I am rummaging around in the Store Room where we keep our drugs and other medical materials. It’s dark and I have to squint closely at the shelves to see anything; I am sure I saw some drugs for leprosy in here. The old, sweet tempered storekeeper doesn’t understand what I am looking for but tries to help anyway. Finally I find it, MDT-Combi it says on the box, Multi Drug Therapy for Leprosy. It hasn’t even expired, my lucky day.
There is only one person receiving treatment for leprosy in our project. He is waiting for me to give him his second month of drugs and authorize his food ration. There could be many more people with leprosy in this part of southern Sudan; probably nobody really knows the scale of the problem. Social stigma, difficulties with diagnosis and limited treatment opportunities make leprosy a hidden scourge.
Leprosy is a ‘Disease of Poverty’ as is malaria, TB, HIV/AIDS, measles, pneumonia, diarrhea and complications of childbirth. These diseases/conditions disproportionately affect the poor. The association between leprosy and poverty is a two way street. Poor people get leprosy because of overcrowding, malnutrition, and lack of care; leprosy makes people poor because of social stigma and chronic disability.
The patient with leprosy is an emaciated old man. His face is riddled with thick nodules and the cartilage of his nose is collapsed, the hand he proffers for his drugs is a claw that is missing most of its fingers.
“He says he doesn’t have enough food,” the Community Health Worker informs me. I explain that our protocol allows him only one week’s food ration per month, a strategy that is meant to improve adherence to treatment. But I feel mean and stingy as I speak. No sooner is he gone than I start to think that this is probably one of those instances for which the rules were made (i.e. to be broken).
There is always next month.