- Volume 68 , Number 4
- Page: 477–84
2000 Damien-Dutton Award
Dr. K. V. Desikan, shown here with his daughter Prabha, receiyes the 2000 Damien-Dutton Award from Wayne M. Meyers, M.D., Ph.D., President of the Damien-Dutton Society Board.
This department furnishes information concerning institutions, organizations, and individuals engaged in work on leprosy and other mycobacterial diseases, and makes note of scientific meetings and other matters of interest.
On 10 November 2000 at the Asian Leprosy Congress in Agra, India, Dr. Wayne M. Meyers, President of the Damien-Dutton Society Board, presented the Damien-Dutton Award for the year 2000 to Dr. K. V. Desikan, a famed leprologist in India.
In the span of 45 years of continuous leprosy work, Dr. Desikan has carried out several aspects of both medical and social work. In the medical field, in addition to the diagnosis and treatment of leprosy that he has always done. Dr. Desikan has worked in various other disciplines including minor surgery, epidemiology, pathology, immunology, microbiology and animal experimentation. Research and teaching were built in with this work. In the social field, he has been able to start, participate in and carry out several welfare activities for leprosy patients. All these activities are briefly described in the following resume.
Gandhi Memorial Leprosy Foundation (GMLF). Dr. Desikan joined GMLF in January 1952 under the "Life Workers' Scheme" -a scheme for workers devoting their lives to leprosy patients.
A new strategy of leprosy control by domicile chemotherapy was first conceived by GMLF. This program had no precedence and had to be tried with imagination, resourcefulness, tenacity and determination. An important part of the work which no one had done earlier was the systematic yearly house-to-house survey for active case finding. This was Dr. Desikan's substantial original contribution. Apart from a methodical and scientific approach, the work involved continuous visits to villages by foot, bicycle or bullock cart (there were no roads in those days), wading through rivulets, walking through slush, sleeping in sheds and eating simple food provided by villagers. The work was effectively carried out, and the experimental SET project of GMLF became the Indian National Policy for Leprosy Control, also adopted by the World Health Organization.
Treatment and management of leprosy cases in village clinics was an integral part of this work, and he also carried out minor surgeries in improvised operating rooms.
Also for the first time in India, training of paramedical workers was taken up by GMLF which he had to plan, organize and execute. Candidates from different parts of the country were deputed for the training. Courses for doctors were also conducted.
CMC Hospital, Vellore. Here, Dr. Desikan registered for an M.D. in Pathology and worked in the Pathology and Microbiology Departments. During this period, autopsy studies in leprosy-the first to be done in India-were carried out. Other work included studies on lymph nodes, nerves and eyes.
Central Leprosy Teaching & Research Centre (CLTRI), Chingleput. Dr. Desikan established the mouse foot pad model and work on experimental transmission of leprosy. This again was the first in India. (The laboratory at SLRT Institute was started almost simultaneously.) The occurrence of sulfone resistance in South India was proved.
He then took charge of the Pathology and Microbiology laboratories and carried out several studies in addition to providing service. For the first time in CLTRI, a fully fledged autopsy laboratory was started.
Central JALMA Institute for Leprosy (CJIL), Agra. Dr. Desikan took over as Director of CJIL under the Indian Council of Medical Research (ICMR). This Institute, started by the Japanese, was well equipped with an electron microscope and several other sophisticated instruments, but clinical work and patient attendance were low. He built up the clinical department, and the number of registered patients quickly rose from 7000 to 25,000.
His responsibilities were recruitment of scientific and other staff, planning of research projects, guiding research scientists and providing service to the leprosy patients. There were practically no scientific publications before he took over, but very soon CJIL had found a place on the international map of leprosy research institutions.
An important chapter in the development of CJIL was the scientific liaison established with institutions in the U.K., U.S.A. and Japan, and Dr. Desikan was fortunate to get a very good response, cooperation and help from several scientists in the three countries widening the horizons of the CJIL scientists.
With LEPRA at Sevagram. In Sevagram, he established a Leprosy Histopathology Referral Centre in Mahatma Gandhi Institute of Medical Sciences (MGIMS). He was appointed Emeritus Professor of Pathology and a member of the Research Committee of the Institute for Tropical Diseases by MGIMS.
As Chairman and Medical Consultant of LEPRA-India, Dr. Desikan shoulders the responsibility of antileprosy work in India by LEPRA U.K. He started the MDT program on national guidelines, and during the 9 years of work LEPRA-lndia has covered a population of 1.5 crores, registered nearly 2 lakh patients and cured nearly 1.5 lakh patients. In Orissa, which is the state with the largest number of patients, LEPRA has taken the responsibility of starting many projects and coordinating antileprosy work.
Most of Dr. Desikan's time now is spent in guiding the work of LEPRA-India, particularly in the tribal districts of Western Orissa, which is a hard and challenging task but results are very encouraging.
The Damien-Dutton Award plaque presented to Dr. Desikan reads as follows:
THE DAMIEN-DUTTON AWARD
For the year 2000
Presented to
DR. K. V. DESIKAN, M.D.
For a lifetime of devotion and sacrifice for the victims of leprosy in India. Dr. Desikan was personally involved in every aspect of the problem; medical care, education, social and physical rehabilitation and research. He is an exemplary representative of the love for the victims of leprosy as emulated by Father Damien and Brother Dutton.
Asian Leprosy Congress
November 2000 Agra, India
Previous Recipients of the Damien-Dutton Award
| 1953 | Stanley Stein, U.S.A. |
| 1954 | Rev. Joseph Sweeney, KOREA |
| 1955 | Sister Marie Suzanne, FRANCE |
| 1956 | Perry Burgess, U.S.A. |
| 1957 | John Farrow, U.S.A. |
| 1958 | Sister Hilary Ross, U.S.A. |
| 1959 | Dr. H. Windsor Wade, PHILIPPINES |
| 1960 | Mgr. Louis Joseph Mendelis, U.S.A. |
| 1961 | Dr. Kensuke Mitsuda, JAPAN |
| 1962 | Rev. Pierre de Orgeval, FRANCE |
| 1963 | Eunice Weaver, BRAZIL |
| 1964 | Dr. Robert G. Cochrane, U.K. |
| 1966 | Peace Corps, U.S.A. |
| 1967 | Dr. Howard A. Rusk, U.S.A. |
| 1968 | Dr. Franz Hemerijckx, BELGIUM |
| 1969 | Dr. Victor George Heiser, U.S.A. |
| 1970 | Dr. Dharmendra, INDIA |
| 1971 | Dr. Chapman H. Binford, U.S.A. |
| 1972 | Dr. Patricia Smith, VIETNAM |
| 1973 | Dr. Jacinto Convit, VENEZUELA |
| 1974 | Dr. José N. Rodriguez, PHILIPPINES |
| 1975 | Dr. Oliver Hasselblad, U.S.A. |
| 1976 | Dr. Yoshio Yoshie, JAPAN |
| 1977 | Drs. Paul and Margaret Brand, U.S.A. |
| 1978 | Dr. Fernando Latapi, MEXICO |
| 1979 | Dr. Stanley G. Browne, U.K. |
| 1980 | Robert Watelet, ZAIRE |
| 1981 | American Leprosy Mission, U.S.A. |
| 1982 | Dr. Ma Haide, CHINA |
| 1983 | Murlidhar D. Amte (Baba Amte), INDIA |
| 1984 | Mother Teresa, INDIA |
| 1985 | Dr. John H. Hanks, U.S.A. |
| 1986 | Samuel J. Butcher, U.S.A. |
| 1987 | Dr. W. Felton Ross, U.S.A. |
| 1988 | Hermann Kober, WEST GERMANY |
| 1989 | Catholic Medical Mission Board |
| 1990 | Dr. Wayne M. Meyers, U.S.A. |
| 1991 | Dr. Ruth K. M. Pfau, GERMANY |
| 1992 | Anwei Skinsnes-Law, U.S.A. |
| 1993 | Dr. Charles K. Job, INDIA |
| 1994 | INTERNATIONAL JOURNAL OF LEPROSY, U.S.A. |
| 1995 | Dr. Joon Lew, REPUBLIC OF KOREA |
| 1996 | Richard Marks, U.S.A. |
| 1997 | Roy E. Pfaltzgraff, U.S.A. |
| 1998 | Jean Margaret Watson, U.K. |
| 1999 | Sister Margaret Anne Meyer, NIGERIA |
India. 1CMR Annual Report 1998-1999. A copy of the Annual Report 1998-99 of the Indian Council of Medical Research in New Delhi has been received. We quote from the Leprosy section of the report:
"With the introduction of multidrug therapy (MDT), it has been possible to reduce the load of leprosy cases in India under the National Leprosy Eradication Programme (NLEP) and a target has been fixed for attainment of prevalence less than 1 case per thousand population by 2000 A.D. However, the new case detection rate has not shown much change indicating that the incidence of the disease has remained almost unchanged. Several problems such as specificity of diagnosis and complications like nerve damage and disabilities still persist. The Council's Central JALMA Institute for Leprosy (CJIL), Agra and its Field Unit at Avadi continue to focus on various clinical, therapeutic and laboratory studies aimed at a better understanding of leprosy, its causative organism and improved methods of diagnosis, treatment and prevention.
Immunoprophylaxis and immunotherapy
A comparative trial of various candidate leprosy vaccines viz ICRC, Mw and a combination of BCG and armadillo derived killed M. leprae (along with BCG and normal saline used as control), was continued at the CJIL Field Clinic, Avadi. All the vaccine candidates were found to be safe for human use and there was no instance of serious toxicity or side effects subsequent to vaccination for which premature decoding was required. Observed incidence rates were not sufficiently high to ascertain the protective efficacy of the candidate vaccines against progressive and serious forms of leprosy. BCG + killed M. leprae provided 64% protection, ICRC provided 65.5%, Mw 25.7% and BCG provided 34.1% protection. Protection observed with the ICRC vaccine and the combination vaccine (BCG + killed M. leprae) meets the requirement of public health utility and these vaccines deserve further consideration for their ultimate applicability in leprosy prevention.
Immunology of leprosy
IgG subclasses against lipoarabinomannan (LAM) were quantified in leprosy patients with ENL reactions and reversal reactions. The level of IgG has been observed to be significantly more in reactional patients than in BT/TT patients. There was a significant reduction in IgG3 levels in ENL cases when compared to that of BL/LL patients.
Studies to compare the sensitivity and specificity of antigen and antibody detection with PCR have shown that detection of antigen is highly sensitive and specific whereas there are some problems of false positivity with antibody detection. Further studies to ascertain the reasons for this have been initiated.
Studies on drug metabolism and drug permeability
In vitro studies on drug permeability indicated that rifampin and dapsone did not influence the permeation of each other suggesting different permeability mechanisms for these drugs. Permeation of rifampin was observed to be temperature dependent. Further, in experiments on non-tuberculous mycobacteria, synergism among rifampin, clarithromycin and minocycline was recorded. These drugs were found to be quite effective in case of both the rapid and slow growers. Investigations on the molecular basis of these observations have been initiated.
Studies on viability
During the year studies on detection of persisters in patients treated with different duration of MDT continued using mouse foot pad and ATP bioluminescence; persisters were observed in a significant number of such cases confirming the trends reported earlier. Attempts to establish rRNA based systems for viability determination for monitoring drug therapy have progressed. Further testing of techniques based on quantitative hybridization were also continued during the reporting period. Expanded studies have confirmed that rRNA based techniques are useful in monitoring the therapy responses.
Miscellaneous studies
Studies on the epidemiology of disability due to leprosy in an MDT district of Varanasi were completed at Banaras Hindu University, Varanasi. Most of the patients with disability had a long duration of disease. Half of them had disease for over 5 years before starting MDT, one fourth had the disease for 3-5 years. The results indicated that disability rate is 5 to 7 times more in MB cases. The deformities progressed during treatment which could have been reduced if proper care and monthly examination of patients was done in actual practice. The results of the study also confirmed earlier findings that if treatment is initiated within 6 months of development of the disease, the disability can be prevented.
A pilot project to study the feasibility of integration of NLEP activities with primary health care services following multidrug treatment was recently completed at the Central Leprosy Teaching and Research Institute (CLTRI), Chengalpattu. The training requirements of the multipurpose workers and supervisors in PHCs were assessed and a manual for training of the staff based on the identified tasks and background knowledge was developed. The training period for NLEP staff was 5 days.
The training methodology involved lectures, demonstration, discussions and field exercises. It was observed that a 5 day training program for general health personnel in leprosy was feasible. Average training gain in the group was 13.4%. The leprosy control activities of this study area were handed over to the PHC staff and the NLEP staff were withdrawn. The study demonstrated that well trained PHC staff with adequate supervision and monitoring can carry out the NLEP activities."
India. LEA established in Chennai. A new nongovernmental organization (NGO) by the name of the Leprosy Elimination Alliance (LEA) has been launched in Chennai (India) recently. The main objectives of the organization, set up in August 2000, with a special focus on India, are: a) to promote and advocate the cause of leprosy and leprosy elimination, b) to promote exchange of information and ideas on leprosy elimination among leprosy workers and others, c) to monitor progress toward leprosy elimination and assist toward development of better strategies and methods to achieve the goal in collaboration with other interested parties, and d) to produce and distribute among leprosy workers and others publications on leprosy elimination.
As part of its objectives LEA expects to produce and distribute a quarterly publication entitled Bulletin of Leprosy Elimination Alliance by the beginning of the year 2001. The publication will be available free of cost to all those interested in leprosy elimination. The chairman of the Leprosy Elimination Alliance is Dr. S. K. Noordeen, formerly Director of the Action Programme for Elimination of Leprosy at the World Health Organization headquarters in Geneva.
Further details on the NGO and its publications can be obtained from: Dr. S. K. Noordeen, Chairman, Leprosy Elimination Alliance, Flat 1-A, K.G. Valencia, 57, 1st Main Road, Gandhinagar, Chennai 600 020, India. Phone: 91-044-4456337, Fax: 91-044-4456338, e-mail: noordeen@eth.net
India. SLRT&C, Karigiri, 2001 Course Schedule. We have received the following 2001 Course Schedule for the Schieffelin Leprosy Research & Training Center in Karigiri from Dr. N. B. Baktha Reddy (see pages 482-483).
The Netherlands. Buhrer-Sekula defends thesis. On 20 December 2000 Samira Buhrer-Sekula defended her thesis entitled "A simple dipstick assay for leprosy: development, evaluation and application" for her Ph.D. from the University of Amsterdam.
"Although many studies were performed using ELISA for the detection of IgM antibody to PGL-I, this assay is too complicated to be applied in most areas where leprosy remains a public health problem. In order to simplify the use of serology in leprosy control a simple assay is urgently required. This thesis describes the development, evaluation and application of a sample dipstick assay (ML Dipstick).
"Chapter II describes the development of the ML Dipstick for the detection of IgM antibodies to PGL-I of M. leprae in serum. The test does not require any specialized equipment and the highly stable reagents make the test robust and suitable for use in tropical countries.
"Chapter III describes a further simplification of the ML Dipstick assay by using whole blood and an evaluation of the assay performance in the leprosy-endemic area of Amazonas in Brazil.
"Chapter IV shows how ML Dipstick could contribute to improved classification of leprosy patients for treatment purposes. In this chapter the results of ML Dipstick were combined with clinical classification by counting the number of lesions. Results were compared with the classification based on the bacteriological index.
"Chapter V investigates whether ML Dipstick is capable of identifying patients with a higher risk of relapse after treatment. With the integration of leprosy control into the general health system, diagnosis and classification will be primarily in the hands of less experienced professionals. Misclas- sification leads to a higher risk of relapse. Identifying those patients who have high antibody levels would in all probability recognize patients who have a high bacterial load and consequently should receive longer treatment.
"Chapter VI shows the results of an epidemiological study performed in Brazil using ML Dipstick for the detection of seropositivity among 7073 school children in three different leprosy-endemic states. It was examined whether seropositivity rates could be related to leprosy detection rates and thus to be used as an indicator of the magnitude of leprosy problem in the community. As such it would be useful to evaluate the effect of control measures.
"Chapter VII gives a summary and the main conclusions of the study."-From the Outline of the Thesis, p. 26
U.K. ILEP Catalogue of Training Courses 2001. The new ILEP training course catalogue for 2001 has been received. It "brings together information on international courses and in-service training available to health workers. Training courses on leprosy, tuberculosis, dermatology, health management and community based rehabilitation are included. This reflects the diversity of the work supported by ILEP Members.
"We would like the information provided to be as comprehensive as possible and for this we rely on information and feedback from ILEP Members, Training Centers, Course Organizers and Participants. We thank all those who have contributed toward this latest edition.
"If you would like information on your training center and the courses you run to be included in this catalogue please use the form at the end of the present catalogue (page 29). We also welcome any suggestions on how this catalogue can be made more useful.
"Inclusion of a training course in this catalogue does not signify its endorsement by ILEP. Also please note that ILEP is not a funding agency and cannot consider sponsoring trainees. For further information please contact the training centers directly or ILEP.
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"The information in this catalogue is available on the Internet and on the ILEP web page. Please visit us on www.ilep.org.uk."- From the Introduction