LEPRA News. The latest issue of our newsletter LEPRA News will always be available at the top of this page, so that you can see how your money is being used and what events are taking place around the country. Click the image on the right to open or save the latest edition of LEPRA News. Please note you need to have Adobe Reader software installed to open this file. This software is available free of charge to download from the Adobe web site. The download file may be quite large and if this is a problem you can often find it included on the CD that accompanies many PC & Internet magazines. If you would like to leave feedback on the latest edition of LEPRA News we would be delighted to hear from you. Just click here to access our feedback form.

April 25th Marks Africa Malaria Day. This year, like every year, April 25th will commemorate Africa Malaria Day. This is a key event for the Roll Back Malaria movement and an opportunity to reaffirm its commitment to rolling back malaria by participating in various activities. This year's Africa Malaria Day highlights the need to provide universal access to artemisinin-based combination therapies (ACTs) and call for these treatments to reach those who need them as quickly as possible.

Globally, an estimated 1 million people die as a result of the 350-500 million cases of Malaria found every year. Malaria is both a disease of poverty and a cause of poverty. This has meant that the gap in prosperity between countries with malaria and countries without malaria widens every single year. LEPRA currently works to reduce malaria in India and Guatamala. We plan to expand our current work in Malawi and Angola to include malaria in the future. In India, Malaria has been effectively controlled for almost 80% population of the country but malaria continues to be a public health problem which seriously affects around 20% population, most of whom live in remote, inaccessible, forest and forest-fringe areas or highly concentrated urban slums. Until recently, India had around 2-3 million cases of Malaria every year and around 25% are found in the state of Orissa. Malaria is more common in poor and malnourished people, but spreads without regard for socio-economic status. The socio-economic burden of Malaria is particularly severe, even if it does not kill, as it impacts adults in their most economically active years pushing families deeper into poverty.

All this is preventable. The mosquitoes that spread Malaria can be reduced and Malaria can be cured if diagnosed and treated promptly and properly. LEPRA’s programmes use different approaches to reduce the deaths and burden of Malaria. For example, in India:

Communities control malaria through fish breeding programme. When the conditions for malaria to be a major public health problem are present, it is essential to have the active participation and involvement of the local community. This is because the intensity of malaria depends on local conditions which vary from area to area and the communities who live in these areas are best placed to address these issues.

In the isolated, rural, tribal village of Guptala in Andhra Pradesh, India, LEPRA works to reduce the spread of Malaria. LEPRA works with groups of villagers who have formed a health committee. The health committee identified Malaria as a major health problem and this was corroborated by the fact that it had the highest cases of malaria in the district from 2002-2004. As part of LEPRA’s intervention, the villagers now breed Gambusia fish which eat the larvee of mosquitoes, thus reducing the number of mosquitoes in the area and consequently reducing the spread of malaria.

Mayurbhanj Integrated Community Health Project (MICHP). In Orissa, Muyurbhanj district, in the first quarter of this year 6 Community Based Resource Centres were established in the project in partnership with the local communities. Located in rural and tribal areas they help address malaria infection at the community level. Community leader and volunteers financed the establishment of the centre and serve as its staff. The centres served as venue for accessing information on malaria and other diseases by local people. They are also utilised by Anganwadi Workers for administering malaria prophylactics to people suspected of having malaria and for blood collection for testing.

Krishna Community Health Intervention Programme (KRISCHIP).

In Krishna District, a Social Marketing Strategy was utilised by the project coordination committee for mosquito net distribution. Recipients contributed 25 Rupees for a 6 x 4 feet and 30 Rupees for a 6 x 6 feet mosquito net. This strategy resulted in a sense of ownership among recipients of the mosquito nets that they paid for. It also generated 1,276,597 Rupees which the committee plan to use to purchase an additional 9,000 mosquito nets for distribution, IEC materials and training of more volunteers. Around 50,000 treated mosquito nets were distributed to Slum Dwellers in Urban Vijiyawada and selected rural villages in Krishna. The activity was implemented with Vasavya Mahila Mandali, the local partner NGO, the district medical and health department. Local people’s representatives and local groups were also involved in the distribution process. A total of 2,545 volunteers were recruited and trained in the benefits of mosquito net use and follow up treatment. 25/04/2006.

New BPRC director is renowned immunologist. LEPRA is delighted to announce the appointment of Dr Indira Nath as the new Director of the Blue Peter Research Centre  in Hyderabad, Andhra Pradesh. Dr Nath is an internationally recognised immunologist and former Professor and Founder Head of Department of Biotechnology at the All India Institute of Medical Sciences, New Delhi.  She was awarded the Civilian honors of Padmashri from the President of India in 2001, Chevalier of the National Order of Merit from President Chirac of France in 2002 and the Silver Banner Award from the Tuscanny Council. In 2002 Dr Nath received the L'Oreal UNESCO Women in Science Award for Asia Pacific in recognition for her contributions to leprosy research. She was also awarded  Doctorate Honoris Causa from Pierre and Marie Curie University, Paris in 2003. She is a Fellow of Science and Medical Academies of India, the Third World Science Academy and the Royal College of Pathologists.

Dr Nath's work focusses on the immunological basis of leprosy, a disease which appears as a spectrum, wherein the same bacteria can produce different manifestations in different patients. When infected, one individual may develop only a small white patch with decreased sensation, whereas another might develop generalized disease all over the body. Her research looked at the way the immune system behaved when  the patient had limited, localized disease as compared to the individual with the generalized leprosy. She also showed that when patients developed episodes called reactions with fever, joint pains and skin nodules the immune system showed a reawakening similar to that observed in patients with limited disease. She was able to show that during such reactions the immune system recognises small defined parts of the bacillus and develops antibodies. Based on this informtion simple tests can be used to predict the onset of such episodes. L'Oreal's "For Women in Science" program developed in partnership with UNESCO is aimed at advancing the role of women in the scientific world. The award also highlighted Dr Nath's efforts towards finding a vaccine for leprosy. However she adopts a realistic stance. "A vaccine is a very long drawn out process in a disease like this." However, recent major breakthroughs from scientists in the U.S. have fueled research in that direction. "We are doing things which will finally tell us what/how the cells get turned on for protective immunity. That's what we want for a vaccine, an immunity that doesn't cause disease, but an immunity that gives you protection before the symptoms come up". 11/04/2006.

March 24th marks World TB day. In his message for the day the UN Secretary-General, Kofi Annan, has called for everybody to play their part in supporting the Global Plan to Stop TB, 2006-2015.  The theme for this year's World TB Day 2006 is Actions for life: towards a world free of tuberculosis. Dr Neil French, who has taken up the post of Director of LEPRA's Research centre in Malawi said "LEPRA has been at the forefront of international research demonstrating the importance of the HIV pandemic to the tuberculosis epidemic in Africa – 70% of tuberculosis in Karonga is HIV related and 50% of all tuberculosis transmissions are from HIV-infected cases". Please support this drive to help stamp out TB. 24/03/2006.

Donate On-Line today. Want to transform somebody’s life? To support LEPRA’s work right NOW click here and have your debit or credit card ready. Our Barclays secure on-line donation service allows you to give instantly to help people with leprosy and other diseases of poverty.

Obituary - Dr. Colin McDougall. LEPRA is sad to announce that Dr. Colin McDougall passed away on Thursday 16th February 2006. Colin qualified in medicine in Edinburgh in 1946 and was awarded the Burn-Murdoch Medal in Clinical Medicine. He worked in the Edinburgh Royal Infirmary, the Radcliffe Infirmary in Oxford and in general practice before joining the Royal Singapore Anti-Tuberculosis Association in 1953. He spent some time as a doctor on a troop ship during the Korean War, where he first encountered tropical diseases.

On returning to the UK in 1956 he completed his training in clinical medicine in the Norfolk and Norwich Hospital and St. Bartholomews in London, then went abroad again to work as a medical specialist in Sumatra, at the Queen Elizabeth Hospital in Aden, and with refugees in Algeria, before being appointed Leprosy Specialist to the Ministry of Health in Zambia in 1967. He soon heard of the dynamic leprosy control programme in neighbouring Malawi, under the direction of Dr. David Molesworth and supported by LEPRA, using Landrovers, motorbikes and bicycles to bring diagnosis, treatment and disability care to people in virtually all parts of Malawi. While on leave in the UK, he contacted the then Director of LEPRA (Francis Harris), and applied for help with leprosy in Zambia. The ‘Malawi-LEPRA Approach’ was soon established in the eastern Province of Zambia. In 1970 Colin returned to the UK and took up histopathology work in Oxford for the Medical Research Council, the World Health Organisation (WHO), and other agencies, which involved the examination of tissue samples and biopsies from leprosy patients worldwide. Under the technical direction of Dr. R.J.W. Rees at the National Institute for Medical Research in London, this work also included microscope studies relating to the possible development of a vaccine against leprosy.

Early in the 1970s, Colin established the LEPRA prize essay competition for medical students to encourage them to write essays on a subject of importance in leprosy control or research. He was also responsible, in association with Dr. Rees, for placing UK medical students in centres in leprosy-endemic countries for their elective periods. In the early 1970s, Colin was given responsibility for the admission, diagnosis and treatment of patients with leprosy, and the development of medical and scientific studies on the survival of the leprosy bacillus outside the human body; he was also instrumental in getting the first blister calendar packs for multidrug therapy in 1983. In 1978 Colin became Editor of LEPRA’s prestigious medical journal Leprosy Review – a position he held for ten years. He retired in 1998, but continued his visits to leprosy-endemic countries as LEPRA’s representative, for WHO and other agencies. Even in retirement, Colin continued to support LEPRA, and was a familiar face at the Annual General Meetings, and his association with Leprosy Review never faded; indeed he not only continued to act as a referee for medical papers, but also as a sub-editor of the journal – roles he fulfilled up to his death.

Colin published over 100 books and articles and was always keen to help others achieve literary recognition. His legacy of providing teaching materials which are easily understood has greatly increased our knowledge of the disease of leprosy and enabled us to pass on this information to the public at large. He was one of the most highly respected men in the leprosy field today, and his loss is incalculable. 15/03/2006.

LEPRA to expand work in Madhya Pradesh. Following a request from the state government, LEPRA India has agreed to take over the coordination of all the leprosy work done by members of the International Federation of Anti Leprosy Association (ILEP) in Madhya Pradesh, India. The state Government has also requested that we help to strengthen services for TB and HIV/AIDS within the region.

Madhya Pradesh has a population of over 60 million and is the second largest Indian state in size covering an area of 308,000 sq. kms. Agriculture is the mainstay of the State's economy and 75% of the people work in rural areas. It is also one of the most important states in the country for mineral production. LEPRA are already familiar with Madhya Pradesh having worked with the St Joseph Sisters and the state Government since 1992, and last year we opened a new reconstructive surgical unit in Sanawad. We also have a large technical support team working in six districts within the state, advising on leprosy TB and HIV/AIDS. Madhya Pradesh is not well served in terms of international funding agencies and LEPRA will undertake a needs assessment as soon as possible. There is obviously a great need for assistance which we hope to meet with your support. To read more about our projects overseas, including those in India, please visit our Projects page. 27/02/2006.

Jersey Aid helps improve leprosy diagnosis. A recent Jersey Overseas Aid grant will be used to help improve leprosy diagnosis in the north of Brazil. The Giselda Trigueiro Hospital (GTH) is a reference centre that offers specialised patient care for complex leprosy and skin diseases for the state of Rio Grande do Norte in north-eastern Brazil. It is responsible for around 30% of all leprosy cases treated in the State during the last 10 years. Although most leprosy cases can be diagnosed on a purely clinical basis accordingly to WHO recommendations, a reference centre is essential for treating more complicated cases referred from other state municipalities. Of the new leprosy cases detected at the Centre, 90.5% were evaluated for disabilities and 9.2% had irreversible physical deformities. The vast majority of these are made up of low-income, poorly-educated and marginalised individuals.

Doctors at GTH see around 1,100 outpatients every month and around 30% come for leprosy care. These are either patients sent for confirmation of diagnosis or existing leprosy cases with immunological reactions or complications. In both of these cases further analysis of affected tissue samples are an important tool for proper patient treatment. The GTH doctors are able to take biopsies for these complicated cases, but the specimens are sent to another laboratory for testing due to the lack of equipment on the premises. Currently this process takes up to 6 months to produce a pathological conclusion, often a crucial period in the onset or exacerbation of nerve damage. As a result, this delay leads to the irregular follow-up of patients and unsatisfactory resolution of their cases.

Jersey Overseas Aid will allow the purchase of the equipment requested for the pathology laboratory, which will be functional for at least the next 15 years. This will also contribute to improve leprosy diagnosis not only at the Giselda Trigueiro Hospital but also for Mossoró municipality - where there are around 150 new leprosy cases every year - and for patients from many other municipalities in the State. It is estimated that around 6,000 patients will benefit from the project during that period, helping to clarify other dermatological cases that also require biopsy samples. Additionally, the biopsies studies will stimulate the local team to develop research in different aspects of the disease. In is also expected that the hospital team will be able to expand their partnership in projects with the Federal University as a result of the purchase of this necessary equipment. 16/02/2006.

Journalist experiences the human face of leprosy. Author and jounalist Victoria Hislop has recently returned from a week long trip to visit LEPRA’s projects in India. In a letter written on her return to Terry Vasey, LEPRA’s Chief Executive, Victoria briefly outlined some of the emotional highs and lows she had felt. She will be writing a full article for LEPRA News later in the year and we will also be sharing her experiences with you on this website, so please keep checking for updates.

LEPRA’s work makes a real and lasting difference to people’s lives and Victoria was clearly stuck by the dedication of our overseas staff and the people she met who had struggled and succeeding in rebuilding their lives: "I met people of almost every age. People whose whole lives have been mended by what you do, as well as people who still face uncertainty and fear. I went through the whole gamut of emotions that week, sometimes upset by the sheer awfulness of people’s suffering but I also found much to smile at with the positive attitudes of so many people and so many stories of cure and healing." "Some of the leprosy affected people will always remain with me, particularly Jothi who lives in a small village and showed me her book in which the whole of Shakespeare’s "All the world’s a Stage" was neatly written out. Sitting in Jothi’s one roomed home, the resonance of Shakespeare’s notion that we are all "merely players" was immense. I felt that I had been given a really easy part to act out in the play, whereas she had landed the difficult role".

World leprosy Week, which ended on the 29th January, gave LEPRA a fleeting opportunity to focus public attention on the plight of hundreds of thousands of people still living with the disease across the world. However, LEPRA’s challenge is to make sure that leprosy remains firmly on the agenda all year round and we very much hope that Victoria Hislop’s writing will help us to do that.

Please direct media enquiries to alistair_heron@lepra.org.uk. 13/02/2006.

Global Appeal marks World Leprosy Day. LEPRA is delighted that a host of respected names including Archbishop Desmond Tutu, former US President Jimmy Carter and The Dalai Lama have backed a global appeal to end the stigma and prejudice faced by people living with leprosy. Timed to coincide with World Leprosy Day on the 29th January, the appeal challenges individuals to change their attitudes and calls on the UN and national governments to redouble their efforts.

At 12:00 in New Delhi, India, Yohei Sasakawa, chariman of The Nippon Foundation, presented a Global Appeal to End Stigma and Discrimination against People Affected by Leprosy. The text of that appeal, which is being issued in the names of 12 world leaders and Nobel Peace Prize laureates, is presented below:

Global Appeal to End Stigma and Discrimination Against People Affected by Leprosy.

Leprosy is among the world's oldest and most dreaded diseases. Without an effective remedy for much of its long history, it often resulted in terrible deformity. It was also thought to be extremely communicable. Patients were abandoned, forced to live in isolation and discriminated against as social outcasts.

In the early 1980s, an effective cure for leprosy became available. Multidrug therapy has successfully treated over 14 million people to date. Contrary to popular belief, leprosy is extremely difficult to contract. With prompt diagnosis and treatment, it can be medically cured within 6 to 12 months without risk of deformity.

Yet fear of leprosy remains deep-rooted. Misguided notions endure - that it is "highly contagious," "incurable" and "hereditary." Some even regard it as "a divine punishment." Ignorance and misunderstanding result in prejudice and discriminatory attitudes that remain firmly implanted as custom and tradition. Consequently, patients, cured persons and their entire families suffer stigma and discrimination. This limits their opportunities for education, employment and marriage, and restricts their access to public services.

Fearful that by speaking out they will invite further discrimination, for long years people affected by leprosy, including their families, have been cowed into silence. Such silence reinforces the stigma that surrounds them. The world has remained indifferent to their plight for too long.

Article 1 of the Universal Declaration of Human Rights states that "All human beings are born free and equal in dignity and human rights." This article, however, is meaningless to people affected by leprosy, who continue to suffer discrimination. We appeal to the UN Commission on Human Rights to take up this matter as an item on its agenda, and request that it issue principles and guidelines for governments to follow in eliminating all discrimination against people affected by leprosy. We further urge governments themselves to seriously consider this issue and act to improve the present situation with a sense of urgency. Finally, we call on people all over the world to change their perception and foster an environment in which leprosy patients, cured persons and their families can lead normal lives free from stigma and discrimination. January 29, 2006

	List of signatories
	Oscar Arias Former President of Costa Rica Nobel Peace Prize Laureate
	Jimmy Carter Former President of the United States of America Nobel Peace Prize Laureate
	The Dalai Lama Nobel Peace Prize Laureate
	El Hassan bin Talal Prince of the Jordanian Hashemite Royal Dynasty
	Václav Havel Former President of the Czech Republic
	Olusegun Obasanjo President of the Federal Republic of Nigeria
	Mary Robinson Former President of Ireland Former UN High Commissioner for Human Rights
	Yohei Sasakawa Chairman, The Nippon Foundation
	Desmond Tutu Archbishop Emeritus of Cape Town Nobel Peace Prize Laureate
	R. Venkataraman Former President of India
	Elie Wiesel President, The Elie Wiesel Foundation for Humanity Nobel Peace Prize Laureate
	Luiz Inácio Lula da Silva President of the Federative Republic of Brazil

Global Fund approves new TB work in Mozambique. The Global Fund for TB have recently awarded grants for work to eight non-governmental organisations including LEPRA working in Mozambique. The grant to LEPRA is for work to begin in March 2006 covering TB healthcare in 3 important states of the country - Maputo, Gaza and Zambezia - and in the capital city of Maputo. These areas combined have an estimated population of 6m people out of a total population of 20m in the country as a whole. LEPRA has been awarded a grant of $531,682 to be spent over two years.

Some 70% of the population of Mozambique live below the poverty line and life expectancy at birth is just 40 years of age. HIV/AIDS is a huge ongoing problem with an annual prevalence rate of around 13% and an estimated 1.5m people in the country living with HIV/AIDS - many of whom go on to contract TB as the disease progresses. Figures provided by UNAIDS estimate that the total number of deaths from HIV/AIDS related diseases will reach 1.2m by 2010. In order to push forward and coordinate our work in the country LEPRA is delighted to announce the recent appointment of a new Mozambique Country Director - Mr Robert Burny - whose first priority will be to recruit and train staff to work from our regional office in Maputo. 20/01/2006.

Global Positioning tracks leprosy. Experience in the field is an incredible advantage for a medical development charity like LEPRA, just as long as we don’t become set in our ways. Although LEPRA is over eighty years old, we continue to develop more efficient methods of working so that we can do even more to diagnose, treat, and cure people affected by leprosy. The use of Global Positioning technology (GPS) to identify hidden leprosy cases in Brazil is a wonderful example of the innovation of our field staff.

LEPRA works in five states in Brazil, one of them, Rio Grande Norte, has seen a dramatic reduction in the prevalence of leprosy in recent years. When compared to the high number of cases still being found in some of our Indian projects, it seems incredible to think that there were only 319 cases officially on record in 2004. However, our success can be a double edged sword. As leprosy becomes less common, people are less likely to come forward for treatment and doctors are less likely to diagnose leprosy believing that symptoms are probably attributable to other diseases. This is typically how we end up with ‘hidden" leprosy cases. LEPRA staff in Brazil were concerned that it was becoming increasingly difficult to track down people who may have ‘slipped through the net’. Although they had made huge strides towards controlling leprosy in Rio Grand Norte, they were well remains untreated for long enough it can cause severe disability. Not only that, but the longer someone is infected the more opportunity they have to pass the disease on to those closest to them.

Having decided that something needed to be done to look for hidden cases, the question was where to concentrate our resources. After consulting with two renowned leprologists, Dr Marcia de Souza Dias and Mr Gutemberg Dias, an answer emerged. Like many diseases, leprosy is found in concentrated pockets, so our first task was to plot the houses of known leprosy patients on an electronic map. Having done that, we conducted an awareness and testing campaign which concentrated solely on their friends, family and neighbours. New cases found would then also be mapped giving a more accurate picture of the spread of the disease.

The results of the campaign were extremely impressive. In one municipality we found the entire official caseload for the year in four weeks. Worryingly, 15% of those new patients already had significant disabilities. This was a good indication that there is a genuine problem with undetected leprosy. Consequently, throughout 2006, LEPRA will be stepping up awareness campaigns in identified hotspots. We will also be providing targeted training for government health staff in those areas to ensure that they are able to diagnose and treat leprosy effectively. The benefits of our experiment with GPS will not be confined to LEPRA projects in Rio Grande Norte. We have always believed in sharing our knowledge for the widest possible benefit and in September our Country Director, Duane Hinders, addressed the Brazilian Dermatological Congress. The GPS project was extremely well received and it highly likely that GPS mapping will become an integral part of leprosy control projects right across Brazil. 19/01/2006.

LEPRA News gets a makeover. The latest issue of LEPRA News is now being mailed and you may have noticed that it has been given a fresh new look. This is thanks to our kind friends at Image Creative Design who have donated their talents to make our Newsletter clearer. We hope that the simple new format will allow our supporters to feel closer to our vital projects and the people whose lives are being transformed with their help.

The article, "From Fire Fighting to Future Building", tells the short but eventful history of our involvement in Angola. Also in this issue, Dr Anthony Bryceson talks about the debates surrounding the future of leprosy treatment and we find out how GPS satellite technology is being used in Brazil. As ever, we finish with a personal appeal. Milki Shetty has an amazing story to tell, but please remember that she is just one success amongst the hundreds of thousands made possible every year with your help!

If you would like to be mailed a copy of the newsletter please let us know by filling in our Information Request Form. You can also ask to be placed on our email list and you will be sent a reminder whenever a new issue is available on our website. May we thank you once again for your support and take this opportunity to wish you all the best for 2006. 16/01/2006.

Posters win Prizes for LEPRA India. The 24th National Conference of leprosy was held at Agra between 12-14th November 2005, entitled "Newer technologies for patient care and Epidemiology of leprosy and other Mycobacterial diseases".

During the conference the scientific committee accepted 65 oral presentations and 87 papers for presentation as posters. Staff from LEPRA India put forward several papers at the conference and 34 of these were accepted - 16 for oral presentation and 18 for poster presentation - meaning that of all the scientific papers presented at the conference, 22% were presented by LEPRA India. A panel of judges examined all 87 posters and announced three prizes for poster presentation. LEPRA India were awarded two of these three prizes for posters explaining our work in Koraput and Bihar. One paper on reactions was also accepted as a lead paper and was presented by Dr.Sudhakar of LEPRA India.

A workshop on case detection trends was also organised with guest speakers invited to present data on the case detection trends in specific geographical areas. Dr. Ranganadha Rao, Chief Executive of LEPRA India, was invited as one of these speakers. A detailed analysis of the case detection trends was prepared and presented in the workshop. Concern was raised on continued occurrence of new child cases and new skin smear positive cases in Sonepur district. Instances of wrong interpretations of government guidelines at the district level amounting to tampering of data was also brought to the notice of the organisers. 12/01/2006.

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