Leprosy situation in India: Assam tops the list of states with highest rates of more infectious patients but lacks required medical intervention

Assam tops the list of states in India with more infectious Multi Bacillary (M.B.) leprosy patients. However, lack of infrastructure support, required human resources and fund shortage has come in the way of leprosy eradication programme in the state.

Even though India achieved “elimination” of leprosy in 2005, rising number of new cases in the country and in the state has pressed an alarm bell. Official data reveal that the situation in tea garden areas in Assam is even more worrisome.

World Health Organisation data reveal that India accounts for 60 per cent of the world’s total leprosy patients. The situation is even more alarming in Assam. On an average three leprosy patients are detected in Assam every day. Altogether 10,739 new leprosy cases were detected in the state over a period of ten years from 2006-07 till 2016-17, reveals data available with the State Health Department. The number of new leprosy cases identified in 2016-17 was 1019 as against 789 cases in 2015-16.

In medical parlance, patients with leprosy infection involving one peripheral vein are called Pauci Bacillary (PB) or less infectious leprosy patients. Patients with infection involving more than one peripheral vein are called Multi Bacillary (M.B.) or more infectious leprosy patients.

Assam accounts for the highest number of more infectious leprosy patients in the country. Data for the year 2016-17 on National Leprosy Eradication Programme show that Assam accounted for 77.59 per cent more infectious leprosy cases in as against all India average of 49.57 per cent. Even though Uttar Pradesh, Maharashtra and Bihar account for highest number of leprosy patients, the number of more infectious leprosy patients in these states is much less than in Assam. The percentage of such patients in 2016-17 was 54.39 in Maharashtra, 41.51 in Uttar Pradesh and 38.35 in Bihar.

Joint Director, Health (Leprosy) and the state Leprosy Officer Dr Pranati Das explains that while leprosy patients can be treated with medicines, disability/deformities caused in P.B. leprosy patients can be corrected with reconstructive surgery. The state, however, do not have adequate infrastructure for such PB patients requiring reconstructive surgery. Facilities for such reconstructive surgery are available at Gauhati Medical College and Hospital (GMCH) in the government sector and at Boragaon Catholic Hospital in Biswanath Chariali in the private sector. However, Data reveal that not much importance is laid in GMCH on reconstructive surgery of leprosy patients suffering disability/deformities. Information available with Leprosy wing of the state Health Department reveals that of the total 25 leprosy patients who had undergone reconstructive surgery, 24 had undergone surgery at Boragaon Catholic Hospital while only one patient underwent surgery at GMCH. In 2017-18, all the 38 such patients underwent surgery at Boragaon Catholic Hospital. Odisha has 15, West Bengal-11, Tamil Nadu-10 and Jharkhand has six centers equipped with reconstructive surgery facilities for leprosy patients.

Assam also accounts for highest number of children affected by leprosy in the country. Data of National Leprosy Eradication Programme reveal that percentage of children affected by leprosy in the state was 77.59 against all India average of 49.57 per cent in 2016-17. While some states have running vaccination programme targeting children for eradication of leprosy, Assam is yet to launch such vaccination programme. Country’s first indigenous vaccine for leprosy eradication- Immunotherapeutic vaccine was developed by Dr. G.P. Talwar, Director, Institute of Immunology, couple of years back. Currently, this vaccine approved by Drug Controller of India, has been piloted in five districts or Gujarat and Bihar. Dr Das says that the vaccine has not been introduced in Assam as vaccination piloted in the two states has not created much impact. She, however, adds that many leprosy patients in the state have not been yet been identified due to superstition, fear of stigmatization and lack of awareness. A section physicians also lack much idea about the disease and lack interest to know about it. Dr Das laments that even though Assam has state wing for leprosy eradication it suffers from lack of required human resources and fund support due to which they have not been able to undertake many initiatives despite the will. As a result, many leprosy patients in the state have remained undetected.

The situation is worrisome in tea gardens of the state, as revealed by data of the Health Department. Dr Das informs that 280 leprosy patients were indentified in tea garden areas of five districts of Cachar, Jorhat, Golaghat, Tinsukia and Sonitpur during a special five-day long drive initiated by the State Leprosy Wing in 2017-18. Of them, 209 were identified in tea garden areas of Tinsukia district alone. “There is lack of awareness on healthcare among tea garden workers. It was noticed during this special drive that children of garden workers who live in unhygienic condition are more prone to leprosy,” says Dr Das about the experience of the special drive in garden areas.

Bhabesh Medhi

All photographs were taken by the author

( Bhabesh Medhi is a journalist based in Guwahati. He can be reached at [email protected])