Sunday, February 21, 2016

Hansen's disease in ShagriLa

AlJazeerah has a nice article about Nepal's busy Leprosy hospital.

Despite the very low risk of infection, the stigma surrounding the disease can be extreme in Nepal. Patients are often isolated and abandoned by their families and communities in a country where the law prohibits infected people from working or marrying. In some rural areas, the disease is considered a curse from God as a punishment for sins committed in a former life.
a similar stigma is found in India, and was present in Europe and in the Bible.

Why? It is not very infectious, but it spreads quickly to children by skin to skin contact, and it leads to deformities that are ugly.

the clinic was founded by a British nurse, but the head doctor now is a local whose parents had the disease and he was raised in a lepersarium.

the disease is easily treated as an outpatient in places like Africa, where the stigma is less, but there is a need for inpatient treatment due to comorbidity (secondary infections of their wounds of example) and need to insure folks take their medicine (similar reason for TB hospitals). They also need specialized rehab work for their injuries and medical problems.

I say only one (mild) case in Zimbabwe, where outpatient treatment wiped it out, but there were still imported cases from Mozambique.

But there might be another reason for isolation.
Sister Humberta, one of our older nurses, had worked in one sanitarium. Once, when I had a patient with ulcers etc. and I asked her opinion if it was Hansen's disease, and she said no: It didn't stink like Leprosy. (it turned out to be ulcerated Kaposi's sarcoma, probably from HIV, which back then was not yet known about).

And in Liberia, I knew the doctor who ran the Hanson disease outreach. She had gone into easier work after the stress of working as a surgeon through the Nigerian civil war, and gotten her PhD in public health. Her job was to go to villages and find cases and put them on treatment, and then check them every three months or so that they were taking the medicines etc.

The outreach was funded by the Knights of Malta, a group beloved by conspiracy theorists.

The truth is more mundane: They are an "independent country" (which is now a mansion in Rome) and they issue their own passports.  UKIndependent article about that group.

. The 118,500 members, employees and volunteers are now in the charity business, working or supporting aid projects in some 120 countries on an annual operating budget of more than £150million.
Haiti, the Democratic Republic of the Congo, and most recently the Philippines, have all been recipients of its emergency relief. Most recently, it even started projects in Turkey, many of which support Syrian refugees, meaning that the eight-pointed Maltese Cross has returned to the modern incarnation of its old enemy.

y es, but conspiracy theories are more fun!

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