Crisis puts a brake on leprosy programme

Some of the effects of the crisis that broke out in Cote d'Ivoire on 19 September 2002 are easy to spot: from the closed banks in rebel-held areas to the empty hallways of local hotels. Others are less evident such as the repercussions of the five-month-old rebel war on Cote d'Ivoire's national programme against leprosy and, by extension, on the hundreds of people whose health depended on it. Since the outbreak of the war, which has divided the country into a rebel-held north and a government-controlled south, many leprosy patients no longer have access to multidrug therapy (MDT), according to Djakeaux Simplice, director of the national anti-leprosy programme. The programme has lost contact with about 650 patients who were being monitored in areas now under rebel control, he said. MDT cures leprosy in six to 12 months depending, among other things, on the state of advancement of the disease when the treatment is started, Djakeaux said. In Cote d'Ivoire, its use has slashed the number of leprosy cases from 120,000 about two decades ago to 1,696 today. Now, however, he fears that the armed conflict could erode the gains of past years. As rebel fighters occupied northern Cote d'Ivoire, leprosy services there suffered similar fates as other health services: drugs were looted, according to the health ministry, and many health workers fled. Some have been replaced by Red Cross doctors through the institution's mobile clinic system. However, there is a limit to what they can do for the leprosy patients. In the district of Manikro, near the rebel-held town of Bouake, antibiotics and anti-inflammatory drugs are administered to people suffering from leprosy because there are no PCT drugs, Dr Nioule Ziade Leonard of the Cote d'Ivoire Red Cross told IRIN. He said the Red Cross was also able to give basic health care to a few people suffering from leprosy in western Cote d'Ivoire. Djakeaux fears that the situation could cause many of the 650 patients no longer undergoing treatment to relapse. That could eventually lead to a higher incidence of leprosy since people whose treatment is incomplete can spread the germ that carries the disease, he said. "The war could well undo 20 years of efforts in Cote d'Ivoire to reduce the number of leprosy patients," said Djakeaux. He said that since September 2002, an estimated 500 new cases had escaped detection, in addition to the old caseload of 650 with whom the programme has lost contact.