speaking to, expressed surprise — almost disbelief — when I said that leprosy was still with us.
"But I thought it had been wiped out", she said, "except for a few remaining small pockets that were being dealt with by a vaccine."
Many people share these and other misunderstandings about a disease that is not only still with us, but one that is now posing new problems for those who seek to treat the sufferer and control the spread of leprosy in the world. The situation has not been helped by a recent BBC broadcast that gave misleading impressions about the number of people affected and the dim prospects of successful treatment.
What is the truth about leprosy?
Do we really need a World Leprosy Day every year to remind us that the many sufferers from leprosy in the world need our compassionate concern as well as competent medical care?
Leprosy may not be the most widespread of the diseases that ravage the topics. It does not kill. Neither does it assume epidemic proportions, and, contrary to much popular opinion, it is not very catching.
But leprosy is still one of the most neglected of the scourges that threaten dwellers in the tropical countries. And it is one of the world's major crippling diseases.
We have had a good medicine available for treating leprosy for nearly 40 years, but it has not been given on a wide enough scale or at the right dose to people suffering from leprosy. It it had been given properly to enough people, then the deformities we associate with neglected leprosy would have been largely prevented, and the disease would have been controlled.
There was a snag about giving this one medicine alone in the treatment of leprosy, and that snag is now seen to be very serious. The tiny living germ that causes leprosy is developing resistance to this drug, dapsone, and in no fewer than 25 countries leprosy patients who have been treated with this drug, and who we thought had been cured, are now experiencing relapses, and the leprosy germs are multiplying in their bodies unhindered by the presence of the medicine they may still be taking.
This "drug resistance" as we call it, is making governments and missions re-appraise their whole programmes for leprosy control.
As if this drug resistance were not enough, another problem has recently appeared. The leprosy germs apparently have the capacity of becoming "dormant", that is, of going to sleep for months or years and then waking up and multiplying again. The patient who thought he was cured suffers a relapse.
These two unwelcome facts are at present throwing a cloud of gloom over the outlook for the control of leprosy in many countries.
What can be done about it? The only way of tackling these two problems is to give the patient three anti-leprosy medicines at the same time: this should prevent the emergence of leprosy germs that are resistant to any one of the three; it should also take care of those leprosy germs that become dormant.
There is, however, a reassuring aspect of these recommendations. With these new multidrug regimens now being advocated by the World Health Organization, the length of treatment advised will be reduced to six months only for patients who have some degree of resistance to the germs, and to two years for those who have no natural resistance.
This should make for a higher compliance rate for the patients, and hence a reduced case-load for the medical auxiliaries upon whom most leprosy control programmes rely.
The other current talking-point about leprosy is the possibility of a protective vaccine being developed. Despite much good work in many countries, and the discovery of some promising combinations now undergoing limited clinical trial, it will be several years before a proven, safe and specific vaccine becomes available for general use.
Meanwhile, the best hope for control is the widespread adoption of a programme of early detection, adequate supervised treatment, and education that will remove the stigma that still surrounds the disease.
Christian missions were in the forefront of alerting the world to the suffering of these afflicted by leprosy, and bring compassionate care to them. Then they helped to popularize . medical treatment when the new drugs became available. It was Christians who pioneered in applying reconstructive surgery to the deformities occasioned by neglected leprosy, and in the rehabilitation of the victims of leprosy into the society that had rejected them.
The present challenge is to integrate leprosy into the programmes of community health and preventive medicine now becoming popular, so that "Health for all by the year 2000" may include care and treatment for those suffering from leprosy_ Contrary to much popular thinking, then, leprosy is not yet conquered. Much remains to be done.
We need to discover the answers to such questions as: how does leprosy spread?, and why do some people catch leprosy after minimal exposure, whereas others don't after years of "close and intimate contact?" and what part was played by socio economic factors in the disappearance of leprosy from the world of the West?
Christian missions and Christian missionaries are still responsible for a high proportion of the three millions or so leprosy sufferers (out of a total of 12-15 million) who are actually getting treatment for the disease. No longer the only people in the field, they still have a strategic role in many countries, showing how a leprosy control programme can be implemented with compassion and cost-effectiveness.
As examples and catalysts, Christians can demonstrate that caring still counts in a medically competent programme for the treatment of sufferers from this ageold scourge.