"Today, leprosy belongs in the category of neglected tropical diseases"
"Today, leprosy belongs in the category of neglected tropical diseases"
Martine Valo

MBALLING — Some 20 people, all officially cured of leprosy, are sitting together at the functional rehabilitation center in Mballing, Senegal. But seeing them calls to mind the ancestral fears linked with this disease: club foots, mere leg or arm stumps, hands without fingers, misshapen faces, washed-out eyes that can no longer be opened.

The leprosarium in Mballing — a town located on the Atlantic coast, 80 kilometers from Dakar — opened in 1955, when Senegal was still a French colony and when leprosy was still incurable. For the authorities, it was about isolating lepers from the rest of society.

Delinquents were also sent here. In 1976, a law turned leprosariums into “villages of social rehabilitation,” transforming these internment camps into places where the sick and their families could enjoy some form of social life again. There are nine such villages across Senegal. But Mballing has since become a town with between 250 and 300 current and former patients and a total population of 5,600.

The people present this morning are all over 70. They formed two mutual aid groups — one for men, the other for women — launched a charity and are part of a microcredit scheme. In a nearby room, three other former patients are soaking their legs in an antiseptic product. Leprosy has deteriorated their nervous systems. They can’t feel their limbs, so they don’t notice when they hurt their feet and when their wounds become infected. Some women want to keep cooking despite the illness and often burn themselves without even noticing. Many suffer from permanent ulceration.

At the other end of the room, a 12-year-old boy observes the scene. A spot on his skin indicates that he’s also infected. But because he has been treated since this first symptom appeared, chances are very good that he will be cured without the stigmatizing amputations that the elders had to experience. For that, though, he must scrupulously follow a lengthy poly antibiotic treatment (up to two years) that is generally well tolerated and costs relatively little (under $50 for a six-month treatment), although the World Health Organization provides it for free.

Even with a cure, prejudice continues

In Senegal, the organization Ordre de Malte and its partner, the German charity DAHW, are the two pillars upon which the fight against leprosy rests. In comparison, the state seems overwhelmed. Since the disease is no longer incurable, the government promised to repeal the 1976 law that confines lepers to villages of social rehabilitation and maintains them in a situation of dependency on state handouts. But prejudices are still strong where the victims of “Hansen’s Disease” are concerned, says Mahamath Cissé, coordinator of the DAHW program.

Cohabitation with the rest of the population is not self-evident. Lepers are still marginalized, sometimes seen as the victims of a hereditary defect or a divine curse — or even of climate change. “We were told about a young man in the North who has been amputated several times,” Cissé says. “His own family has been saying that they’re going to burn him. We’re going to get him and take him to the General Hospital of the Ordre de Malte in Dakar.”

Indeed, the hospital seems like a haven of calm and cleanliness in the capital. It treats most of the 220 to 240 new patients diagnosed each year in Senegal. Although the figures have been stable for the past 13 years, they are underestimated. Doctors say they should be multiplied by two or three to account for those who never see a doctor.

“The number of new cases has been decreasing for some 20 years, but multibacillary forms that are extremely contagious keep appearing, there are relapses, and children are affected,” says Charles Badiane, an orthopedic surgeon who for a long time was director of the General Hospital of the Ordre de Malte. “And patients take refuge in denial because they’re scared of amputations: Between 10 and 20% of them come to us too late.” The professor fears that the prevalence of the disease might rise “if we do nothing.”

“We’ve put the emphasis on detecting AIDS,” says Richard Pau, the hospital’s current director. “Today, leprosy belongs in the category of neglected tropical diseases. Some doctors and nurses pay less attention to it, and confuse the first symptoms with those of simple dermatosis.”

He proudly shows us around the building — the 40 beds, the surgical unit that meets European standards, and the area where other patients, those without leprosy, undergo surgery with a maximum of precaution. A large medical staff has been trained here.

In one of the smaller buildings, other experts are working: the hospital’s three shoemakers. Last year, they made 540 shoes. Not pairs, of course, but unique models made to measure the feet of lepers. “When we bring them to the villages, patients put them on, try to walk and start doing the Senegalese wrestlers’ dance,” the head shoemaker says, smiling and miming the dance.

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