This article was published in the March 2012 issue of the Tama Zenshōen Sanitorium�fs newsletter.

Tama Zenshōen Sanitorium is a 20-minute walk from Akitsu Station on the Seibu Ikebukuro Line in Tokyo. The facility is situated next to the National Hansen�fs Disease Museum, and its spacious gardens are famous for their cherry blossoms

September 2011, I visited Chhattisgarh State in the eastern part of India and Andhra Pradesh State in the south. The purpose of my visit was twofold: to visit colonies for current and former leprosy patients and their families, and to call on state leaders to improve the lives and living conditions of these people.

At the end of 2005, India achieved the World Health Organization standard for the elimination of leprosy as a public health issue (less than one case per 10,000 persons), and as of March 2011 the rate had fallen further to 0.69 cases per 10,000 persons. Nevertheless, India is a large country with over 1.2 billion people, and each year approximately 126,000 new cases are still being diagnosed. At present, there are 850 colonies where people affected by the disease and their families reside. Prejudice against leprosy sufferers is extremely deep-rooted, and these individuals and their families face severe discrimination on a daily basis. I have visited India over 40 times, but continued lobbying of the relevant Indian authorities and officials is needed to improve the situation.

The morning after my arrival in India, I flew to Raipur in Chhattisgarh and from there drove four hours to Bilaspur. Chhattisgarh is one of the less developed Indian states. Most of its roads are unpaved and filled with potholes. Here and there, herds of cattle can be found walking in the middle of the road and even napping. The cows pay no mind to automobiles, even when they pass right alongside them. The full-body �gmassage�h I got from this car ride and the scenes of cattle gave me the unmistakable feeling I was in India.

The area around Bramba Vihar Colony was waterlogged due to the heavy rains before my visit, and sanitary conditions were said to be poor. The colony was established in 1979 and is now home to 45 persons from 23 households. With support from the Leprosy Mission, a British organization that has been active in the state for over 110 years, residents have formed four self-help groups and set up joint bank accounts into which they regularly deposit their savings. While living conditions in the colony are far from good, it was clear that residents are well organized under their leader Chitra Singh. Introducing Mr. Singh to the president of the State Leprosy Rehabilitation Committee of Chhattisgarh, Mr. Ghasiram Bhoi, I encouraged the two to work together closely, stressing to them: �gBy combining your strengths, you can achieve more and your situation is certain to improve. I also pledged to them that I would do my best to help improve their living conditions. Mr. Singh reported that he had called on the government to improve drainage infrastructure to prevent flooding at the colony but had received no response. I encouraged him to work together with colonies dotted throughout the state to ensure that residents�f voices are heard.




Next I moved on to the city of Bilaspur to attend a meeting of 30 district officers for leprosy, which Chhattisgarh�fs state leprosy officer, Dr. D. Bhatpahare, arranged to coincide with my visit. I heard from Dr. Bhatpahare that the number of registered leprosy patients had decreased sharply from 11 persons per 10,000 people in 2001 to 1.46 in 2006, and since then has risen slightly to remain at the current rate of around 2.0. In India, only two states, Chhattisgarh and Bihar, have over 1.0 cases per 10,000 people. Chhattisgarh has the highest rate of infection, with over 10 new cases a year per 100,000 persons in 10 of the state�fs 18 districts. Various issues to resolve remain, such as reaching remote areas, reversing the decreased priority given to the leprosy program, and dealing with the lack of personnel. However, Dr. Bhatpahare was clearly committed to strengthening leprosy elimination strategies, focusing particularly on reconstructive surgery for deformities and support for former patients�f full participation in society. With an introduction from Dr. Bhatpahare, I also visited the home of Mr. Harilal Kumhar, a former patient who underwent reconstructive surgery on his hand and now makes a living as a potter. Although his small home is crowded with rows of his pottery, I was deeply impressed by his confident demeanor and happiness with his wife and three beautiful children. At the conference I told other delegates, �gAfter seeing how Mr. Kumhar has been empowered, I have reaffirmed my belief that supporting rehabilitation of survivors is our key responsibility.�h




After the conference, Mr. Bhoi and I met with the State Health Minister, Mr. Shri Amar Agrawal, on a day that happened to be his birthday. In terms of population, each Indian state is large enough to be considered a country. Further, as India is administered on a federal system, each state has ministers with great authority. The minister and with his daughter, a physician, promised to work with Mr. Bhoi, affirming their desire �gto make Chhattisgarh a model for leprosy programs.�h

The following day, September 23, we first drove for around one hour to visit Ashadeep Colony in Durg District, where the Sasakawa India Leprosy Foundation (SILF) is conducting a microfinance program. At the time of my visit, too, women were weaving rugs on looms bought with loans secured under the program. The rugs are woven from used saris, with five saris required to produce one rug. The women have even begun receiving orders from the government for rugs to be used in schools. Through these efforts, the women can earn around 4,500 rupees a month (approximately \9,000). One smiling participant told me, �gI�fve even begun to save some money.�h Other microfinance users have different occupations, such as making brooms or cleaning the streets, but all participants have honed money-making skills and are working to support themselves and their families. After school, the children also cheerfully helped with their parents�f work. Children from this colony have become doctors and engineers, and men from the colony have also gained enough social standing to marry women from outside the colony. Through their hard work, colony residents have dispelled stigmas related to leprosy and gained the respect of the general public. I have visited India over 40 times and seen over 100 colonies, but I feel this is the most successful colony. Mr. Vishwanath, the colony residents�f leader for the past few decades, was jailed 19 times for his activist struggle to improve life in the colony. Seeing Ashadeep�fs success, reaffirmed my commitment to raising India�fs other colonies to this level.

That same afternoon, NGOs involved in leprosy programs met for a workshop organized by the Leprosy Mission and the State Leprosy Rehabilitation Committee. The Leprosy Mission runs two hospitals and three vocational training institutes. It conducts reconstructive surgery and counseling, organizes self-help groups, and provides vocational training in fields such as computer use, weaving, and mechanics. Speaking at the workshop, Mr Bhoi said, �gAlong with continuing our advocacy efforts toward the government, we must also start our own income-generating enterprises.�h Referring to the Ashadeep Colony I had visited that morning, I said the following: �gThe colony residents have the will and the capacity to work but they just lack opportunities. If they are given the chance, they will achieve great results. In this very state, they have shown that hard work can transform a stigma into respect.�h

September 24 was the last day of my stay in Chhattisgarh. In the morning we took around a one-hour car trip to Santvinoda Leprosy Colony. This colony is located in a holy area where Chhattisgarh�fs largest river, the Mahanadi, converges with two other large rivers. Many colony residents are engaged in begging, and the colony is unsanitary. In stark contrast to the colony of hard workers I had visited the previous day, the residents at Santvinoda Colony looked downcast and there appeared to be no organization or leadership. Eliminating begging from India�fs leprosy colonies has been a goal for the second half of my life, but after visiting Santvinoda I felt the need to increase my efforts exponentially.

It was a busy day. I also visited the Jivodaya Dormitory for 400 schoolchildren affected by leprosy (from elementary school to high school), held a press conference on our activities in Chhattisgarh, met with other local officials, and was interviewed by a local newspaper. Although Chhattisgarh has the highest rate of infected persons in India, during this visit I was able to hold vigorous discussions with key persons, and I look forward to seeing continuing improvements in the living standards and in the lives of persons affected by leprosy in the state.

On September 25, I traveled by plane to Andhra Pradesh in the south of India. Upon arrival I immediately met with the press and set out on a three-hour car journey to Nizamabad. One region of Andhra Pradesh, Telengana, is campaigning for an independent state, and at the time of my visit, the movement�fs organizers had called a general transport strike and demonstrations were going on in urban areas there. Given this situation, Nippon Foundation staff had considered calling off my visit to Nizamabad. However, the locally elected member of Parliament, Mr. Madhu Goud Yaskhi, guaranteed my safety, and I was able to carry out my visit accompanied by a military escort.

At Niazamabad�fs Devanagar Colony, I received a big welcome from a diverse crowd made up of almost 200 residents, many reporters, and security personnel. After shaking hands with Mr. Yaskhi, I shook hands and individually greeted the people at the colony. Mr. Yaskhi did the same, while also expressing love and concern for them. The colony is home to 850 persons from 180 households. Most of the residents are engaged in agriculture or are self-employed, but around 10 percent are beggars. The youth run various types of retail shops with the support of their parents and have also set up various businesses with the help of microcredit from the Sasakawa India Leprosy Foundation. These businesses include hair salons, photo shops, laundries, small retail shops, and buffalo husbandry operations. After my talk, Mr. Yaskhi also spoke to the group. In his comments he said the following: �gI will work for an increase in pensions, improved roads and infrastructure, and employment opportunities for youth. Also, I have visited Japan twice as part of my exchange programs with the Sasakawa Peace Foundation and developed a deep concern for leprosy programs in the course of my exchanges with Mr. Sasakawa. I will set up an association of parliamentarians to fight for the elimination of leprosy related discrimination.�h




The next day Mr. Yaskhi invited me for breakfast at his home, and made a rousing speech at a seminar held that afternoon on the human rights of people affected by leprosy. The seminar addressed laws discriminating against people affected by leprosy in such areas as marriage, voting, and use of public facilities. Mr. Yaskhi announced: �gI will set up a bipartisan committee on the issue and take it to the Supreme Court. We do not need money. The important thing is to have empathy with people affected by leprosy. I will do my best to bring smiles to their faces and to allow them to live with dignity and hope.�h

There was also a meeting on the same day of 50 delegates, both men and women, from thirteen leprosy colonies. They reported on the difficult living conditions in their colonies. Andhra Pradesh has a total of 101 colonies, the most of all states in India. The colonies face a variety of issues in such areas as land and housing, roads and sanitation, pensions, and education; and the discussion got somewhat out of control. However, this sort of forum for exchanging views and information is extremely important, and the state is slowly but steadily becoming organized under the leadership of Mr. V. Narsappa. I urged participants to work together, saying: �gIf all 101 colonies stand together as a united force, you will make your voice heard. Stand together with your leader, Mr. Narsappa.�h Mr. Narsappa is also a trustee of the National Forum, an Indian organization that I helped to establish, made up of and intended for people affected by leprosy. In a strong appeal to the assembled colony residents, he stressed, �gWe must not rely on others, but stand on our own feet.�h

My next episode is somewhat off the subject of leprosy elimination. As we moved on after the meeting, our vehicle was caught up in the Telengana independence demonstrations. Completely surrounded by demonstrators, our vehicle was stuck. Army personnel, police, ambulances, and members of the media were all running to cover the demonstration. Following my motto, �gYou have to be there to understand,�h I squeezed through the crowd to the front of the demonstration. My Nippon Foundation staff escort walked behind me to avoid being noticed as he recorded the scene with a video camera. I noticed, in the midst of the crowd, a parliamentary member who had shared breakfast at Mr. Yaskhi�fs home that morning. Upon meeting, we shook hands, and he motioned for me to take a seat on the ground beside him. If I were to accept, I�fd be caught on TV camera, the only Japanese around, sitting in at the head of the independence demonstration. The government would probably label me a dangerous foreigner and refuse me future entry to the country. Visiting areas impacted by leprosy around the world, I run into situations I could never experience in Japan. Each encounter leads me to a deeper understanding of the local context, and further fuels my philanthropic efforts.

The next day, my last in Andhra Pradesh, I met with the CEO of the Society for the Elimination of Rural Poverty, Budithi Rajsekhar; Andhra Pradesh Minister for Social Welfare, Pithani Satyanarayana; and Andhra Pradesh Human Rights Commission Acting Chairperson, Kakumanu Peda Peri Reddy.

At all of these meetings, I was accompanied by Mr. Narsappa and other people affected by leprosy, and I made sure there were ample opportunities for them to speak directly with the officials. If the colonies make separate demands to the government, it cannot respond to all of them. In contrast, if the statewide representative of colony residents can identify priority issues and make appropriate demands to the relevant authorities, it is easier for the government to respond. During this visit I encouraged both leprosy survivors and government officials to take this approach in their discussions.

Leprosy organizations in Andhra Pradesh boast not only the most progressive programs in the country but a large number of young active colony residents. On my last day in the state, I attended a meeting of 20 young colony residents�|my first time to meet so many promising young residents together. Seeing their determination to help their parents, all of whom have or had leprosy, I hit upon the idea of setting up a youth section in the National Forum, as a nationwide organization of colony resident youth. If the educated youth unite and organize, they can make a great contribution to changing society.

On this trip, I saw a wide range of situations, from a colony where begging is the main source of income, to a colony where beaming residents work with pride and energy. Many excellent leaders of the leprosy survivors are fighting tirelessly to organize their communities. Although the situation differs from state to state, each state organization can learn from other states ways to develop strong leadership. By organizing together, the state organizations can pool their strength, improve public awareness of leprosy issues and of the National Forum, and improve the lives of all colony residents. Together with this country�fs leprosy survivors, I too will continue to visit India and work toward a world free from leprosy discrimination and a society where people are not forced to beg but can work and live with dignity.

The following is a reprint of an article that was carried in the February 2012 issue of Kikuchino, published by the National Sanatorium Kikuchi Keifūen.

In April 1909, the Kyūshū Leprosy Sanatorium was established by the seven prefectures of Kyūshū, the southernmost of Japan�fs four main islands. The facility was renamed National Sanatorium Kikuchi Keifūen in 1941; and today 359 men and women, averaging 80.6 years of age, live here.

Honmyoji Temple, located in the Kyūshū prefecture Kumamoto is dedicated to Kiyomasa Katō (1562�|1611), a powerful daimyō who rebuilt Kumamoto Castle in 1607. The temple is said to have attracted a large number of leprosy patients who made a living by begging for money from visitors. Hannah Riddell, a British woman who came to Japan in 1891 for the Church Missionary Society, founded Kaishun Hospital after witnessing their plight.

Riddell played an influential role in the history of leprosy in Japan. Her records and other documents are now on display at the [building that once housed] Kaishun Hospital. A book about her, Hannah Riddell: An English Woman in Japan, written by Julia Boyd, the wife of the British ambassador to Japan, was published in 1996 . It is a work that I would recommend.

Around the same time, in 1898, Father Jean Marie Corre, a French Catholic, built a hospital for leprosy patients in Kumamoto City called Tairoin Hospital. Today, a handful of people cured of the disease live there.



From July 17 to 21, 2011, in my capacity as WHO Leprosy Elimination Goodwill Ambassador, I visited the Central African Republic, a landlocked country in central Africa that borders Chad, Sudan, South Sudan, the Democratic Republic of the Congo, Republic of the Congo, and Cameroon. Though I have made many trips to Africa over the years, this was my first visit to this country.

The Central African Republic has an area of 620,000 square kilometers and a population of around 4.3 million. It is located close to the equator, and the southern part of the country is covered with rainforests and dense vegetation.

The country gained its independence from France in 1960, but the political situation has remained unstable because of repeated coups d�fetat and civil wars. In recent years, however, progress has been made in restoring order and stability.

As for religion, around a quarter of the population is Catholic, a quarter is Protestant, another quarter is Muslim, and a quarter is animist. The economy is primarily agrarian. Though there are diamond, gold, and uranium deposits, they have not been fully exploited because of political instability, and economic development has lagged.

In 2005, the national leprosy prevalence rate fell below 1 in 10,000, the level at which the disease is considered to be eliminated as a public health issue. However, the rate remains above that in 4 of 16 prefectures. And in 2010, 235 new cases were diagnosed, for a national prevalence rate of 0.52.

My trip to the Central African Republic was made for a reason. I had gotten word that the number of leprosy patients has risen slightly, something that could be attributed to the political instability as well as the lower priority the disease had in the government�fs health policies. I decided to go there and appeal for a renewed commitment to the fight against the disease.

I arrived in Bangui on the afternoon of July 17. When I stepped out of the airplane, I was struck by the blistering heat and blazing sun, making me acutely aware I was in the heart of Africa. A group of officials met me at the airport, including Public Health, Population, and AIDS Minister Jean-Michel Mandaba ; Social Affairs, National Solidarity, and Gender Promotion Minister Pétro Koni Zezé née Marguérite; Primary and Secondary Education and Literacy Minister Gisèle Annie Nam; and Dr. Zakaria Maiga, the World Health Organization country office representative. Local residents performed a dance to welcome me. A group of men and women affected by leprosy were also there to greet me, something that had never happened in all my years of traveling around the world.

Before leaving the airport, I was interviewed by the local media. I spoke about the reasons for my visit, explaining that the prevalence rate for the elimination of leprosy had been achieved, but more work was needed to completely eradicate the disease and root out discrimination. I also expressed my hope that public awareness of the disease could be improved, including the fact that leprosy can be cured, its treatment is free, and discrimination against leprosy patients is unacceptable.

That evening, I visited the WHO office and was briefed on the situation in the Central African Republic by Dr. Maiga and other officers. The Central African Republic�fs fight to eliminate leprosy is backed by the Swiss organization FAIRMED (formerly called ALES), a member of the International Federation of Anti-Leprosy Associations. The current initiatives, I was told, are targeted at Ombella-M�fPoko near the capital, Lobaye, Vakaga, and Haute-Kotto, the four prefectures with a prevalence rate above one in ten thousand.

In my comments, I stressed that the conditions were in place to root out the disease completely and expressed my hope that my visit as a goodwill ambassador would be useful for facilitating the work of the health ministry.

On July 18, I visited the Ministry of Health and spoke with Health Minister Mandaba. I expressed my gratitude for the tremendous efforts that had been made to eliminate leprosy in the country, despite the small number of patients and the existence of other diseases that need to be dealt with, including HIV/AIDS, malaria, and tuberculosis. I asked that WHO and the health ministry continue to work together to further reduce the total number of cases. Mandaba responded positively, stating he would join forces with WHO to eliminate leprosy in the four prefectures. My own impression was that the health minister, despite his youthful age of 41 years, was hardworking and a man of his word.

Following the meeting, we drove two hours west and visited the village of Kaka deep in a forest in Lobaye Prefecture. The prefecture has 280,000 people, 52 of whom are registered leprosy patients, which puts the prevalence rate at 1.84. The indigenous people here, known as �gpygmies,�h are short in stature and semi-nomadic forest dwellers. The prevalence rate is apparently higher among them.

Upon our arrival, the entire village, young and old alike, performed a spirited dance and sang songs to welcome us. About 50 of the village people are affected by leprosy. I shook hands and greeted them one by one. Many have a disability, and I could see their wounds were not being cared for properly. My heart ached for them and the hardships I knew they must endure.



For the past year, Belgian nurses have lived in the village and provided health care services. The nurses came to the Central African Republic in 1985, but when they visited the village a year ago, they were so shocked by the conditions there they decided to stay on there.

One villager, speaking on behalf of the patients, described the sadness he felt when he found out he had contracted the disease and his despair as the disease progressed, deforming his hands and feet. There was also a request for shoes because many villagers with leprosy walk around barefoot, leaving the affected areas uncovered and unprotected.

The health minister, who accompanied me on this trip, made a speech. He said that after seeing me interacting with leprosy patients, he realized it was crucial that he and his compatriots first do what they can to alleviate the suffering of leprosy patients in their country.

I also addressed the villagers and told them leprosy is neither a divine punishment nor a highly contagious disease. I stressed that medication is free and should be taken at an early stage to prevent disabilities from developing.

At the end of our meeting, the villagers danced, and I, along with a mayor from a nearby city and the health minister, joined in. I think that in a small way, I was able to convey my message that all people, whether sick or healthy, are brothers and sisters and must stick together.

The following day, July 19, was spent entirely in talks with government officials. The day began with a courtesy call on Prime Minister Faustin Archange Touadera. During our meeting, I urged the prime minister to support programs aimed at reducing the number of leprosy patients and enhancing public awareness of leprosy. The prime minister revealed that an anti-leprosy program is under consideration that encompasses various measures to improve the lives of people with leprosy, including housing for those who are cured but have a disability and assistance to allow children affected by leprosy to attend school.

Prime Minister Touadera, noting Nippon Foundation�fs involvement in agricultural programs in Africa, said that 80% of the people in the country are engaged in farming and that large-scale agricultural development programs are necessary to break the chain of poverty. I am in complete agreement with his view. I mentioned that an international symposium marking the twenty-fifth anniversary of Sasakawa-Global 2000, an initiative to increase food production, would be held in Mali in November 2011, and proposed that an official from the Central African Republic attend the gathering.

Following this, I met with Célestin Leroy Gaombalet, president of the National Assembly, and Zeze, the minister for social affairs who met me at the airport. President Gaombalet stated that it would be possible to consider legislation to ban discrimination against people affected by leprosy and increasing the budget for issues connected with leprosy. The social affairs minister, who oversees a broad range of issues connected with the elderly, people with disabilities, and discrimination, said the ministry would disseminate information to promote a proper understanding of the disease and help end discrimination.

On July 20, I visited the education ministry and met with three ministers: Higher Education and Scientific Research Minister Jean Willybiro Sacko, Technical and Professional Education and Training Minister Djibrine Sall, and Primary and Secondary Education and Literacy Minister Nam. Mr. Nam stated that younger children would be educated about leprosy, along with AIDS, malaria, and other public health issues. Mr. Sall, meanwhile, expressed concern that there is just one high school offering instruction in technology in the country, and that girls in particularly have few opportunities to get an education in this field.

I was also told by Mr. Sacko that there is just one university offering a general course of studies in the country, and that the number of enrollees had risen from 700 when the school opened 30 years ago to an estimated 20,000 for the coming term. He noted that farming techniques were being taught at the country�fs agricultural university, and this in turn was contributing to the country�fs development. The ministers�f comments made me acutely aware of the extraordinary difficulties of nation building within the confines of budget limitations.

For my part, I advised them that the vision of the educational system should be shaped by their own ideas of what is right for their country, rather than what other countries are doing. I stressed that people are the key to the future, but the cultivation of human resources is something that takes decades and whose progress unfolds slowly. As the old Chinese saying goes, �gIf you want a year of prosperity, grow grain. If you want 10 years of prosperity, grow trees. If you want 100 years of prosperity, grow people.�h Finally, I reiterated a point I had made to the prime minister, namely, that agricultural production and instruction in farming were the keys to alleviating poverty and achieving development.

My trip to the Central African Republic also included a visit to the UN Integrated Peacebuilding Office, where I exchanged views with Margaret Aderinsola Vogt, special representative and a specialist in human rights issues. I was able to report to her that after years of making calls in the UN Human Rights Council, which meets in Geneva, a resolution was adopted in 2011 by the council, through a unanimous vote of all 192 countries in the UN General Assembly, calling for the elimination of discrimination against persons affected by leprosy and their family members. I added that though the adoption of the resolution will not mean an end to discrimination, it does offer a means for approaching heads of state and media organizations and will contribute to changing laws and customs.

Ms. Vogt touched on the local belief in magic and the problem this poses for human rights, explaining that many people in the Central African Republic think those with a condition such as leprosy or a disability, as well as women who are ill, are under a spell. This, she lamented, is why they sometimes become the target of criticism and in extreme cases are killed. She stressed that we needed to ensure this does not happen and added that the scenes of me with leprosy patients in the media would go a long way toward overcoming discrimination.

The same day, I visited a health center in Darama district, about 24 kilometers away from Bangui. The center is one of the five leprosy clinics that have existed in the country. In 2000 it was integrated with a health clinic and has served both functions since then. At present, eight people are being treated for leprosy on an outpatient basis. Upon looking around, however, I could not find a single multidrug therapy medication, and I saw that patient records were incomplete. I was told that MDT was on order and the staff had fled because of the recent unrest. Of all the health clinics around the world I have been to, however, this was the first one that did not have MDT, and I could not help feeling that the struggle against the disease there is in limbo.

Later that afternoon, I held a press conference and recounted my four-day trip. Many media personnel had accompanied me during the trip, closely covering my arrival at the airport, the meetings I had with high government officials, and my visits to the health center and other facilities. I noted that the cooperation of the media is essential to finding a resolution to leprosy and related issues. Early detection and treatment, for example, are not possible if people are ashamed of the disease and try to hide it. Reintegration into the community is also not possible if people cured of leprosy are discriminated against. The medical and social dimensions of leprosy must be dealt with, and the media has enormous potential to serve as a catalyst for change in social attitudes. This was one of the things I touched on in response to their questions, in addition to requesting their continued cooperation in the future.

On the last night of my stay, I attended a reception hosted by the government. The president was not present, but Prime Minister Touadera was on hand, as were most members of the Cabinet were, along with a number of representatives of international organizations. I was presented with an award from the Central African Republic government for my efforts in fighting leprosy. The award gave me new motivation to remain passionate and unwavering in my fight against the disease. I believe, however, that the medal also honors all of the people who have been with me in this struggle, including officials from the WHO and the health ministry, NGOs staff, and, above all, the people affected by leprosy.



The poverty and suffering of the people affected by leprosy and the lack of MDT at the health center were painful reminders that there are still places that do not provide essential health services. During my trip I had a chance to meet many of the country�fs leaders, and I was encouraged by their show of support for the fight against leprosy. I strongly hope that my trip will serve as a springboard for cooperation by the WHO and the health ministry in eliminating leprosy in the four states where the prevalence rate is still high�|subsequently bringing the number down to zero and putting an end to discrimination. The trip provided me with the chance to renew my lifelong commitment to the fight against leprosy.

On January 28, 2012, I got up at 5 AM in order to make a one-hour flight to Pucallpa City, located in Ucayali Region in the Amazon basin. The purpose of my visit was to meet people affected by leprosy and express my solidarity with them. Ucayali is said to be the starting point of the Amazon River, but even at the headwaters it is wider than the mouth of the Tone River in East Japan. The mighty Amazon is fed by the Ucayali and Maranon rivers. Locals bemoan the fact that these two tributaries are not considered part of the Amazon, because if they were it would be the longest river in the world�|outstretching the Nile.




Peru�fs neighbor Brazil has the second largest number of leprosy patients in the world after India, and is the only country that has not effectively eliminated leprosy as a public health problem . By contrast, Peru has an extraordinarily low number of leprosy patients, with just 32 registered patients in 2011. However, many parts of the Amazon basin in Peru are inaccessible, so it is quite likely that many cases there have gone undiagnosed.

The director of the Hospital Amazonico de Yarinacocha explained that many patients live far away from the hospital and some have to travel hours by boat to get there. He spoke mournfully of the poverty of the patients, the local government�fs lack of awareness about the disease, and the absence of medical specialists .

During my visit, 20 people affected by leprosy gathered together to meet me. People of all ages were present, from their teens onward, but only the elderly showed signs of a disability, an indication of the steady progress that has been made in leprosy treatments.




The Amazonico de Yarinacocha Hospital was apparently once visited by the Argentina-born revolutionary Ernesto �gChe�h Guevara (1928–67). Che fought alongside the Cuban revolutionary Fidel Castro as he built up his forces in the Sierra Maestra mountain range in Cuba, before ultimately taking control of the country.

As a young student in medical school, Che traveled around South America on a motorcycle and by other means, documenting his experiences in a memoir titled The Motorcycle Diaries, which was later made into a widely acclaimed film. In the movie, Che swims across a river to visit a leprosarium in the Amazon basin in Peru and meets with patients there. He sits among them, treating them as he would anybody else, though at that time, in 1952, people affected by leprosy were still isolated and discrimination ran deep.

The leprosarium featured in the film is San Pablo of Iquitos in Loreto Region, about a four-day trip by boat from the hospital that I visited. Though it is no longer open, I would still very much like to visit it someday.

In addition to visiting the leprosarium, Che Guevara also came to the hospital for two days. I was told there is one person, still alive today, who met Che at the time. Unfortunately, a meeting could not be arranged because he lives in a remote region.

Che Guevara�fs meetings with people affected by leprosy no doubt touched him deeply and had a formative influence on his worldview.

I hope I have a chance this year to visit facilities in Russia, Ukraine, central Asia, Romania, Yemen, and other countries, and offer words of encouragement to the patients there.

The Drive to Root Out Leprosy in Malawi

National Sanatorium Suruga is one of 13 national facilities for leprosy in Japan. Founded as a leprosarium for wounded soldiers in June 1945, it was settled and built by people with a relatively mild form of the disease, who were brought in from Tama Zenshōen in Tokyo, Okukōmyōen and Nagashima Aiseien in Okayama Prefecture, Kikuchi Keifūen in Kumamoto Prefecture, Matsuoka Hoyōen in Aomori Prefecture, and Tōhoku Shinseien in Miyagi Prefecture. According to one account from the time, �gconvalescence�h was not what awaited the early residents, who �gengaged in construction work in extremely harsh conditions.�h At present, 86 men and women, averaging 80.7 years of age, live in the sanatorium. The following article was carried in the fall 2011 issue of National Sanatorium Suruga�fs newsletter.

***********************************************************

From July 13 to July 16, 2011, I traveled to Malawi in the southeastern part of Africa. This was my second visit there; my first was made 11 years ago, in 2000.

Malawi is a relatively small African country, with 15 million people inhabiting 118,000 square kilometers of land (roughly equivalent to the size of Hokkaidō and Kyūshū combined). Lake Malawi occupies a fifth of the total area and is home to many species of tropical fish and other living creatures.

Malawi is a peaceful, orderly society that has known neither civil war nor a coup d�fetat since its independence from Britain in 1964. Many people call it the �gwarm heart of Africa�h because of the warmth and friendliness of the people. About 75% of the population is Christian, and the official languages are English and Chichewa. Agriculture is the main industry, and the major crops include leaf tobacco, coffee, tea, cotton, and sugar. About 85% of the population is engaged in farming. In recent years, the economy has grown rapidly , but per capita gross national income is still just $290, and Malawi remains one of the least developed countries in the world.

In 1994 the national prevalence rate of leprosy in Malawi fell below 1 per 10,000 population, the level at which the condition is considered �geliminated,�h meaning that the disease is no longer a public health problem. Locally, the rate continues to be above that level in 4 of 26 districts. In 2010, 321 people were diagnosed with the disease, and the national prevalence rate was 0.5 in 10,000.

My trip to Malawi was prompted when I heard that because leprosy is no longer a high priority in the country�fs health administration programs, accurate patient data is no longer being collected and distributed, health authorities have stopped making regular visits to the districts to monitor and supervise the situation, health workers are not being educated sufficiently on the disease, and medium- and long-term strategies are not being formulated. I was also told that
the country does not have the human resources, funds, and supplies to implement necessary policies. Based on this information, I resolved to visit Malawi and do whatever I could to get the government to commit itself to the disease�fs eradication.

I arrived at Lilongwe International Airport on the afternoon of July 13. Since July is winter in Malawi and Lilongwe is located about 1,000 meters above sea level, the weather felt chilly, a contrast to the fierce heat and humidity in Japan. I was met at the airport by Dr. Storn Kabuluzi, the director of the Preventive Health Unit of the Malawi Ministry of Health, Dr. Kelias Msyamboza, the national professional officer of the World Health Organization�fs Malawi office, Dr. Landry Bide, the officer in charge of leprosy at WHO�fs Regional Office for Africa in the Republic of Congo, and Dr. ??? Shimizu , the officer in charge of tropical diseases at the same office.

As I was being welcomed at the airport, I noticed that the Nippon Foundation personnel who accompanied me seemed worried about something. As it turns out, nine of our ten bags were lost in transit. I have made many trips to Africa, but this is the first time that not two or three but nearly all of our bags were lost.

Before leaving the airport, I was interviewed by a local TV station. Asked why I came, I said that although leprosy had been eliminated as a public health issue, there was still work to be done to completely eradicate it and overcome the discriminatory attitudes toward people affected by it. I ended by stating my hope that a correct understanding of the disease could be disseminated among the public (including the fact that it is treatable and that medication can be obtained free of charge), and also emphasized that discrimination against patients should not be condoned.

That evening, Professor David Mphande, minister of health, hosted a dinner party for me at the hotel where I was staying, and we spoke about the situation in Malawi regarding leprosy. I first made the acquaintance of Professor Mphande in May 2011 at the World Health Assembly in Geneva, Switzerland, and he gave me a very warm welcome in Malawi. I was happy to learn that he very much liked a CD I gave him during our first meeting, featuring performances on the Stradivarius violins that are owned by the Nippon Music Foundation and loaned for free to aspiring young musicians. He also commented on the Sasakawa Global 2000 initiative to increase food production, which is popularly known as the �gSasakawa method.�h

Malawi was one of the first countries to attain the elimination target for leprosy, and today there are far fewer Malawians suffering from this condition than AIDS, malaria, and tuberculosis. It was clear from what he told me that the government continues to give it top priority and is taking steps towards its complete eradication. I expressed my respect for the initiatives taken while also underscoring the importance of both rooting out the disease and the discriminatory attitudes toward it.

The following day, July 14, we drove from Lilongwe to Balaka District, a roughly 230-kilometer, three-hour journey, to visit a leprosy colony in Utale.




On the way to Balaka, we passed stretches of land and mountains, trees and fields, and villages, and I was able to get a glimpse of how the people there live. Most of the houses had brick walls and a thatched roof. Power lines were rare. In reality 90% of all communities are not hooked up to the grid, and most people live without electricity and running water.

Balaka is a relatively small district with a population of 340,000. It has 31 registered leprosy patients (as of 2010) and a prevalence rate of 0.9 per 10,000 people, somewhat higher than other parts of the country. Utale, our destination, is a village in Balaka where leprosy patients and those who have recovered from the disease live.

The rehabilitation center was founded in 1946 as an isolation sanatorium by French Catholic missionaries , who had lived in the country since the 1920s. It is the only one of five leprosariums built at the time that is still open today. At present, 34 people live in the facility, and 43 others live outside it in the village. With the support of the church, Father Francis Kachere, who runs the center, plays a central role in building new houses and securing food supplies for the village, making it one of the best run communities of its kind in Africa.

While there, I had an opportunity to get to speak with individuals who have been affected by leprosy .




Young people diagnosed with leprosy generally do not end up with a disability because of early diagnosis and treatment. By contrast, the older people there tended to have a physical disability on their hands or feet, or a sight or hearing impediment. Many of these people had children or grandchildren, though, and were upbeat on the whole despite the difficulties they have faced.

This was not true of everyone, however. One older woman told me she fled neighboring Mozambique, where a civil war was being fought, and came to Malawi alone. Apparently, when her family found out she had leprosy, she was abandoned and, with nowhere left to go, she came to Utale. This woman had to endure the humiliation of discrimination on top of the disease and had suffered severe emotional trauma as a result. The experience strengthened my own resolve to continue fighting discrimination.

The history of humankind seems to be a cycle of discrimination against fellow men and women. Changing the way people think and act won�ft be easy. But by making use of the media and connecting with government officials, as I did on my trip, it may be possible to educate the public about the facts.

On July 15 I held a joint press conference with Professor Mphande, the health minister of Malawi. Staff from 15 television and radio stations, newspapers, and other media outlets attended the event. I started off by reiterating my hope for a better understanding of leprosy among the people of Malawi, and I recounted my impressions of the rehabilitation center in Utale. While praising the Malawian government�fs success in reaching the elimination goal in 1994, I noted that there had been a slight rise in the number of patients in recent years and expressed my hope that Malawi would find a way to completely eradicate the disease through its initiatives.


Health Minister Mphande stated that leprosy had been regarded by the Health Ministry as a top public-health priority for many years, and he described the initiatives taken to eliminate it. He added that though the number of patients was low, he was committed to doing what he could, from a humanistic perspective to bring down the total to zero.

My trip to Malawi made me realize that reaching the elimination target was one milepost but not the final goal, and that our next target�|of further reducing the number of patients�|will require steadfast dedication. I also reacquainted myself with the importance of educating the public and creating a base in society so that people with leprosy can return to the community and live their lives with dignity.

In February I had the chance to visit the Philippines to speak before some key people pursuing solutions to leprosy-related issues. This was a regional meeting of national managers in the World Health Organization�fs National Leprosy Programme, held in Manila thanks to efforts by the WHO and the Culion Foundation, an NGO in the Philippines actively tackling leprosy issues.

As I noted in my speech there, we are close to a milestone goal in the battle against leprosy, namely the reduction of leprosy cases to 1 per 10,000 population worldwide. This does not mean we will no longer face challenges, though. We will need to continue working on the social stigma associated with the disease, its economic impact on leprosy-affected individuals, and other related problems.

You can read the transcript of my speech here on our website. I hope you will keep in mind the challenges we have still to overcome in the field of leprosy.

A Chance to Speak to India�fs State Leprosy Officers

In 2005, the nation of India achieved the target set by the World Health Organization of reducing the number of leprosy cases to below 1 in 10,000 population. This was a great achievement, and everyone involved in bringing it about deserves praise for helping to do away with leprosy as a public health problem.

This does not mean, of course, that we are in a world without leprosy today. It is vital to ensure that reaching this milestone goal in countries around the globe does not lead those countries to ease off in their fight against the disease and against the social and economic issues associated with it.

This was the gist of a speech I presented to the state leprosy officers of India, who gathered in the city of Goa on February 9 for a two-day conference. You can read my comments here on our website.