Hanson's Disease 101

So! Leprosy. Also called Hansen's Disease, although how Dr. Hansen managed to stick his name on one of the world's most ancient illnesses remains a mystery of hubris. The SRH was actually founded, 30 years or so ago, with the chief goal of taking care of India's leprosy patients. They've expanded to other infectious diseases over the years, mostly HIV and tuberculosis, but you still tell the cab drivers that you're going to the "Kushdaviadee" - leprosy hospital.

I'm not sure if they're setting up a straw man or what, but the SRH doctors often claim that the Indian government has proclaimed leprosy eradicated from India. Couldn't actually find any evidence of this on the interwebs. Either way, patently untrue. Six days a week, the outpatient center here sees leprosy in all its various stages of treatment, mostly repeat patients with complications but at least 10 brand new patients a month, including kids.

The past two days, I've been hanging out in the outpatient ward, trying to look like I understand the conversation and sneaking peeks at the stockpiles of dusty medication boxes (ofloxacin with mango flavour!). The doctors drop knowledge on me in between seeing patients.

Essentially, the leprosy cycle:

1) patient appears with some combination of weird pale skin patches that lack sensation and/or nerve malfunction - can't flex their fingers, pick up their feet, close their eyes entirely, etc.

2) patient has to take at least two antibiotics, every day, for A YEAR

3) patient spends the rest of his/her life dealing with either "reactions", where the body's immune system causes these painful flares in the skin and has to be tamped down with steroids, or secondary infections that happen when patients can't feel their injured limbs.

The infections are what we really spend most of our time doing. In terms of lost productivity/mortality/morbidity/stigma/any other index you care to measure, foot ulcers are the worst by far. It's actually a bit like diabetes in the States, weirdly. When you lose sensation to your feet, you just don't notice when you develop a blister, or step on a nail, or burn your toe - you don't protect your foot, you don't stay off it, and a nasty infection takes hold. And honestly, how often do you look at the bottom of your feet if they're not bothering you? By the time patients notice the smell (the number one complaint), things are often to the point of requiring hospitalization. Chronic infections lead to osteomyelitis (bone infections) leads to gangrene leads to amputation, and then you have a population of people with very little education who can't do physical labor. Bad cycle. The hospital campus is home to many employees-slash-former patients who simply could never find a job anywhere outside.

The new multi-drug regimen, which the WHO recommended in the 1980s, has definitely cut rates of new cases down considerably, but if eradication requires everyone to adhere to a year's worth of vaguely toxic antibiotics, it's going to be tough. In any case, I'm really glad to see these patients - something I'd never get to see in the US, but also very interesting from a public health perspective in terms of managing the long-term consequences of infectious disease.

As a side note, there was a patient today who came in looking just...terrible. Dirty bandages on his broken arm and ulcerated toe, one eye nonfunctional due to nerve damage, hobbling along with a cane...classic image of the leprosy patient. We're waiting in the physical therapy room with him, when a strange little music starts to play - and he hobbles off to talk on his cell phone.

India! Lepers with cell phones.