Leprosy is no longer considered a major public health threat as it is easily treated and controlled with multi-drug therapy (MDT). But in Bainganwadi, Shivaji Nagar, where the number of new leprosy cases has gone up between 2006 and 2010, the biggest challenge facing health workers is coaxing patients to come to health clinics to start the MDT regime before the disease disfigures their bodies permanently.
In 2006, Lok Seva Sangam (LSS), a community project run by a non-profit group, detected 18 new cases of leprosy in the area. The numbers shot up 24 in 2007, declined to 20 in 2008 and 16 in 2009 before going up to 24 in 2010.
Last year, LSS screened 192 cases up to June though the actual number of leprosy cases has yet to be counted.
Etheldreda D’souza, manager at LSS, said in their latest 15-day survey, healthcare workers found 4 to 5 positive cases among 25,000 residents. This means the trend is increasing, warned D’Souza.
LSS has been detecting and treating leprosy cases with the help of Alert India, a non-government organisation.
At its 15 clinics, including ones in Govandi, Sion, Saki Naka, Vashi Naka and Chunnabhatti, LSS has treated 28,473 leprosy patients since 1979.
The World Health Organisation reports about 500,000 to 700,000 new cases per year worldwide; since 1985, 14 million cases have been cured. In India, the disease still has a firm hold: 130,000 cases are detected annually - more than any other country.
Though the disease can be completely cured with drugs, the stigma associated with it means patients are reluctant to undergo treatment. Ankit, a young resident of Bainganwadi, was diagnosed with leprosy a few months ago. Health workers are finding it difficult to make him visit the clinic. “He has a job and he has to be coaxed to visit the clinic to avail of MDT,” said a health worker at the LSS-run clinic.
In Shivaji Nagar, a cluster of large slums where minorities constitute 80% of the population, detecting patients with leprosy is a challenge. D’souza, who has been monitoring the problem by frequenting Bainganwadi since 1988, said it is hard to detect new cases for several reasons. “First, patients don’t come to us until the symptoms are severe. They come to us 12 years after they contract the disease; by that time they get non-reversible problems like deformed limbs,” said D’Souza.
Health workers also complained that doctors attached to health posts in the area receive a 15-day training on leprosy which is inadequate. “They cannot detect it accurately; our paramedical workers do a better job in detecting cases than MBBS doctors,” D’Souza added.
Poverty, illiteracy, unhygienic conditions and the old stigma means leprosy has not loosened its grip in Mumbai’s slums. Worldwide, one in three persons lives in a slum; 54.1% of the population in Mumbai are slum dwellers (2001 Census). The congested conditions in which the slum population lives is driven home by the fact that though they form more than half of the city’s population, they are squeezed into just 6% of all land in Mumbai.
Some 29% — between a fourth and third of Maharashtra’s urban population - resides in a Mumbai slum.
Shivaji Nagar is located near one of the largest garbage dumps in the city. Sanitation and congestion are the biggest problems here. Over the years, with help from corporators and the municipal corporation, residents have tried to improve hygiene in the area.
“During every election, politicians promise us water, electricity and toilets, but you can see that the promises are not delivered,” said 38-year-old Pramila Yadav, a homemaker and mother of two.
While the slum’s population increased over the last 25 years, things have deteriorated considerably. Yadav said she plans her day around the collection of scarce water. Lack of water and sanitation contributes to the spread of contagious diseases like leprosy and TB, said healthcare workers.
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