East Timor Declares War on Leprosy

Voice of America

East Timor Declares War on Leprosy

Chad Bouchard | Dili 30 January 2010

East Timor is one of the few remaining countries where leprosy is
endemic, and one of only two in Asia where it has yet to be
eliminated. The government has declared war on leprosy, and vows to
eliminate it this year.

Florindo di Silva started feeling pain in his eyes four years ago.
The 60-year-old father of six says he went to a doctor in the East
Timor capital, Dili, but no treatment was available. The disease that
caused di Silva to lose vision, and his hands and toes to go numb –
turned out to be leprosy.

He says he can walk a little bit, he can chop wood, but it hurts.
Right now, his hands cannot do anything. Di Silva says his eyes and
head hurt every day, and he is not strong enough to cut coconuts with a

According to the World Health Organization, di Silva is one of about
1,300 new cases of leprosy that have been detected in East Timor since

Health officials say the number of undocumented people living with
disabilities caused by leprosy is likely three times higher.

Some progress has been made. In 2004, the overall ratio of infection
was 4.7 per 10,000 people. In 2009, that fell to 1.3 per 10,000.

The decline is due in large part to a program that blanketed the
country with hundreds of health ministry staff members able to
diagnose and manage the disease.

One of those health workers, Jose Pereira, works at a clinic where he
monitors di Silva and about 12 other patients with leprosy.

Pereira says if his patients do not come to the clinic to get
medicine, he goes to their houses in the villages to give them
medicine. But, he says, they often ask for food, and he does not have
any to give, and it is very difficult.

Leprosy is relatively easy to treat with a cocktail of antibacterial
drugs known as multidrug therapy. After taking the medicine for one
month, patients are no longer contagious, and damage from the disease
stops for good after a few months.

Poverty – a key challenge

But poverty is a key barrier to eliminating the disease. Natalie
Smith, the country leader for the Leprosy Mission in East Timor, says
the bacteria that causes the disease is endemic here, and flourishes
in a population that is largely isolated, malnourished and living in
unsanitary conditions.

“It really thrives where there’s poverty, poor sanitation, poor diet
and poor hygiene and those sort of contribute to affect the people
living in that environment’s immune system, so when their immune
system is compromised, they’re more susceptible to catching leprosy,”
said Smith.

In rural East Timor, where about three quarters of the country’s 1.1
million residents live, diagnosing patients and ensuring treatment
remains a challenge. Smith says failing to identify the disease and
treat it perpetuates a crushing cycle of poverty.

“I think it needs to be a priority because of the disability that it
produces. And there’s been a lot of studies on the burden of
disability now and the fact that if people with disabilities are
assisted and helped they can actually add to a country’s economic
viability rather than economic demise. But the longer we delay in
treating someone, the more likely they’re going to get nerve damage
and that’s going to lead to long-term disability,” she said.

Leprosy campaign

The government has vowed to eliminate the disease this year. The head
of East Timor’s Leprosy Program at the Ministry of Health, Jose Liu
Fernandes, says to do that, the government has begun a radio and
television campaign about the disease and how to prevent it.

He says East Timorese do not yet know enough about the disease, so
they are surprised when they contract it. Fernandes says they need to
teach people that if they start feeling numbness in their hands, it
could be leprosy.

In many countries, people with leprosy are shunned and face a
lifetime of isolation.

But Salvador Amaral, with the World Health Organization, says there
is no such stigma in East Timor. Salvador says traditionally here,
leprosy is not considered to be a disease, but a result of eating
certain foods, like fish, or a curse from God.

Back in the outskirts of Dili, 22-year-old Joao Godinho Sarmento
recounts how he started noticing light patches on his arms six years
ago. It turned out to be early signs of leprosy. Doctors caught the
disease before it caused serious disability.

Sarmento says his life is pretty normal. He does not have problems at
school, and no one considers him to be different or disabled. He
hopes other people who have this disease can realize they are not
different from anyone else.

Sarmento studies mathematics at the national university, and hopes to
become a teacher or an engineer.



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