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
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
Philippine Leprosy Mission, Inc.
(http://www.leprosy.org.ph/ • firstname.lastname@example.org) 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
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.
to end Neglected Tropical Diseases by 2030
archaeology: When history helps health
Early detection is key to reducing the spread of leprosy in the Philippines – Dr Belen Lardizabal-Dofitas
Jemar Nicdao, 14 Feb 2018