lecture 5

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Published on 2 Nov 2010
School
UTSC
Department
Geography
Course
GGRB28H3
Professor
Page:
of 4
L05 Leprosy - Hansen's Disease
- infectious disease that attacks the nervous system
- Microbacterium Leprae
- low infectious rate, 90% are immune
- enters body
-- immune cells seals off infection (destroys sweat glands, hair follicles, skin's sensitivity)
-- immune cells unable to destroy (bacteria multiplies freely within the skin)
- attacks the cooler areas of the body (colour of skin changes, patchy red marks, progresses
and degenerates, loses sensitivity of nerves/articulation)
- destroys neurons in parts of the body - becomes numb and loses feeling
- causes cartilage in areas to get absorbed back into the body, causing fingers, toes, ears,
noses to disappear
- lepromatous: damages respiration, eyes, and skin
- tuberculoid: affects nerves in fingers, toes, and surrounding skin
- borderline: effects of both types
- long incubation period (2 weeks to 30 years)
signs of leprosy
- pale or slightly reddish patch
- definite loss of sensation in the patch
- signs of damage to nerves (loss of sensation, weakness of muscles, visible deformity, large
bumps on the skin that do not feel pain/do not heal)
- irreversible effects
how leprosy affects lives
- eventually, people lose their fingers and toes and become disfigured
- physically/emotionally disabled - rejected from society and forced to live on their own
* condemnation of society, minimal contact from family
- later stages - lose sight & most of the feeling in their body
cure
- invented since 30s but bacterial became resistant
- multidrug therapy (MDT) in 80s
- 15 million lepers effectively cured in most affected areas
* deny treatment as they don't want to be known to have leprosy
* to prevent association between illness & stigma, people travel far distances for treatment
epidemiology
- discovered by Gerhard Hansen in 1873
- ancient disease - seen to be evil, criminal offense (1940s)
- shipped off to islands/sent to homes for 'quarantine' for the rest of their life
- diagnosis of leprosy was not very effective - diagnosed wrong
- high in Central Africa, Madagascar, India, Indo-Malaya, Brazil
- 17 countries = 94% of new leprosy cases worldwide - 620 638 (2002), 254 525 (2007)
- prevalence is declining between 2006-2007, increased in 10 countries
- India = 54% of total leprosy burden in 2007
* declined within the last 10 years, less infected/diseased due to MDT
- direct link between social stigma and epidemiology - few WHO approved treatment
centres - underreported cases
urban leprosy
- leprosy elimination in urban areas is challenged by
rapid increase in population, density
migration
www.notesolution.com
slum/shanty towns, poor living conditions - lack of basic services
violence
- lack of funding
- patients not aware of havoc the disease can cause
leprosy stigma
- outcast of carriers, forced into leprosy isolation centres
- Separatio Leprosarium - Mass of Separation
- considered to be 'dead' in a social point of view
- thought that people who had leprosy were highly contagious .'. isolated
in Brazil
- many people still believe that leprosy is highly contagious (can be attracted through casual
contact, visiting a leprosarium or from sexual encounter)
- "falling of limbs disease" and is thought to be incurable
- Catholic church/Evangelical religions - form of divine punishment
- Afro-Brazilian religions - result of sorcery or witchcraft
- poorest people of the social 'class' - poverty increases susceptibility to leprosy
- do not want to let others know (hesitant to seek treatment or continue treatment that may
expose their condition to the public)
stigma in Leprosy
- physical outward appearance (disfiguration)
- progressive characteristics over time (may be chronic)
- communicability and disabling
- religious links
- poverty related (those in harsh conditions/slums)
- isolation and segregation
- myths and mysteries
- leads to discrimination
* stigmatized (anticipated - perceived, self - internal, enacted - discrimination - stigma)
* stigmatizers (enacted - discrimination, fear - of the disease, symbolic - associations,
anticipated - attitudes - stigma)
= participation restrictions, social exclusion, poor quality of life
- stigma Æ social exclusion Æ poverty Æ disability Æ stigma
- becomes vulnerable to other forms of disease
in India
- 'untouchable' people who do not belong to the caste (Dalits)
- people with leprosy are normally Dalits (the outcasts)
- discrimination legitimated by spiritual, legal, and moral sanctions of Dharmashastras
- graded inequality regulated by central values of purity/impurity maintained by the caste
(restricted food sharing, educational/occupational mobility)
- 160 million = 16% of total Indian population
- lacks/unrespected human rights
- forced to live separately from caste Hindus in rural/urban areas, usually in slums (rarely
recognized as formal settlements by the government)
Æ lack of basic services e.g. education, health, water, hygiene
in Korea
- abolished force isolation policies Æ made it possible for affected to become economically
independent in resettlement villages (Resettlement Village Policy, enacted 1963 to present)
- if achieved economic independence (through farming) - prejudice would decrease
Æ however, continued to persist - villages limited true social reintegration
- sterilization & abortion practices (1191 between 1949 - 1958)
www.notesolution.com
- forced separation of children from leprosy patients
- forced isolation and relocation (continued until 1980s)
- obliged to work long hours, physically abused
- 1963, sent to Sorok Island until 2005
Community-based rehabilitation
- equalization of opportunities and social inclusion of all people with disabilities
- implemented through combined efforts of people with disabilities, their families,
organizations and communities, and relevant governmental and nongovernmental health,
education, vocational, social, and other services
advantages
- patients detected/treated early
- reduction of transmission of infection
- prevented development of deformities (access to treatment)
- stigma reduced further
Principles:
* inclusion: in mainstream programmes and services, participation in society
* participation: involved in programmes themselves at decision-making level
* self-sufficiency: manage their own livelihood, cultural autonomy
* self-advocacy: speak up for themselves
* equity, empowerment, social justice
* reverse integration: self-care and self-help groups, rehab, leprosy villages/communities
* implement human rights perspective: self-organization, empowerment, attention for
structural discrimination and dis-empowerment
* increased attention: empowerment (literacy, self-esteem), poverty reduction (skills),
stigma and discrimination (discriminatory legislation, among service providers, self)
* research to improve services/effectiveness of interventions
REHAB MAP
Leprosy Elimination Action Programme (LEAP)
- practical and simple diagnostic tools (can simply be based on clinical signs)
- availability of an effective intervention to interrupt its transmission (MDT)
- single reservoir of infection (humans)
* integration = provide "comprehensive" essential services from one service point
- improve patients' access to leprosy services (timely treatment)
- remove "special" status of leprosy as a complicated/terrible disease
- consolidate substantial gains made
- ensure that all future cases receive timely and correct treatment
- ensure that leprosy is treated as a simple disease
* good coverage:
- health facilities are easily accessible to every member of the community
- health services are provided on a daily basis
- health workers are able to diagnose, cure, and provide basic information about the
disease
- health facilities are equally distributed (urban/rural, male/female, poor/rich, etc)
- program with defined intervention to ensure the rights of people affected by leprosy
through sustained leprosy control measures and enhanced quality care with public health
care system
- implemented in States of Maharashtra and Chhattisgarh (India)
- selective special drives: creating mass awareness in local community members
- leprosy referral centres: train and equip health care providers with primary/intermediate
level with necessary skills and tools
www.notesolution.com

Document Summary

Infectious disease that attacks the nervous system. - immune cells seals off infection (destroys sweat glands, hair follicles, skin"s sensitivity) - immune cells unable to destroy (bacteria multiplies freely within the skin) Attacks the cooler areas of the body (colour of skin changes, patchy red marks, progresses and degenerates, loses sensitivity of nerves/articulation) Destroys neurons in parts of the body - becomes numb and loses feeling. Causes cartilage in areas to get absorbed back into the body, causing fingers, toes, ears, noses to disappear. Tuberculoid: affects nerves in fingers, toes, and surrounding skin. Long incubation period (2 weeks to 30 years) signs of leprosy. Definite loss of sensation in the patch. Signs of damage to nerves (loss of sensation, weakness of muscles, visible deformity, large bumps on the skin that do not feel pain/do not heal) Eventually, people lose their fingers and toes and become disfigured. Physically/emotionally disabled - rejected from society and forced to live on their own.