Leprosy Elimination Activities in Egypt and Lebanon

I visited Egypt and Lebanon between December 13th and 16th, 2010.
The main aim of my trip was to visit leprosaria in Egypt and to exchange views with the Ministry of Health and the WHO's Eastern Mediterranean Regional Office (EMRO) there on leprosy elimination activities as well as to attend the conference hosted by EMRO in Lebanon.

Egypt had achieved the WHO�fs standard for leprosy elimination (less than one case per 10,000 population) in 1994 at the national level. In 2009, there were 700 new cases of leprosy and at the end of that year, the number of registered patients was 912, making for a prevalence rate of 0.13 per 10,000 population. In Egypt, the leprosy burden is heavier in the upstream region where five provinces are yet to achieve the elimination target than in the densely populated Nile Delta region where Cairo and Alexandria are located.

On the morning of the first day, I visited a leprosarium in Abu Zaabal in the north of Cairo. This leprosarium is a public hospital set up as compulsory lifetime isolation facilities (at the time of establishment). Currently it houses approximately 700 residents affected by leprosy (35% of them women). The site can be divided into three main sections; the central area with clinics and pharmacies, and two hospital wards; one for men and the other for women. It was a sunny cloudless day and residents looked contented basking in the well-tended large garden, and maybe due to many long-time residents, it looked more like an old people�fs home with medical facilities than a hospital. What struck me most was that while the residents were expressing their gratitude to the medical staff and pleasantness of the facilities. When I asked whether they wanted to go home, they answered murmuring, �gNo, I don�ft want to go home, there is no place to go back�h. When I was later interviewed by CNN, I commended the leprosarium for the good environment it offered, even on a global level, with clean facilities and medical staff well-liked by the residents. However, quite frankly, I do not wish these medical facilities to be their �gpermanent home�h. Residents have families. Once cured, they should spend their future with their families. Yet they do not wish to return. That is because the society discriminates and rejects them. Their families can warmly welcome them home only when prejudice and discrimination have been eliminated from the society. Unfortunately, in the world today, despite the fact that most patients are completely cured of leprosy, discrimination against them still persists. My efforts to eliminate the disease and discrimination will not cease till they are able to live with their families without fear and rehabilitated into society.

That afternoon, I called on the WHO's Eastern Mediterranean Regional Office (EMRO). EMRO is one of the six WHO regional offices, which oversees North Africa, the Middle East and West Asia. There are 22 countries from Morocco to Pakistan in the region, all of which have achieved leprosy elimination target (less than one registered case per 10,000 population). Another thing that characterizes this region is that there are countries plagued by civil wars and political uncertainties such as Afghanistan, Somalia, Sudan and Yemen. As I was due to attend a conference hosted by EMRO in Beirut, Lebanon at a later date, we had a briefing session and exchanged our views on leprosy in the region, at the office.

The following day I visited Egypt's second largest city, Alexandria, about 200 kilometers from Cairo. Alexandria is a port town on the Mediterranean Sea, and it is a historic and a very beautiful city known as �gThe Pearl Of The Mediterranean�h. My destination was Amria leprosarium in the southwestern part of the city. Buildings of the leprosarium were surrounded by thick and imposing walls as they were renovated British Army barracks from the colonial period. I was told that facility housed around 200-250 residents at its peak time, about 10 years ago, but today there are only 20 residents with still about 4 new people coming in every year . There was a hospital on the premises where 2 doctors and 6 nurses were stationed at.

That afternoon, I called on The Suzanne Mubarak Regional Centre for Women's Health and Development. Mrs. Mubarak, the wife of the former President Mubarak serves as the executive director of the Centre, which, as a medical institute, conducts research on child bearing and women�fs diseases and provides training programs to develop skills in this field. The Centre accepts trainees not only from Egypt but also extensively from the African region. We exchanged views on the improvement of the standards of medical care in the Middle East and African Region.

On my last day in Egypt, I visited the Ministry of Health of Egypt and exchanged views with Dr. Nasar El Sayad, Deputy Minister of Health on leprosy and healthcare services in Egypt. I was told that the private sector played a prominent role in controlling leprosy, and that there were 17 leprosy clinics in Egypt, quite a few of which had long been run by the efforts of Catholic sisters from overseas. In the field of healthcare services in Egypt, the child public health had become an issue, thus currently they were planning to implement a program in collaboration with universities to counter this problem, by mobilizing one million students to establish a habit of thorough gargling and hand-washing. For HIV/AIDS control, an education campaign was running concurrently with the one on hepatitis as strategies were being developed based on the research findings on maternal-child health. A health program had been rolled out to all the schools in the country through which school meals were provided, and preparations were underway to introduce a health insurance system which would cover 70 to 80% of the population.

That night, I left Cairo for Beirut, Lebanon by air. Lebanon is a country of a size of Gifu Prefecture sandwiched between Syria and Israel. Its capital, Beirut, was once called a �gParis of the Middle East�h as it used to serve as a financial centre of the Middle East by offering highly developed financial functions, and tourism had thrived as it became the air hub of the region. However, as a result of repeated civil wars and consequent political instabilities, the city has suffered armed terror attacks. Recently the new Cabinet was inaugurated in November 2009 and the local elections in May 2010 were held without major disturbances, yet tension is rising around the investigation of the international tribunal on the assassination of the former Prime Minister Rafik Hariri in February 2005.

The day after my arrival at Beirut, I attended the conference hosted by the WHO's Eastern Mediterranean Regional Office (EMRO). This conference was attended by leprosy officers from the Ministries of Health and representatives of NGOs from 14 of the 22 countries in the EMRO Region, who made reports on the situation of leprosy control programs in their respective countries. Whenever I try to describe the leprosy issue, I use the analogy of a motorbike. The front wheel represents curing the disease. The rear wheel is about eliminating stigma and discrimination associated with leprosy. I will renew my effort to work not only on the front wheel of the motorbike but also on the rear wheel now and into the future, through eliminating stigma, discrimination and prejudice in order to create a society where leprosy affected people and their families can live without fear.

The scope of activities for leprosy is steadily expanding �gfrom leprosy disease control & elimination to elimination of prejudice and discrimination caused by leprosy�h. I have made appeals at different places to the international community to address the issue of discrimination suffered by the leprosy affected people and their families around the world. With the help of the Japanese Government and interested parties, the Principles and Guidelines for the Elimination of Discrimination Against People Affected by Leprosy and Their Family Members was unanimously adopted by the United Nations Human Rights Council in September 2010 and by the United Nations General Assembly in December the same year. This Principles and Guidelines clearly state two points namely, that basic human rights, and promotion, protection, and security of freedoms shall not be compromised on the grounds of leprosy, and also the right of persons affected by leprosy and their family members to participate in the community without being discriminated should be disseminated.

Such an unequivocal gesture from the international community towards elimination of discrimination associated with leprosy will serve as a powerful instrument in bringing anti-discrimination activities to success. Willing or unwilling, leprosy affected people are protagonists in the rear wheel battle to eliminate discrimination. They are no longer there to just accept. They need to change their passive mindset and start being proactive, taking action for themselves. In this battle, I do not wish to have a one-sided relationship of �gsupporter and support recipient�h with leprosy affected people. Instead, I wish to have a relationship between comrades. I shall spare no effort or cooperation till I share the victory with my comrades. I shall visit them, have discussions with them, and take actions for them as many times as it takes to achieve this goal.