More than 213 000 people mainly in Asia and Africa are infected with Leprosy, with approximately 249 000 new cases reported in 2008.
Leprosy is a chronic infectious disease caused by Mycobacterium leprae, an acid-fast, rod-shaped bacillus. Leprosy impacts the skin, the peripheral nerves, mucosa of the upper respiratory tract and also the eyes.Leprosy manifests with a skin lesion - single or multiple, usually less pigmented than the surrounding normal skin. Sometimes the lesion is reddish or copper-coloured. A variety of skin lesions may be seen but macules (flat), papules (raised), or nodules are common and with definite sensory loss, with or without thickened nerves. Leprosy is also diagnosed with positive skin smears. Sensory loss is a typical feature of leprosy,
Leprosy has afflicted humanity for centuries. It once affected every continent and it has left behind a terrifying image. When M.leprae was discovered by G.A. Hansen in 1873, it was the first bacterium to be identified as causing disease in man. Treatment for leprosy only appeared in the late 1940s with the introduction of dapsone, and its derivatives. Leprosy bacilli resistant to dapsone gradually appeared and became widespread.The drugs used in WHO-MDT are a combination of rifampicin, clofazimine and dapsone for MB leprosy patients and rifampicin and dapsone for PB leprosy patients. Among these rifampicin is the most important antileprosy drug and therefore is included in the treatment of both types of leprosy. Treatment of leprosy with only one antileprosy drug will always result in development of drug resistance to that drug. (Source WHO, 2011)
Our trip to the Kein Khleang Center was extremely profound in understanding the far reaching implications that this disease has on the Cambodians. The Kien Khleang Centre was opened in January 2000 and operates as a free national referral centre for patients with leprosy complications as well as an outpainet centre providing free consultations for suspected leprosy. The center offers surgery (debridment of wounds, release of tendons and amputations), physiotherapy, medical management of the disease, food and child care. We met a family with three small children while we were at the centre who were intrigued by our camera and the instant pictures we were able to produce.
|Mary with Dr. Monica Joyner|
|Cathy with children who's young mother was afflicted with leprosy|
The Centre provides them with healing sandals but many patients only where them in the home because of the stigma associated with the sandals when they are out in the public. We couldn' t help but think of the similarities we face a home with our diabetic population and the lack of compliance to wear off loading footwear at all times. The Centre has a prevention focus providing patients with examples of proper footwear they can purchase at the market and gloves to protect their hands. Treatment of plantar ulcers includes twice daily soaking of feet in water for 20 minutes and then the application of cooking oil to decrease the dryness and cracking to the feet. In front of the Centre there were rows of wooden benches with bowls of water and several patients soaking their feet.
The Center has iron bed frames with wooden slates. Woven bed mats are used instead of a mattress and sheet. Clients stay at the centre for 40 days for treatment, education and rehabilitation. We wondered how these patients could tolerated lying on a wooden bed for 40 days, but it was apparent that there is no other options. This is such an extreme dichotomy to Western health care where there is a strong emphasis on patient comfort. We take for granted the ability to do laundry and disinfect mattresses. There is such a lack of resources here in Cambodia for health care.
We learned that many Cambodians have leprosy and are unaware that they have this chronic disease. Signs and symptoms present as aching joints or small skin discolorations that are dismissed as the flu or normal skin abnormalities. The loss of feeling in hands and feet are not understood by these people and injuries are treated at home. We were told by the Director of the Centre that many Cambodians self amputate fingers and toes at home because they are unable to get transportation for help or do not understand implications of the disease.
In 2010, 250 leprosy patients received treatment and 114 underwent surgery at the Kien Khleang Rehabilitation Centre. 259 leprosy patients were treated as outpatients. Because of much needed funding that was received last May the Centre Director was able to do a contact survey to go to homes of suspected families exposed to leprosy. Due to this survey, 100 people were discovered to have leprosy and treated successfully.
The deformaties caused by leprosy creates a stigma that erodes the confidence and abilities of patients and their families, thus denying them equal access to education and income-earning opportunities. The Centre helps patients continue to be productive members of society by providing them with loans and education to set up small business or provide skill re-training.
When we left the Centre we asked the Director what he needed to support the sustainability of the program. He stated he needed people to come for 3 - 4 months to provide treatment such as surgery and wound care. He needed supplies, such as gauze, self adherent wraps, cling and wound contact layers.
|Cathy and Mary with the manager of the clinic|
We thought of how a few resources could make a difference in the lives of people with leprosy in this country; a treatable disease that impacts the confidence and income earning potential of so many Cambodians, many who are unaware that they have the disease.