CAMBODIA: "I wanted to die because of leprosy"

PHNOM PENH, 22 December 2010 (IRIN) - Leang Sopheap always averted his eyes when he collected alms or charity payments for his temple from villagers to hide his leprosy scars.

"I dared not to look up," he said. "All the monks laughed at me and isolated me. I stayed alone in my room for one year, and only came home during the night when nobody could see my face."

"I wanted to die," he said.

In 2004, Leang found treatment at Cambodia's only leprosy centre, the Kien Khleang National Leprosy Rehabilitation Centre, in a suburb of the capital, Phnom Penh.

The experience drew him to work as a counsellor at the centre, helping leprosy patients deal with discrimination.

Burden on the poor

Many communities continue to ostracize the infected, survivors of the disease say, despite success in curbing the prevalence of leprosy in Cambodia.

Some people harbour misconceptions that the disease is incurable and inherited. They are reluctant to touch, shake hands with, dine with, or use the same toilets as leprosy patients, fearing they will also become infected.

The isolation often plunges the poor further into poverty. For example, some customers refuse to buy food or products if they believe a shop owner is infected.

Leprosy patients also cannot continue doing some jobs, such as manual labour, after their hands become disfigured.

In Cambodia, more than 300 new cases are reported each year, according to statistics gathered by the International Committee of the Order of Malta (CIOMAL), a non-profit organization based in Geneva that funds the centre in Phnom Penh.

According to the World Health Organization (WHO), almost 500 registered cases of leprosy exist in Cambodia, less than a third of the number two decades ago.

The rate has generally remained steady for the past decade, ever since leprosy was eliminated at the national level in 1998.

Leprosy is caused by a bacterial infection that can affect the skin, nerves, and eyes. It is not highly infectious even through recurrent contact. When untreated, it can cause patients' faces and hands to become disfigured, develop ulcers on their skin, and lead to nerve damage.

"Many medical professionals are not well educated about leprosy," Sophal Bou, a manager at Kien Khleang, said. The stigma still exists, he said, although it has declined in the past five years.

Many patients report not having trouble finding medicine in Cambodia, but have difficulty speaking to medical staff, according to a study at Vrije University in Amsterdam, as health staff thought that people with visible impairments were contagious. This led to their social exclusion.

Victory?

Around the world, leprosy often affects the poorest of the poor.

In 2008, about 250,000 new cases were reported, WHO reports, mostly in Asia and Africa.

For the most part, healthcare workers are winning the global battle against leprosy, however. Over the past 20 years, more than 14 million leprosy patients have been cured.

The world health body also reached its goal of eliminating leprosy as a public health problem by 2000 through multidrug therapy.

The WHO defines "elimination of leprosy as a public health problem" when the prevalence rate is less than one case per 10,000 people. Cambodia has a rate of about 0.2 per 10,000 people.

"Progress has been achieved, but we need to be careful to say it's a victory," Harald Schmid de Gruneck, CIOMAL head of mission, told IRIN in Phnom Penh.

"We're doing most of the funding with NLR [Netherlands Leprosy Relief, an NGO], but what happens the day we don't?"