Has the term "elimination" outlived its utility?
To the Editor:
Please permit us to make some more observations (arising from our combined experience of over 60 years in leprosy relief work) particularly relevant to India, which contributes 77% of active cases to the global pool of active leprosy cases. One to 1.5 million out of 2 to 3 million leprosy-disabled in the world are reported to live in India.
Dr. Yo Yuasa, who was the President of the International Leprosy Association for two terms, exhorted everyone to work towards a "World Without Leprosy at the International Leprosy Congress, Beijing in 1998. He defined this state as "a world without leprosy-related problems, both medical and social, emphasizing the point that it is not the disease per se but its related problems, mostly social but some medical, which require attention.
This slogan was, however, pooh-poohed by the World Health Organization (W.H.O.) and the W.H.O.-influenced governments and the "program managers, who were obsessed with the term "Elimination. The target year was 2000, which is now revised to 2005, when the mean prevalence rate of 1 case per 10,000 is expected to be reached. Unfortunately by then, the world will also be free from the so-called "Leprologists. The enormous funds still needed to do justice to the clinical problems related to leprosy and the rehabilitation of patients would have dried up. The "pool of leprosy patients with reaction, neuritis and its sequelae, and those needing rehabilitation contributing to the "disease burden in the community will far out number the active cases needing multi-drug therapy (M.D.T.) As yet there is no evidence of the much talked about secondary level and tertiary level "Referral Centers easily accessible to patients living in areas deprived of even basic health services, where the primary health centers with which leprosy is "integrated. Most patients and the health providers are not even aware of the technology to prevent the adverse progression of complications and palliative care of irreversible disabilities, let alone the concept of "Community-Based Rehabilitation.
It is strange that the same public health specialists who talk about "Elimination have now started fighting for "Human Rights of leprosy patients without even attempting to formulate a mass-based strategy for addressing the clinical problems of patients "released from control.
Perhaps they are waiting to celebrate the eventful day of 31 December 2005 to announce their "Victory over Leprosy before thinking of planning the secondary and tertiary level referral centers! It is time that the people, patients, and particularly the donors are made aware that this victory is by no means a victory over all leprosy-related problems, as enshrined in the definition of "World Without Leprosy. The donors are made to believe that with the magic word "Elimination, the disease is already on the verge of being wiped out.
Has not the jargon "Elimination of leprosy outlived its utility? Though it is rather late, should we not devise a more patient-friendly term for "Elimination that truly reflects the sincere attempt at the eradication of all ills afflicting the persons who have contracted specially the progressive forms of the disease?
- Dr. R. Ganapati,
- Dr. V. V. Pai
Bombay Leprosy Project