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Last Updated: Tuesday, 3 April 2007, 17:37 GMT 18:37 UK
Leprosy 'could pose new threat'
By Fergus Walsh
BBC News, Medical correspondent

Mahamaadi
Mahamaadi is taking thalidomide
Leprosy is one of the world's oldest diseases - written accounts of leprosy in Indian Sanskrit date back to 600 BC.

India has been fighting hard to combat the condition and according to official records it has eliminated leprosy.

And yet the country still accounts for more than half the world's cases.

I went southern India to investigate this apparent contradiction.

Leprosy is very hard to catch. Most of us have a natural immunity to the germ responsible.

As soon as patients begin treatment, they can't pass on the disease.

But even though it has been curable for decades leprosy still carries huge stigma and the risk of discrimination.

Nerve damage

The disease causes nerve damage and creates what¿s called "anaesthetic skin".

Woman with damaged hands
Leprosy can cause severe disfigurement

If you can't detect heat, cold, or pain you run the risk of serious limb damage.

Repeated injury can mean people with leprosy lose fingers and toes.

That is why it is vital that sufferers are treated early - before they suffer permanent limb damage.

Multi-drug treatment with antibiotics for six or 12 months completely cures the disease, but many are left disabled.

Mahammadi was washing clothes on the stone floor of the courtyard when I arrived.

She has been cured of leprosy, but the disease damaged her immune system. She has infected lesions on her arms.

Infamous medicine

Mahammadi showed me the drug she was taking - called thalidomide - the most infamous medicine of the 20th century.

LEPROSY
Leprosy is caused by a mycobacterium - a germ
Most people have natural immunity
It is spread through prolonged personal contact
Leprosy is completely curable
15 million people have been cured since 1985
Nearly 11 million of that total have been cured in India

It caused birth defects when taken by pregnant women, but is now a specialist treatment for leprosy.

Mahammadi said the name "thalidomide" meant nothing to her, but the clinic had told her it was vital she did not get pregnant during the treatment.

Mahammadi's parents said they were praying that the marks left by leprosy would clear from their daughter's arms; otherwise it might be hard for her to find a husband.

The risk of social rejection is so great that many people cured of leprosy end up living in isolated settlements.

There are thought to be still more than 1,000 leprosy colonies in India.

Amputation

At the Shanthinagar colony outside Hyderabad I came across Laxmi. She was sitting in the shade bathing her feet.

The scent of jasmine hung in the air from the flowers tied in her hair.

She told me how, when she was 18, she was diagnosed with leprosy.

Her family were frightened they would get the disease and kept her in a room at the edge of the village.

"For the first few weeks I kept crying - and asking why me?" she said.

After six months in isolation she was taken away to a clinic and hasn¿t seen her family since.

The disease robbed the sensation from her right foot - and it became so damaged that eventually it was amputated.

While being treated she met her husband - also marked for life by leprosy.

More than 130 families live at the colony.

Begging

They survive on a meagre government pension which many supplement with weaving. But the main occupation is begging.

Patients with leprosy
Leprosy has a shattering impact on lives

Many of the disabled who stand outside the temples and at road junctions in Hyderabad carry the marks of leprosy.

One man, who had lost several fingers, told me that he rarely leaves the colony because people are so hostile.

"It's impossible to buy a drink at a café¿, he told me. "People cover their faces, and tell us to leave."

But there has been huge progress in the global fight against leprosy.

In the past 20 years 15 million people worldwide have been cured - the majority in India.

Recently India announced it had "eliminated" leprosy.

That is a pretty bold statement. If something is eliminated you might expect it not to be there anymore.

But according to a target set by the World Health Organisation elimination simply means there is now fewer than one case in every 10,000 people.

In the vast populace of India that still means there are more than a hundred and fifty thousand newly infected each year.

Not searching for cases

Leprosy may have been officially eliminated as a public health problem in India, but eradication is a different matter.

Dr Arunabala Chaudhry
Dr Chaudhry is worried about complacency

India has stopped actively searching for leprosy cases - instead relying on communities to recognise the disease.

The danger is that patients will either not realise they have the condition or be too scared to come forward.

Dr Arunabala Chaudhry works for LEPRA in India. She is worried that the disease may not get the attention it deserves in future.

"A few decades ago tuberculosis that is TB was said to be eliminated and the people became complacent and because the bacteria of TB and leprosy are similar so we find that if the complacency is there maybe leprosy will come back in the same way."

The Indian government says it is determined to wipe out leprosy, but the signs are that this ancient disease will continue to disfigure and disable well into the 21st century.




SEE ALSO
Leprosy is not dead
14 Sep 06 |  Health

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