Book ReviewRestoring Dignity: The Yemeni experience of ending the isolation and ostracism of leprosy patients [Archives:2008/1156/Health]

May 19 2008

Dr. Yasin Al-Qubati
For The Yemen Times

The history of leprosy is closely intertwined with the phenomenon of stigma, which is the main subject of a new book by Dr. Yasin Al-Qubati, offering a panoramic historical narrative of leprosy in many regions and countries of the world, with extensive coverage of Yemen.

An overview of stigma associated with nwwwumerous diseases, including vitiligo (a chronic skin condition causing loss of pigment resulting in irregular pale patches of skin), psoriasis and scleroderma (a chronic disease characterized by excessive deposits of collagen in the skin or other organs), precedes an in-depth examination of stigma in leprosy. To trace the origin of the stigma, the author has used 179 references, including the Bible and the Qur'an.

He discusses the linguistic origin of stigma in ancient Arabic language and Arabic poetry. Some 179 references are cited to pinpoint the origins of stigma regarding this disease, among which are ones from both the Bible and the Qur'an.

Al-Qubati examines fear, particularly fear of infection, which causes people to isolate those affected by leprosy and even ostracize them from their communities. The effects upon the ostracized are detailed.

Unfair laws regarding those affected by leprosy also come under scrutiny. Linguistic confusions and mistaken diagnoses, which have perpetuated stigma in leprosy, also are probed.

Considerable attention is given to describing health education methods used in Yemen to educate and mobilize the community and inform them about the nature of stigma. Such initiatives have had the positive effect of ending lives of isolation for those affected by leprosy.

The extent of the irrationality and unjustness of stigma and stigmatizing behaviors is underlined by the author's comparison of the minor likelihood of contracting leprosy with the much higher risks of being involved in a car accident, contracting tuberculosis or the risks associated with smoking.

In the first part of the book, Al-Qubati highlights the danger of isolating leprosy sufferers and the consequences of such ostracism by both the community and individuals, including the danger of the spread of communicable diseases due to the fear of infected individuals being isolated, which leads to hiding the source of infection.

In the second part, he describes leprosy itself, beginning with its history in ancient Egypt, followed by a description of leprosy in ancient Arabic medical books and treatment of the disease by ancient Arab physicians, which mostly depended on snake extracts and a special diet.

Al-Qubati then describes the wrong linguistic notions, mixing between leprosy and vitiligo, and the relationship of the stigma in both diseases.

In the same chapter, he describes the definition of isolation, as well as the history of isolating those Persons Affected by Leprosy, or PALs, highlighting verses appearing in the Old Testament book of Leviticus in the Bible.

He also offers some hints about leper hospitals begun during the Abbasid period of Khalifa Al-Walid (a member of a dynasty that ruled an Islamic empire from Baghdad from 750 to 1258) between 668 and 715 A.D.

He further mentions the magic powers or prodigy of some communities said to be granted to PALs by God.

In the third part of the book, Al-Qubati talks about medieval leprosy, its historical trend in Europe and the development of societies against in it Europe, beginning from the Middle Ages. He then describes leper colonies and their wrong interpretation in the holy scriptures.

Next, Al-Qubati discusses the history of leprosy in the East, including India and China, as well as its history in the West, including Canada, the United States and Latin America, particularly concentrating on Carville, La., Hawaii and Father Damian.

In the fourth part of the book, he describes the history of leprosy in the Arabian Peninsula, particularly in Yemen, highlighting the roles of British physicians, as well as Irish and Scottish missionaries in Aden during the British colonization of Aden between 1839 and 1967.

Following this is the role of Mother Teresa and her organization, the Missionaries of Charity, during the period 1973-1992, with special mention about the assassination of nuns in Hodeidah and the conversion to Islam of a nun in Yemen and Mother Theresa's reaction to both incidents.

Al-Qubati then talks about the leprosy situation in Yemen prior to implementing the National Leprosy Control Program and how the program started with support from the German Leprosy Relief Association, especially highlighting the support of friends in the U.S. and the World Health Organization.

After this, Al-Qubati recounts numerous tragic stories about the suffering of leprosy patients in various parts of Yemen.

The author's visit to the U.S. and England, as well as his training in Carville, Louisiana, offers some other nice descriptions of places and stories about leprosy and organizations fighting leprosy, including his meeting with well known activists of Britain's Leprosy Mission, and ILEP, the International Federation of Anti-Leprosy Associations.

He describes the development of World Leprosy Day by Raoul Follereau, comparing it with Yemen's Leprosy Day initiated by a saint approximately 700 years ago. On this day, healthy individuals celebrate the memory of the holy man's death from mixing with PALs, believing that there's no such infection on this day.

Al-Qubati's book further discusses the different social attitude of communities in southern Yemen toward PALs and how rural villages deal with leprous members by building a small hut outside the village, as well as how they serve his or her food and other beneficial treatment.

The book then describes the different methods of health education implemented in Yemen to educate and mobilize the community to end isolation and fight the stigma against leprosy.

It also discusses various hadiths (sayings) of the Prophet Mohammed in light of different religious and scientific books.

Al-Qubati then discusses civil law in Yemen and Egypt and their unfair treatment of PALs.

In the 30 pages after this, he describes leprosy itself, including its types, diagnosis, treatment, complications, leprosy control and rehabilitation.

Finally, Al-Qubati talks about the International Leprosy Congresses and the stakeholders in controlling leprosy, including ILEP members and WHO. In the end, he compares the risks of leprosy, cancer, tuberculosis, car accidents and smoking.

Dr. Yasin Al-Qubati is secretary-general of Yemen's Leprosy and Tuberculosis Elimination Society, the German Leprosy Relief Association's local representative in Yemen, assistant professor of dermatology at Taiz University's School of Medicine and initiator of Yemen's National Leprosy Control Program.