Lepers in Indonesia

On the island of Bali you don’t see many lepers but if you travel to Java and Sumatra then they are prevalent in all the major cities and can be seen on the roadside begging for money, their open and infected appendages open to full view. When I first went to Yogyakarta, I can well remember seeing a leper one particular night and sat down next to him for a chat, much to the aghast of my newly-acquired friends. I was curious as to how he got into that situation and wanted to know if the government would do anything to help him. I was told they wouldn’t.

So, is the problem of lepers a health issue or a social issue?. I tend to think it is both. Emmy Fitri wrote an article recently about this whole situation:

Leprosy no longer a health but social issue

One may well wonder whatever happened to public health and social services for it is still easy to see beggars with missing arms, legs or fingers at the traffic lights on downtown streets.

Is the presence of beggars proof of poorly or half-implemented services?

The answer is always either one.

But, in bringing down the prevalence rate to one case per 10,000 population, Indonesia has come closer to reaching the global target of eliminating leprosy than a number of other countries.

The Health Ministry’s Director General of Communicable Diseases, I Nyoman Kandun, said that in the past 10 years 371,000 lepers had been cured.

“At national level, this disease is considered gone, but there are other regions like South Sulawesi, East Java and Maluku where new cases are being reported.”

Considering the relatively low case numbers, leprosy is no longer considered a public health problem here. Though, in Kandun’s words, surveillance and free medicine are readily available for those who need them.

An ancient scourge, leprosy is an infectious disease caused by Hansen’s bacillus, or the Mycobacterium leprae bacterium.
As the disease progresses it can cause a range of skin conditions, loss of feeling and paralysis of the hands and feet.

At an international meeting on tropical diseases in Jakarta in February a report was released that stated there were still one billion people in tropical countries suffering from debilitating and disfiguring diseases associated with poverty, but many remain untreated due to official neglect.

“Despite the existence of inexpensive and safe treatment, those who suffer from diseases such as leprosy remain untreated due to a lack of resources and political will,” said Jai Narain,
Southeast Asia director of communicable diseases at the World Health Organization.

“These diseases are closely related to poverty. The elimination of such diseases would be a significant step toward poverty reduction,” Narain said.

Narain said that despite the limited funding allocated to tackling neglected diseases such as leprosy, WHO remained committed to helping countries eradicate the disease.

“Multidrug treatment for leprosy is available for free and governments must make extra effort to optimize surveillance because early detection is one step toward curing a patient,” he said.

Meanwhile, the Health Ministry’s Director General for Health Services, Farid Husain, said leprosy might no longer be a health issue here but the stigma attached to it lingered on.

“The Health Ministry cannot work alone in this case because it is closely related to social issues and local administration policies.”

Farid said the directorate general could only ensure lepers were treated for free until they were cured.

“Our health workers and leprosy hospitals must also help rebuild patients’ confidence so they can begin new lives,” he said.

Public education campaigns, he said, were also key to reducing the continuing stigma and prejudice against leprosy patients.

Farid nevertheless said improved health services alone would not be enough to change the attitudes and actions that affected lepers.

“Local governments and related offices such as the Social Services Ministry must also work with us to make an integrated program,” he said.

Emmy Fitri