The Drive to Root Out Leprosy in Malawi [2012/02/18]
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, “convalescence” was not what awaited the early residents, who “engaged in construction work in extremely harsh conditions.” 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’s 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’etat since its independence from Britain in 1964. Many people call it the “warm heart of Africa” 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 “eliminated,” 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’s 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’s 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’s Malawi office, Dr. Landry Bide, the officer in charge of leprosy at WHO’s 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 “Sasakawa method.”
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.
A visit to 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 .
Chatting with patients at the colony
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’t 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’s 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.