Dr. Al-Sami’i: “The wrong popular myths about leprosy must be eradicated, it can be treated like any other disease.” [Archives:1997/44/Health]

Dr. Abdulrhaeem Al-Sami’i is the Deputy Director of the National Leprosy Control Program in Taiz. He has participated in several training courses in leprosy field control in India and Sudan. Dr. Salah Haddash of Yemen Times met Dr. Al-Sami’i and filed this interview.  Excerpts:
Q: Could you give us an idea about the National Leprosy Control Program (NLCP) in Yemen? A: The NLCP was founded in 1982, but actual activities did not start in earnest until 1986 when a cooperation agreement was signed between Yemen and the German Clar organization. The WHO also organizes training courses in combating leprosy for doctors in Yemen. Local NGOs such as the Yemeni Society for Eradicating Leprosy which is headed by Mr. Ahmed Hayil Saeed.  
Q: What is the main hindrance to leprosy control in Yemen? A: Lack of public awareness is a major problem. As soon as a person is diagnosed to have leprosy, a social war starts. The patient is immediately seen by society as a sinner and treated as an outcast. Many people in Yemen think that there is no treatment for leprosy. This is not true. An active cocktail of drugs is currently being used for the treatment of this affliction.  
Q: What are the causes of leprosy? A: People used to believe that leprosy is a punishment from heaven for the sinners in this world, until the leprosy-causing germ was discovered in 1873. Like many other contagious diseases, leprosy is transmitted by inhaling its germs. Skin contact is a possible, yet unproved, means of infection. For skin contact to be infectious, it has to be over a long period and by an infected person who is not getting any medical treatment. Patients being treated for leprosy do not infect others. About 99% of humans, however, have a natural immunity against leprosy. This leaves only 1% of the people vulnerable to infection with leprosy. But wrong ideas still prevail in our society.  
Q: How do people in Yemen view lepers? A: A leprosy-infected person in Yemen is forced to divorce his wife, denied inheritance, prevented from entering a mosque, and is even greeted with a handshake by a long stick. There are weird stories of lepers being prevented from going out in the rain. Some people really believe that the disease would go with the rain water into the ground, be absorbed by plants, and infect humans who eat these plants. In some areas in Yemen, lepers are not allowed to switch the light on for fear of transmitting the disease via electricity.  
Q: What are the objectives of the NLCP? A: It is very important to diagnose and treat leprosy in its early stages. When the disease reaches the stage of causing deformity, the infected person becomes a burden on society and costs the state a lot in terms of medication and health care. Every sick-bed annually costs the national budget about YR 58,000.  The NLCP provides the necessary care and rehabilitation services for leprosy patients who have reached the point of disability. Due to the destruction of the nerve cells by the leprosy bacteria, a patient would lose all sense in the fingers, which start to get paralyzed and become twisted. Wounds and ulcers appear, leading eventually to the patients losing his or her fingers. So we try to rehabilitate those patients to be able to use their hands. At Al-Noor center, we providing training programs for bee keeping, cattle raising, sewing, etc. The German Embassy has also promised to provide us with flour milling equipment.  The NLCP provides medication in accordance with the WHO standards and instructions. The administered medicines are very effective, and bacteria have no resistance to the drugs. The time it takes the first symptoms of leprosy to appear varies from one person to another, according to the strength of his or her immunity. It could be six months or one year. If the patient comes forward immediately after the first appearance of the spot, than the disease can be successfully cured. The maximum period for a successful treatment is five years. Leprosy is quite rare among children.  
Q: How many people receive treatment by the NLCP? And in what areas is the disease more prevalent? A: Up to the second quarter of 1997, there have been 663 patients getting treated for leprosy. The areas with the highest leprosy rates are Hadhramaut and Hodeida. The reason can be attributed to the hot and humid climate. Malnourishment due to bad economic conditions can also reduce the body’s resistance to leprosy and other diseases. Also, in remote and desert areas, primary health care facilities are quite lacking. The NLCP, in cooperation with the WHO, have special teams that regularly visit these remote areas and organize public health awareness programs. There is a special budget allocated by the Ministry of Health for the NLCP. The German organization provides a lot f financial support, too.  We have covered the areas of Seihout, Maseela valley, Bani Ziyad, Qashan, Hajar, Abad, and Thamood. Our teams have discovered cases of leprosy among the nomads in the Empty quarter desert. Few cases were also discovered in distant army camps. The beduins accept the medication easily and respond to treatment, so good results have been achieved.  We are about to start a leprosy treatment program in Shabwa.
Q: Are there any popular myths regarding the treatment of leprosy? A: Yes, many, unfortunately. In Mahra, instance, some people think that a leprosy patient should go to a remote area, kill a traveler, open his brain, and use it as an ointment. Many people in Yemen believe that letting blood from the veins of the wrists and ankles will cure leprosy. An extremely weird belief in Hodeida indicates eating the flesh of an infant as a cure for leprosy. I have not come across any such incidents since the beginning of the program in 1982, but they must have some foundation in reality.  
Q: Do the patients pay for the medicines? A: No, we receive theses medicines free of charge from the WHO, and distribute them through 63 clinics covering 80 of the country. The remaining areas are covered by the NLCP mobile clinics. The current rate of leprosy in Yemen is 5 patients to every 100,000 citizens. The accepted international rate, which we hope to achieve by the year 2000, is one patients in every 100,000 citizens. We are not very far off.  
Q: Any last comment? A: I am proud to say that all NLCP staff are Yemeni. The Yemeni general director of the project, Dr. Yaseen Abdulaleem, is a WHO expert who had helped organize similar programs in India, Sudan, Pakistan, and now he is in Indonesia.
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