Dr. Qubati: “We hope to make Yemen  leprosy-free by 2000.” [Archives:1998/01/Interview]

January 5 1998

Dr. Yassin Abdulaleem Al-Qubati, YT 1997 Person of the Year, is the Director of the National Leprosy Control Program and the Manager of the Hospital for Dermatology and Venereology in Taiz. A father of five, Dr. Al-Qubati, 48, is involved in several social and charity activities and is a member of a number of medical societies such as the Yemen Leprosy Elimination Society, the International Society of Dermatology, the Society for Water Resources and Development, the Asian Dermatological Association in Hong Kong, the New York Academy of Sciences, the Royal Society for Tropical Medicine and Hygiene in London, the Pan Arab League of Dermatologists, and the International Leprosy Association in the USA. He is also the General Secretary of the Yemen Leprosy Eradication Society and head of the Committee for Environmental Health and Sanitation in Taiz.  Dr. Al-Qubati has authored and co-authored several research papers and books on dermatology in general and leprosy in particular. He has written the script of many short television episodes aimed at enhancing awareness on leprosy. Yemen Times is happy to present this personality to the public. On this occasion, Bin Sallam filed the following interview. Excerpts:
Q: How did you get involved in the effort to eradicate leprosy? A: My interest in fighting leprosy started while I was still a student at the College of Medicine in Cairo. I was moved by the harrowing scenes of lepers being treated at Qasr Al-Aini hospital. I started examining lepers in some of Egypt’s large leprosariums like Abu-Zaabal and Al-Kalaa clinic. I also began to see leprosy patients during my summer vacations which I spent back in Yemen. They were looked after by a Swedish medical team in the 1970s.  Upon graduation with an M.Sc. degree in dermatology from Cairo University, I became the director of environmental health in Taiz and later assumed the post of director of Al-Jumhoori Hospital in Taiz. Thus, I started in 1982 to develop my activities to control leprosy in the City of Light which was run by nuns from the Mother Theresa mission to treat leprosy patients. I myself traveled all over the country to Reima, Hajjah, Mahweet, and Khowlan where leprosy was rife.  
Q: How was the beginning? A: We were fighting an uphill battle. The leprosy patients were outcasts, to say the least. People so ignorant then as to shoot a leprosy patients seen walking after the rain, believing that his disease would be transferred by water to their agricultural crops and later to the person who eats it. People also shot at any leprosy patient seen lighting a lantern, believing a stranger in the night might be led by their light and become infected. In 1984, we started getting support from international humanitarian organizations such as the German Leprosy Relief Association (GLRA), in Wurzburg, Germany, which is combating leprosy worldwide. This organization, established by a German journalist called Herman Koeber, helped and is still helping us immensely.  We also receive considerable assistance from Dr. S.K. Noordeen, head of the WHO leprosy unit; the late Dr. H.B. Ostler, former head of the Ophthalmology Department in San Francisco University; Dr. L.K. Bhutani, head of the Institute of Dermatology and Venereology at the All India Institute of Medical Sciences, New Delhi; Dr. M. Robinson, Associate Professor, Unversity of Western Ontario, Canada, and many others.  
Q: What is the general success rate of treating leprosy? A: Only 1% of the population are susceptaible to being infected with leprosy. All of them get successfully cured if they get the disease. The main problem lies with the mistaken popular beliefs regarding the disease, not only in Yemen but also in many other countries.  
Q: Can religion play a role in changing people’s beliefs on leprosy? A: Some clerics in Yemen still insist on reciting a saying erroneously attributed to the Prophet (P) which calls for ostracizing leprosy patients. The truth of the matter is that the Prophet (P) once held a leper by his hand to eat with him from the same plate. Irrational fear of leprosy among people in almost all nations has led to bad treatment of leprosy patients.  One factor that led to wrong beliefs regarding leprosy in Yemen was that ships belonging to the East India Company used to dump leprosy patients on the shores of Al-Mahara, and leave them fend for themselves in the wilderness. Thus, simple people really believed then that leprosy patients were devils from other lands who could be cured only by eating the brain of a human being!  I once met a whole family living in one room in their neighbors’ house while their four-storey house was left empty. The reason was that their father died of leprosy and they just abandoned the house.  
Q: How is the campaign to fight leprosy getting on? A: We have special medical teams working in remote areas such as Shabwa, Maseela, Hajar, Abar, Thamoud and Haradh where they are setting a special camp for leprosy patients. All these sepcial teams receive financial assistance from the WHO and the GLRA. Surveys are conducted in remote villages to detect any possible cases of leprosy. It is quite difficult to achieve something in this country because of the prevalence of corruption, suspicion and insecurity.
Q: What has been achieved so far? A: With assistance from the GLRA, we started in 1989 with four leprosy clinics in Hodeida, Dhamar, Ibb, and Taiz. By 1994, 64 leprosy clinics were spread in various parts of Yemen.  Only two years later, we started closing down some of the old clinics because leprosy cases became rare or disappeared altogether.  Let me give examples. In 1989 when we started in Dhamar,there were 600 cases. Today, there are only 17 cases under treatment. The picture is similar in Ibb, with no cases left. Of the 16 leprosy clinics that had been opened in Ibb and Taiz, only one is now left in Ibb which is visited by a superviaser form Taiz once every two weeks, and one clinic in Taiz at the City of Light. So our efforts have been successful. All in all, there are now 25 clinics left from the 64 that were opened in 1994, and I expect that only 20 would remain by the end of 1998.  There is still higher prevalence in Hodeida and Hadhramaut compared to the rest of the centers, but overall Yemen is considered free of leprosy according to WHO standards. The prevalence of leprosy has dropped from 4 cases in 10,000 to 4 in 100,000 people. It is expected that the prevalence of leprosy will further drop next year to 1 case in 100,000 people. We hope by the year 2000, there will be only 200 cases of leprosy left in Yemen.
Q: Do you have any means to re-integrate cured leprosy patients back into society? A: Yes, rehabilitation programs are planned and carried out to re-integrate the persons affected by leprosy into society. In Taiz, for example, we are doing corrective surgeries for the deformed people and with help of Handicap International, Belgium, in 1995 we constructed a workshop for making sandals and crutches. This will help decrease the disabilities of the persons affected by leprosy. Lately, with aid from Hayil Saeed Anaam Cahritable Society, a two-floor building was constructed for the administration department and workshop for small scale income oriented industry. We contacted some embassies and the UNDP to get some assistance, but got no response. To decrease disabilities, reconstructive surgeries are also conducted on some cured leprosy patients who have lost part(s) of their body such as absorbed nose, finger, or part of an earlobe. Presently, two volunteer French surgeons; Dr. J.A. Noirclerc and Dr. F. Jacquin are doing these corrective surgeries. We only had to pay their plane tickets for which we thank Mr. Suhbi, the Director of Yemenia Airlines for his kind assistance. I’d also like to thank Mr. Ahmed Hayel Saeed, the President of the Yemen Leprosy Elimination Society and Mr. A. Al-Sanabani, the director of the Aden Central Bank for their great efforts in raising money from merchants and businessmen for this worthy cause.  
Q: Could you tell us a little bit about the society you are heading? A: The Yemen Leprosy Elimination Society, established in 1992, is continuously supporting the field work for detection of new leprosy cases, the salaries of the staff and building of houses for the patients, and their food and clothing.  
Q: As a member of the WHO Expert Committee, what are your international activities? A: I am now sharing in the fight against leprosy worldwide. For example, in May, 1997, I worked as a part-time consultant for 15 days in Libya. In September, I participated in the leproisy elimination monitoring program in Indonesia and a workshop in Oman for all the Gulf countries. Through WHO, I also organized training courses on leprosy management for Egyptian and Pakistani physicians. I am expected to organize a monitoring program in Sudan at the beginning of this year.  
Q: Where do you get your finances from? A: Locally, we rely on donations from Yemeni merchants and businessmen working abroad, especially those from Hadhramaut origin and from Mr. Ahmed Hayil Saeed. We also get donations from community leaders. They helped us immensely by providing cars and big donations some of which were allocated to build a hospital in Hadhramaut. Unfortunately, and I am sorry to say this, due to rampant corruption and lack of security, many philanthropists are discouraged from making donations.  GLRA assists us with about $200,000 every year, plus experts and medical vans, etc.  The WHO provides us with large quantities of medication, which we distribute free of charge to all our patients. The Ministry of Health has provided the necessary buildings and it pays our salaries. The Ministry also promised to raise the budgetary allocation for combating leprosy during 1998.
Q: How many cases of leprosy have been treated so far? A: We have been successful in treating 6,000 cases of leprosy. I believe that there are about 1,200 hidden cases left in the country. We aim for a leprosy-free Yemen. In order to raise doctor awareness of this disease, we are conducting special training programs in Hodeida, Sanaa, Aden, Shabwa, and Lahaj.  
Q: What other social and humanitarian activities do you have? A: I am the head of the Committee of Environmental Health and Sanitation. Since we are not an environmental law enforcement agency, we try to persuade factories and stone quarries to eliminate or even reduce the pollutants they emit.  I am also a member of the Society to Combat Begging and the Society of Benevolence and Social Solidarity. As far as health is concerned, I am also working on a project to fight tuberculosis in Taiz where we detected 110 cases so far. We give TB patients free medication through the GLRA. Other diseases we are currently trying to control in Yemen are scabies and leishmaniasis and onchocerciasis.  
Q: What are the main obstacles and problems that you face in your work? A: The most pressing problem we face in the City of Light today is a land dispute. Leprosy patients started to settle in that area back in 1964. They started building homes for themselves, and the area was fenced off by the Ministry of Health. Some of the old leprosy patients got cured and returned back to their original areas, others died. The sons of some former patients returned to claim plots of land in the City of Light, which of course still belongs to the government. When a patient dies, his or her heirs come to us demanding thjeir rights. Seeing that there are no longer any leprosy patients left, even local tribal sheikhs started claiming the land. Cont’d. on p. 6 These people are causing much trouble for us. The state just looks on while all this is taking place. Other problems include lack of qualified staff. The pay is very small, thus it is difficult to get hold of the needed trained doctors and nurses.  
Q: Can you specify the kind of support provided by the government towards combating leprosy? A: We can use all state hospitals in the country as outlets to provide medicines for the patients. Without these facilities we would not have been able to conduct our campaigns. Also, all those who work with us get their salaries from the Ministry of Health which also gives us a token budget. Low pay, however, has put many people off working for combating leprosy. The municipalities where we work provide us with free water and electricity.  
Q: Services in state-owned health facilities have visibly declined. Private hospitals have yet to fill the gap. What do you think must be done to remedy the situation? A: This is a general trend. Almost every public service is on the decline. Health services in particular are suffering. Most of the country’s national income is spent on security and defense, and very little on health and education. Protecting and preserving the regime is paramount. They don’t realize that all public organs are essential for the smooth running and the future of the country.  The rich and powerful members of society can get all the medical help they need abroad. They never think about their less fortunate brothers. They will never work for the establishment of decent and modern health or education systems inside the country, because their needs are covered.
Q: What is an issue that you wish to raise in this interview? A: I believe that the greatest scourge of Yemen is qat! Every single day, millions of people chew qat which is a waste of time and resources. Qat makes us dream of building castles in the air. After the effect wears off, we become depressed and start looking for means to sedate our frustrations. Our backwardness stems from qat and so do several nutritional, gastro-intestinal, respiratory, and mental illnesses. About 50% of our precious water resources are used to irrigate qat farms. We have a duty to take the initiative to fight the qat chewing habit of Yemen.