In the first part of Dr Belen Lardizabal-Dofitas’ interview with MIMS, she shed light on the various aspects that complicate a leprosy patient’s treatment journey. She said that healthcare professionals tend to get fixated on finding and treating patients that they often overlook the disease’s socioeconomic, physical rehabilitation and the reintegration of persons affected by leprosy.

For the second part, Dr Lardizabal-Dofitas’ emphasises on ways the country is aiming towards the elimination and reduction of leprosy.

Please tell us more about the government’s National Leprosy Control Program.

The National Leprosy Control Program is the Philippines’ public health program that aims to eliminate leprosy in the country. This program has made effective antibiotics available for decades. For this reason, leprosy patients do not have to be segregated in a special hospital because medicine can be taken at home.

The current standard treatment is called Multi-Drug Therapy (MDT) which is provided for free at our government health facilities. In order to avail of this service, patients must register in the health facility. Medications must be taken for 6-12 months, and monthly check-ups are required.

MDT has successfully treated millions around the world since the 1980s and is still the most proven cure for leprosy. There are alternative antibiotics that can effectively kill the leprosy bacteria but long-term clinical trials are still needed before these can replace MDT.

Complications such as lepra reactions and nerve inflammation are still being controlled through oral corticosteroids. There are other drugs that can be added but these have to be purchased by the patient.

Can you walk us through a leprosy patient’s treatment journey?

Once a patient has been diagnosed with leprosy, the physician will prescribe the appropriate MDT regimen based on the type of leprosy, either a mild form (paucibacillary or PB) or the more severe form (multibacillary or MB). Possibly, baseline laboratory tests and screening for other medical problems are done prior to the start of MDT. In higher level treatment centres, slit skin smears and skin biopsies are performed to confirm leprosy and assess the bacterial load. The physician or other health personnel explains the disease, MDT, possible side effects, and duration and schedule of follow-up.

MDT is composed of three antibiotics: rifampicin, clofazimine, and dapsone. The PB regimen only requires rifampicin once a month and daily dapsone intake for a total of 6 months. The MB regimen requires all 3 antibiotics for a total of 12 months. In some severe cases, treatment may be extended. Ideally, the health personnel should directly observe the intake of rifampicin by the patient each month because it is the most important and most potent drug in MDT against the leprosy bacteria. Most of the bacteria are killed with even just one dose of rifampicin. MDT is supplied for free by the World Health Organisation to all countries and distributed through the countries’ respective ministries or departments of health.

The key to reducing the spread of leprosy is early detection and treatment. Multi-Drug Therapy quickly renders a leprosy patient non-infectious during the first month of intake. Leprosy, as with many other infectious diseases, will decline as a community becomes more socioeconomically developed and healthier over-all.

How close or how far do you think we are in eliminating leprosy in the country?

Leprosy takes around 2 to 10 years to become a full-blown infection. For this reason, we will continue to see new cases. We are still far from eliminating the problems brought about by leprosy. We need a game-changer to prevent new cases from cropping up. MDT was believed to be the game-changer in the past. However, in almost 4 decades of MDT worldwide, the number of new cases have not declined.

On the other hand, it is worth noting that there have been huge gains since the leprosy control program and MDT were instituted in our country in the early 1980s. The total number of existing leprosy cases have fallen below 1 per 10,000 population in many parts of the country by 1999. We are seeing fewer deformities over the years but it gets frustrating when a new patient gets diagnosed very late and with multiple complications—knowing that this person resides in Manila.

We still lack community-based rehabilitation of persons with disabilities. The former leprosy patients have to deal with the physical damage brought about by leprosy, as well as continuous socioeconomic and spiritual support for themselves and their families after the treatment period.

At times, even MDT is lacking in some areas. An all-out campaign to reduce stigma and discrimination of persons living with leprosy is also lacking. Leprosy control is not much of a priority and lacks funding because other health programs with international support and large funding tend to be given more attention. Because of this, leprosy is in danger of becoming difficult to recognize by our health personnel and new cases will just keep on emerging in the years to come. MIMS

About Philippine Leprosy Mission, Inc.

Philippine Leprosy Mission, Inc. ( is a 55-year-old non-government organization that aims to find, treat, and rehabilitate persons afflicted with leprosy. They envision a world where the worst problems due to leprosy are eliminated: disability, stigma, and poverty. PLM has been a long-time partner of the Department of Health National Leprosy Control Program. PLM’s projects include:

1) Partners In Leprosy Action (PILA), an internationally recognized Social Innovation in Health care delivery. PILA is a community engagement strategy that brings together stakeholders such as the Department of Health, Department of Education, Local Government Units, and a number of private individuals/organisations.

2) The Leprosy Chat Room—an online chat room for leprosy patients and former patients to share their stories. They can ask questions about leprosy and treatment with the more experienced patients providing useful and practical information to the newer patients.

3) The Leprosy Storybook: In 2016, PLM published a children’s storybook in partnership with the Phi Lambda Delta Sorority of the University of the Philippines College of Medicine. The storybook tells a triumphant story of a boy who overcame leprosy.

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