owed so much to them. Perhaps under the blessings of the W.H.O., there may be a way out. We hope.
FBIS – DefenseTechnicalInformationCenter http://www.dtic.mil/cgi-bin/GetTRDoc?Location=U2&doc=GetTRDoc.pdf&AD=ADA354453