LEPRAnews LEPRA Health in Action, improving health and quality of life for people in the developing world.
Wheels to heal Focus on: Neglected to protected in Nepal
Spotlight on: Stories from Indiaâ€™s slums
May 2009 www.leprahealthinaction.org healthinaction | 14
Dear Friend, I was in Sanawad recently, visiting St Josephâ€™s surgical unit where we carry out surgery on people with severe deformity of the hands and feet. Because of the huge numbers, children and young people are given priority. Cataract and eye surgeries are also carried out. The work is wonderful and the dedication of the staff, as always, is remarkable. Yet even with all their hard work and long hours, there are still over 9,000 people awaiting surgery. This unit is the only one of its kind within an 800km radius. We are desperate to enhance the unit so that we can increase the number of surgeries and would like to add a new 30-bed ward. Can you help us to do this? You would be helping some of the most deprived people in India. Thank you for all the support you give us which does so much good for those in need.
Terry Vasey CMG KLJ Chief Executive LEPRA Health in Action
Editors Joanna Belfield Irene Allen Writers Irene Allen - Journals Manager Joanna Belfield - Marketing Officer John Cornes - Hon Treasurer Raja Ahmad - Programmes Officer Fiona Cook - Programmes Officer Yasmin Entwistle - Programmes Officer Jose de la Cruz Senior Programmes Officer Liz Radley - Events Manager Dr. Chris Reynolds, Wheatgrass Inc. Australia Photography LEPRA and Peter Caton Design and Print The Print Connection, 01787 269821
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In this issue... News
Access to health services in developing countries
Country Focus Neglected tropical diseases in Nepal
Reg Charity no. 213251 Charity registered in Scotland no. SC039715
LEPRA Health in Action 28 Middleborough Colchester CO1 1TG 01206 216700 www.leprahealthinaction.org
Stories from the slums
Three generations of leprosy
Dates for your Diary 2009-10 Madagascar Bike Ride 23rd Sept - 8th October
India Bike Ride 19th Jan - 3rd February 2010 Virgin London Marathon 25th April 2010
India Trek 7th - 18th November
BUPA London 10K 31st May 2010
India Supporters Trip 21st Jan - 2nd February 2010
Edinburgh Marathon 31st May 2010
Malawi Bike Ride 19th June - 5th July healthinaction
For more information about any of these events, please email email@example.com or telephone 01206 216799. If you are planning an event or taking part in a challenge, the events team would love to hear from you. We offer tips and advice, sponsorship forms and t-shirts to help you fulfil your fundraising potential.
LEPRA over the last 17 years As LEPRA wishes a fond farewell to Treasurer John Cornes, John shares his memories of 17 years of service. “I joined LEPRA’s Executive Committee as Treasurer in 1991. LEPRA was much smaller then, and it was a real struggle to get to the end of the financial year without drawing on reserves. LEPRA had not long started to work with LEPRA Society India, providing essential aid with scarce resources.
Business as usual
Bihar flood update You may remember our report on the devastating floods that hit India’s north-eastern state of Bihar in 2008. Around 3 million people were affected as the waters washed away lives, land and homes. Generous support enabled us to reach thousands of people, especially children, who needed us the most. LEPRA’s fieldworkers distributed food and other vital relief items to flood affected communities in the district of Bhagalpur. LEPRA’s team worked actively with the state government health department in setting up flood relief camps, and health facilities were also set up to assist people affected by leprosy, TB and malaria. LEPRA’s staff in India generously donated one day’s salary for the relief efforts. Flooding in Bihar is a recurring problem. LEPRA has produced a flood preparedness project proposal to cope with the problem and help communities during times of crisis, yet needs your support to be proactive in developing the means to serve communities both during and after natural disasters. Reacting is not enough. Preparedness is crucial.
“LEPRA’s fortunes changed in 1996 when we received a phone call from the BBC children’s programme Blue Peter. We learned that LEPRA would be chosen as the charity partner for the Blue Peter Appeal. The public’s response was magnificent. 2.8m was raised and we needed, then, to maintain a new level of income and ensure that new projects would be supported in future years. “The Committee had a strategy meeting in 2000. We resolved not to concentrate on being the same size doing things better, but to grow LEPRA each year. In these last eight years, Terry has been elected President of ILEP, we have received substantial donations from national and international agencies, and LEPRA has indeed grown year-on-year. “At the forthcoming AGM, I will be leaving the Executive Committee and hope that Julian Briant will be elected to succeed me as Treasurer. He is a Director of ING Bank in whose London office the AGM will be held.”
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Miking with a trike
‘Wheels to heal’ – Access to health services One of the major challenges of delivering health services in developing countries, other than lack of infrastructure and trained personnel, is patients’ inability to physically access services for diagnosis and treatment. The areas in which LEPRA works are often the most isolated rural communities, where roads are in an appalling condition and susceptible to flooding in the rainy season. Safe and affordable public transport does not exist, and people can only dream of owning their own cars. People weakened by TB and HIV/AIDS, or immobilised by leprosy ulcers, are unable to walk the long distances often required to access health facilities. As a consequence,
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many people do not get the help they so desperately need. This results in the worsening of disease and disability, loss of livelihood and pushes people further into poverty. Ultimately it could lead to death. LEPRA prides itself on its resourcefulness and capacity to innovate in the face of challenges. In Mozambique this comes in the form of bicycle ambulances, which are being used in our Community Health Projects to counteract the extreme lack of transport in some of the country's most underprivileged rural areas. Pedal power Since 2008, bicycle ambulances have been used in the Zambezia Province to transport medical emergencies to the nearest hospital or health facility. Dedicated volunteers cover distances of up to 20km a day by bike, and negotiate harsh pot-holed roads which are
coverSTORY often no more than a dirt track. They use bicycle ambulances to carry severely malnourished toddlers, heavily pregnant mothers and critically ill TB and HIV/AIDS patients to safety. As a result, maternal mortality has been reduced by 100 per cent in two districts. Mobile health services In India, where almost 70 per cent of the population live in rural areas, LEPRA has launched mobile health clinics in response to the most common health issues affecting isolated and hard-to-reach rural populations. These mobile clinics concentrate primarily on the health needs of children, women and senior citizens, treating conditions such as fever, diarrhoea, jaundice and ulcers. As well as providing vital medical services to villages, LEPRA uses these mobile clinics to deliver key health education to communities with limited awareness of health issues. In Bangladesh, LEPRA has successfully pioneered the use of Information Education and Communication Vans to carry out mass health education. These vans are adapted with digital projectors and portable screens and used as mobile cinemas to show films on TB in some of the country’s most remote rural communities. These films, each one attended by an average of 1,400 people, are having a hugely positive impact on communities, leading to a direct increase in the number of TB cases being detected and treated. Within seven months of being introduced by LEPRA, these vans had already reached 181,325 individuals with core messages on TB. Triking and miking Another innovation by LEPRA Bangladesh has been the hiring of rickshaw tricycles with loudspeaker systems, to announce key information to communities. Rickshaw drivers use ‘miking’ to inform people about forthcoming health campaigns such as free drug distribution for disease prevention. Rickshaw tricycles have proved to be a costeffective means of ensuring that whole communities are aware of when, where and how health campaigns will take place.
A faster road to rehabilitation In Brazil, the second most leprosy-endemic country in the world, a lack of affordable transport has long been a problem for those affected by leprosy. Although public transport does exist, LEPRA works in the north-east region of the country, where most people livng with leprosy simply cannot afford to make the journey to the health centre. For those with disabilities who require consultations with several different services such as physiotherapy and occupational therapy, this leads to days of waiting, and the consequent loss of earnings. As a result, many patients abandon treatment, which leads to the worsening of their condition. They then require more time and resources for treatment to succeed. To counteract this, LEPRA provides small grants to cover travel expenses and refreshments for some of the poorest people affected by leprosy. This has helped to: reduce the number of people abandoning treatment by five per cent; increase the healing time of wounds; and encourage a speedier road to rehabilitation for disabled patients.
Wheels in action
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Taking the drugs that stop the spread of LF
Neglected tropical diseases in Nepal Nepal has always been associated with scenic snow capped mountain ranges, Sherpa guides, alluring remote mountain villages and Ghurkhas in the service of the British Army. This conjures an image of a hilly farming country, romantic and ideal: reinforced by the countless tourists who visit the country to climb Everest and bring back home tales of their adventures.
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countryFOCUS We do not immediately associate Nepal with neglected tropical diseases such as leprosy, lymphatic filariasis (LF), soil transmitted helminthiasis (STH) and trachoma. These diseases are disabling, cause suffering and stigmatise those afflicted by them. Yet with todayâ€™s technology they are easy to detect and treat. Unfortunately, Nepal is one of the few countries in the world not to have achieved the goal of elimination of leprosy as a public health problem even after years of hard work by LEPRA, the Nepal Leprosy Trust, other ILEP partners and the government. To make matters worse, Nepali people are also at risk of LF infections with 60 of the 75 districts endemic to the disease. STH or worms, a disease affecting children and pregnant women, is found throughout the entire country. Trachoma, a disease that can cause blindness, affects people in 15 districts. The burden of dealing with these health issues is adding to the problems faced by the Nepali people who are also struggling to rebuild their nation after years of Maoist insurgency and political instability. The lack of substantial development for more than a decade provides Nepalis with very little opportunity with more than half earning less than a dollar every day.
In partnership with the Nepal Leprosy Trust, LEPRA is helping people affected by leprosy to care for their disabilities and prevent them from worsening. It has done so with much success for many years. With the experience gained in the prevention of leprosy disabilities we are in a very strategic position to help patients disabled by lymphoedema (swelling) through LF. LEPRA has also been providing training and support to the LF programme manager. As the interest in neglected tropical diseases expands and funding support to them increases, we will be seeing heightened investment mainly in preventive chemotherapy campaigns to provide people with drugs to avoid infection and disability in the long term. Now more than ever, LEPRAâ€™s expertise in training, mobilising and caring for patients gained from years of working on leprosy and now also applicable to lymphoedema, is being increasingly called upon as we are one of the few organisations focusing on LF self-care management. Building on our experience in Bangladesh, it is our intention to use these funding opportunities in order to help the Government of Nepal in mobilising the population to receive mass drug administration for LF and STH and to treat trachoma.
Administering preventative medication for LF
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Stories from the slums The runaway winner at this yearâ€™s Oscars was the film Slumdog Millionaire, which carried away eight Oscars at the internationally acclaimed ceremony. It tells the story of an Indian orphan boy who grows up in the urban slum areas of Mumbai. LEPRA Society India has been working to mitigate health conditions exacerbated by poverty and stigma in India for the past 21 years. Life is tough for slum dwellers, not only because of the precarious living conditions, but also due to the appalling social discrimination and humiliation to which they are subjected. Many children collect refuse for Rupees
Although India is a rapidly growing economy, it is still a low income country with 44.2 per cent of families earning less than one US dollar a day (currently around 72 pence). Despite the national economy showing signs of growth, regional economic disparities have increased. Poverty, illiteracy, migration, and socio-cultural elements including high levels of stigma and discrimination, are some of the reasons for the high incidence of disease in slum areas. The film only shows us the tip of the iceberg, but the truth is that children living in Indiaâ€™s slums have very few opportunities and are at constant risk of disease. Attending school may mean the equivalent of winning the lottery for many slum dwellers. Slumdog Millionaire gives a glimpse of
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the conditions and degrees of poverty in which LEPRA works everyday. Working in landfill sites, sleeping in mosquito infested areas, and often malnourished, these children are vulnerable to exploitation, infection and disease. HIV, leprosy, TB and malaria are part of the everyday reality for slum children. With the support of the European Commission and Interact Worldwide, LEPRA started work in some of the poorest slums of Orissa. This health promotion project uses innovative health education strategies to capture the attention of slum children and teenagers. Through transmitting health education messages and providing counselling and advice, LEPRA hopes to improve health conditions and reduce the vulnerability to disease of those living in poverty. The project has also introduced health check-up camps in the slums as their residents are accustomed to being discriminated against and rejected outside these areas. Film shows promoting health messages are broadcast from the back of a LEPRA customised van to engage teenagers and to warn them about the signs of common diseases and how to prevent them. Extreme poverty and precarious slum living conditions can drive people to do desperate things. This is what happened to Sita*. She was married by 14, had a miscarriage and two boys within one year, and lives in a tiny slum hut with her husband, her two small children, her in-laws and her three sisters-in law. They moved from a rural village to the slums hoping for a better life yet they hardly earn enough to eat. Not able to make a living, her husband soon turned to alcohol. Being the only bread winner in the household, Sita turned to sex work in a desperate attempt to support the family.
Education from the back of a van
LEPRA’s trained health workers are able to offer counselling, advice and health education to desperate young people like Sita, who live in extreme poverty and appalling insanitary conditions, with little hope of ever visiting Hollywood. The film has done a very good job of drawing attention to some, but not all the realities of life in India’s urban slums. LEPRA’s work will not turn slum dwellers into millionaires or even earn them an appearance in the prestigious TV show ‘Who wants to be a Millionaire?’, yet our work can change their lives and increase their chances of survival. Hollywood happy endings are rarely seen in Indian slums, but with your help LEPRA works to solve real problems using real solutions.
* Her name has been changed to protect her identity.
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Journeys of inspiration LEPRA’s Bike Rides and other overseas experiences can have a lifechanging effect on individuals. The stories below illustrate how people are inspired to lend their support to the important work of LEPRA.
Inspired by India India and LEPRA had a profound impact on Margaret. Returning from the 2008 India Bike Ride, she knew instantly that she had to go back. After discussing her options with LEPRA, Margaret decided that teaching English was what she wanted to do. LEPRA put her in touch with a headmaster in India who offered her a position in his school. On completing a teaching course she signed up for the 2009 bike ride and left for her new home. Having completed this year’s ride, Margaret has settled into her Indian home with a family who have welcomed her with open arms. “It was nice not to be thrown in head first into what is a very different life here. School is going well and it finishes at 1pm so I often visit LEPRA afterwards to see what’s going on. Seven cases of leprosy were diagnosed in Jeypore alone in one day - incredible! They are doing such a great job here and working such long hours. I’ll continue to do all I can to help support them.” “I wouldn't want to be anywhere else in the world right now. India might just be where I’m supposed to be forever... who knows.”
Desire to change lives “I’ve completed a couple of half marathons and have always wanted to do the London Marathon, Sarah Tribe so I decided now was as good a time as any”. Sarah’s education and personal experiences drove her to want to do something to make a real difference to the lives of others, so LEPRA was the perfect charity for her to support. Sarah spent time working in Tanzania, India and Sri Lanka and says: “I’ve seen so many people affected by the horrible diseases LEPRA works with, so I wanted LEPRA to benefit from my sponsorship.” Sarah studied parasitology and tropical diseases at university so she appreciates the importance of LEPRA’s work and the impact it has on individuals, communities and countries. Now studying for a Masters in Education for Sustainable Development, Sarah says: “The education work that LEPRA does is directly relevant to my studies as many of the diseases have an impact on development in the third world”.
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Trekkers take note! India Trek 7th-18th November 2009
Intrigued by Madagascar “Through my work for health and human rights organisations in the UK, I began to realise what huge suffering people encounter in Madagascar. In 2008 I joined a group of LEPRA supporters to experience this wonderful country.” LEPRA put Julie in touch with the Tanjamoha community (near the village of Vohipeno in the south). She worked as a physiotherapist, volunteering for a three-month period. Julie recalls: “I was greeted with amazing kindness and I spent my time helping those with physical disabilities caused by polio, TB and neurological impairments, as a result of leprosy and malaria.” During her time on the island, Julie participated in LEPRA’s Bike Ride covering some of the most beautiful and dramatic scenery of the south-east coast over a two-week period. “In the villages we were welcomed by unbelievably poor people with the most wonderful smiles.” “The people in Tanjamoha that I met are a marvellous example for us all, and I will certainly carry some of their compassion and joy with me as I return to my job with the NHS.” The current political upheaval in Madagascar brings into focus the difficulties experienced by the people of this country.
Orissa is spiritually rich, culturally diverse and fascinating. Landscapes are wild and picturesque, making it one of the most interesting states in eastern India. Extreme poverty and limited tourist facilities make for a challenging destination. This year, trekkers are being given the opportunity to access these landscapes on the new LEPRA India Trek. Interested participants can take part in this unique and potentially demanding adventure, and explore plateaus, misty valleys and forests. They can see the effects that diseases of poverty can have on the communities and distant villages that they will be passing through. The trip will cover 120km on foot over a period of six days. The trip costs £840 plus taxes and a deposit of £250 will secure a place, a minimum sponsorship of £1,500 is required.
Run like the wind in the windy city! Chicago Marathon 11th October 2009 The Chicago Marathon is famed for its fast flat course, weaving through 29 neighbourhoods and countless landmarks. LEPRA is offering people the chance to run the course on 11th October. Our places are limited, yet are not tied to any tour operators so applicants are free to make their own travel arrangements; staying in Chicago for as long as they wish. All we ask is a minimum of £500 sponsorship.
If you or anyone you know would like to take up these challenges, LEPRA needs your help to change lives. For full information or a chat about starting your own inspirational journey, please contact the events team on 01206 216799 or firstname.lastname@example.org
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Tough times call for difficult decisions After six years of working in Angola, LEPRA Health in Action has made the difficult decision to close its programme there. Our work in Angola has been characterised by the resilience of dedicated staff, who struggled against frequent power cuts, shortages of running water, flooding and constant insecurity in order to bring vital health services to communities in need. Despite LEPRA’s achievements in Angola, we were forced to close our operation at the end of 2008 due to the repeated failure of major donors to supply agreed funding, which placed the programme in difficulty, further exacerbated by the global financial crisis. During the life of its programme, LEPRA worked in the impoverished provinces of Moxico and Lunda Sul where less than 50 per cent of the
population has access to health services. It supported the combined Leprosy and Tuberculosis Programme and National HIV/AIDS Programme. Highlights of LEPRA’s work in Angola include the opening of treatment centres for TB and leprosy across the whole of the Moxico Province, and the successful training of 90 per cent of health technicians in Lunda Sul in leprosy and TB, meaning that there is now at least one technician per health centre. With the end of the Angolan conflict in 2002, many emergency-focused aid organisations left the country, whilst LEPRA remained, working with the government to rebuild a shattered health system. As well as training health staff, carrying out health education and providing medical resources, LEPRA built TB laboratories in areas where these facilities did not previously exist. Next to these laboratories, LEPRA constructed multi-purpose ‘palaver huts’ (known locally as Jangos): there is now a Jango in each municipal hospital in Lunda Sul, being used for vaccination campaigns, mother and baby clinics, meetings and health education talks. In 2008, LEPRA held the first ever ‘health day’ on TB and leprosy in Lunda Sul, which was broadcast on Angolan National Television. This culminated in an active search for leprosy cases in remote villages where access to diagnosis had traditionally not been available.
LEPRA’s Jangos are used for educational awareness activities
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Conscious of the need to sustain the positive impact of our work, LEPRA has transferred control of a major part of its work and its equipment in Angola to a local partner organisation which we have worked with and strengthened over the past few years. In this way we hope that the positive impact of our hard work will live on.
A glimmer of hope for leprous ulcers by the use of wheatgrass by Dr. Chris Reynolds
Wheatgrass has been in Indian culture for thousands of years and is known to have remarkable healing properties, in particular, wound and ulcer healing. Although leprosy is diagnosed by various symptoms, an unseen problem is the damage to peripheral nerves. Patients develop loss of sensation in the hands and feet, and because the skin patches are anaesthetised, the patient traumatises the skin easily but is unaware damage has been done. Once this happens, an ulcer forms which can sometimes last more than 30 years. Repetitive trauma (e.g. walking) can also prevent the ulcer healing. Wheatgrass spray was used on a patient in Mumbai who had leprous ulcers on the sole of his foot and was also a non-insulin dependent diabetic. Diabetic ulcers are notoriously difficult to heal so this represented a double challenge for wheatgrass. In just six weeks, the ulcer, present for a year, showed significant signs of healing. Throughout treatment the patient had walked daily to and from work yet the ulcer continued to heal. According to medical staff this, like the healing, was an exciting observation because even after surgery, wounds frequently break down again once the patient resumes walking. Given this success, a small pilot study was undertaken. Twenty people with foot ulcers were selected for treatment, and the process was recorded with serial digital photographs. The wheatgrass spray was applied every second day and the wound re-covered. As wheatgrass quickly softens the surrounding dead skin which tends to hold the wound open and prevent healing, calluses could be easily removed with a scalpel, which helped promote healing. Often the slough on and around
Dr. Chris Reynolds visiting the pilot study
the ulcer, which can be quite thick, disappeared and revealed the full extent of the ulcer’s surface. Re-covering with new skin can then commence. This usually starts from the edges, but can also develop as small islands of skin on the surface, that fuse as the healing proceeds. The old approach to ulcer care was to cleanse the wound, keep it moist, and apply a protective dressing to prevent infection. The weeping on the wound surface contains all the growth and other factors essential for the healing process, but they are simply washed away whenever a dressing is changed. It was noted that wheatgrass in some way ‘resurfaced’ the wound – usually within 24-48 hours – with a new layer of cells. It is very thin, but sufficient to contain the fluid underneath and prevent bacterial invasion from above. The growth or healing factors in this fluid can then do their work unhindered. They also appear to stimulate localised immunity which eliminates unwanted bacteria; in other words, rather than interfering with the healing process, wheatgrass facilitates it. The trial participants had a combined total of 30 ulcers. One has healed completely, there has been significant healing in 28, and one as yet appears not to have responded. The study will continue for at least six months when the findings will be reviewed.
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communityNEWS Edinburgh to St Andrews cycle ride Saturday 20th June This will be the 29th Edinburgh to St Andrews Bike Ride, and plans are well underway to ensure that another fantastic day’s cycling is enjoyed by LEPRA supporters. This year the ride starts from Iverleith Park, overlooked by Edinburgh’s magnificent castle. The usual route down Princes Street is not possible due to the closure of this street to allow tramlines to be installed. LEPRA would like to take this opportunity to thank the Edinburgh Bike Co-op for their ongoing support, providing repairs and maintenance along the route, Edinburgh and Fife Police Forces for their co-operation, the Forth Road Bridge Authority for marshalling cyclists over the bridge, the Kinross Ladies Circle for preparing superb lunches, and last but not least, the ladies of Freuchie Parish Church who so cheerfully serve the now legendary home baked afternoon tea. So many contributions go into making this a wonderful day for LEPRA and our supporters. A huge ‘thank you’ to all.
The LEPRA Chelsea and Kensington committee cuts a dash! The Chelsea and Kensington committee, led by the Baroness Gerda Von Posch, organises beautifully presented fundraising events for LEPRA. A recent function at Miller’s was held in the beautiful rooms of this prestigious London venue by kind permission of Mr Martin Miller. Baroness Gerda Von Posch, Chairman of the Chelsea and Kensington Committee with Dr Venetia Newall, a valued supporter, are pictured below, at Miller’s. We would like to say a sincere ‘thank you’ to Gerda, her committee and all those who support the work of LEPRA through these events which raised over £8,000 for us during 2008.
Kensington and Chelsea committee at Miller’s
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Mathew and friends
A young man makes a mark Mathew Fossett attends Daviot Primary School in Aberdeenshire and after a talk on the work of LEPRA at his school, decided that he wanted to do something himself, independent of his school, to help the children and adults who have leprosy. For his tenth birthday, Mathew opted to forgo gifts and asked instead for sponsorship for a bike ride that he organised for LEPRA. On 12th October, he and 12 friends, accompanied by parents, cycled 20 miles, and in so doing raised a magnificent £918.00 for LEPRA. Mathew’s mum Jude said: “Mathew decided to give up birthday presents in lieu of sponsorship by himself, and as a family we felt we wanted to support this very mature decision from our young son.” A big thank you to Mathew from all at LEPRA for raising funds in such an inspirational way.
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we would like your help
Three generations of leprosy Bablu was around 29 years old when he contracted leprosy, but as he didn’t know what was wrong, he ignored the patches on his body for some time. Although the patches didnt hurt, they increased in size and new ones appeared. He visited a doctor who treated him for a year with tribal medicines, but because he was not provided with multi-drug therapy, his condition remained the same. One day Bablu saw the Health Education Van from St
Joseph’s Leprosy Centre, and once he saw the pictures on the side of the van he realised he could have leprosy. He discussed his problem with one of his neighbours who, having been treated at St. Joseph’s himself, recommended that Bablu went there. So he went with his 12 year old son, Kalu, and his mother Nisharbai - all of whom were diagnosed with multibacilliary leprosy and were started on treatment immediately. The rest of the family were then examined and another child was also diagnosed with leprosy, with two others put under observation for small patches on their skin. Now seven family members are on multidrug therapy. Bablu and his wife are day labourers, when they are able to find work, and between them earn just over £1 a day, so if they had to pay for treatment it would have been out of their reach. With LEPRA’s help, treatment was free, and now they are all cured of the disease.
Please return the form on the reverse to FREEPOST RLUB-KCXE-ZRRY, LEPRA Health in Action, 28 Middleborough, Colchester CO1 1TG You will save us even more money if you attach a stamp to your return envelope.
Published on Aug 14, 2009
Publication from LEPRA Health in Action, is a medical development charity with a mission to restore health, hope and dignity to people affec...