Côte d’Ivoire’s leprosy programme was consistently under-funded during the civil war (2002-2007) and last year’s political turmoil, say health practitioners, leading to a loss of expertise in terms of detecting or treating the disease.
Not considered a public health priority, the government and donors de-prioritized the leprosy fight over the past decade, with funding dropping to 30 percent of the original total, according to Alain de Kersabiec, Côte d’Ivoire and Benin representative for French NGO the Follereau Foundation (FRF), which helps treat existing and new leprosy patients around the country.
The World Health Organization (WHO) considers a disease to be a public health emergency if the prevalence is greater than one case per 10,000 inhabitants (a 0.01 prevalence rate). In 2009, the leprosy prevalence rate was 0.036 in Côte d’Ivoire.
While there is enough medicine available to treat leprosy - WHO provides it all - detecting and monitoring new cases in remote areas is difficult given the lack of qualified nurses and means of transport such as motorcycles to reach villages, said Joachim Akochi, one of 70 state nurses trained to detect and treat leprosy countrywide.
FRF has in many cases been stepping in to fill the gaps: It provides nurses with petrol coupons to help reach leprosy patients for instance - but now it is trying to ease off, said Kersabiec, hoping state institutions will step in to take responsibility, he told IRIN.
There is good news: The caseload is going down. But it is decreasing very slowly, said Kersabiec. In 2011 some 770 new cases were detected versus 887 cases in 2009, according to the Côte d’Ivoire Health Ministry.
Over the past few years the health system’s understanding of leprosy has gradually been eroded, said Kersabiec. “A nurse at a health centre may never have encountered a case of leprosy - they are not accustomed to treating it,” he said.
Too many cases are left to develop into advanced stages, said Kersabiec, who describes the disease as “insidious and silent”: A painless incubation period can last for years, while the first symptoms can take up to 20 years to appear. “The symptoms appear very late. Thus, when a new case is detected, it is very difficult to know where and when the person was infected,” he told IRIN.
Leprosy can be treated in 6-12 months, at which point the patient will no longer be contagious, but once symptoms such as loss of limbs or blindness have set in, they cannot be reversed.
Treatment is particularly patchy in the north, which was ruled by the ex-rebel Forces Nouvelles for a decade, during which time much of the state infrastructure was neglected. Many nurses left northern Côte d’Ivoire to work in the south, according to health practitioners.
Many leprosy patients are reluctant to come forward as some associate the disease with having been cursed, said Akochi, who works in the southern central department of Tomoudi. "Once they [patients] start to lose their limbs, many patients become ashamed and hide,” he said.
Traditional healers often play into this dynamic, having little medical knowledge of leprosy and giving patients inappropriate treatment, said Akochi.
Part of the shame may also be linked to poverty: Leprosy mainly affects poor and remote parts of the country, partly because unhygienic living conditions help the bacteria carrying leprosy to spread (it is spread via droplets in the mouth or nose).
"Leprosy is a disease of poverty: it is caused by poverty and throws sufferers into even greater poverty once they contract it,” says Kersabiec.
A nun, Sister Pauline, runs a health clinic in Dimbokro, south-central Côte d’Ivoire, and looks after people living with leprosy in the village of Chrétienko 5km away, trying to build their confidence and help them lead productive lives.
"They are encouraged to get to work, not to pity themselves or their situation,” Sister Pauline told IRIN.
"They try to help patients but not so much that they become overly-dependent,” said ex-patient Bernadette. "To be mutilated will always be painful, but people must leave the house, do what they can to survive. They must live,” she said.
Former leprosy patient Samuel, lives in Chrétienko, where he is undergoing training to become a shoemaker, making special shoes for people living with leprosy. "I am very proud because it allows me to show the world that despite the handicap, we can do things," he told IRIN.
Views on leprosy are changing slowly, said Sister Pauline. "Things are moving in a positive direction, and there is less [societal] rejection than before," she said.
After just eight months in power, it is too early to tell if President Alassane Ouattara’s government will reinvigorate the leprosy fight, said Kersabiec. But, having met the health minister on 2 February, he has hope: “I wait to see if the engagement is real, the resources put in place, and promises kept.”
This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions