"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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European Debt? The First Question For Merkel's Successor

Across southern Europe, all eyes are on the German elections, as they hope a change of government might bring about reforms to the EU Stability Pact.

Angela Merkel at a campaign event of CDU party, Stralsund, Sep 2021

Tobias Kaiser, Virginia Kirst, Martina Meister


BERLIN — Finance Minister Olaf Scholz (SPD) is the front-runner, according to recent polls, to become Germany's next chancellor. Little wonder then that he's attracting attention not just within the country, but from neighbors across Europe who are watching and listening to his every word.

That was certainly the case this past weekend in Brdo, Slovenia, where the minister met with his European counterparts. And of particular interest for those in attendance is where Scholz stands on the issue of debt-rule reform for the eurozone, a subject that is expected to be hotly debated among EU members in the coming months.

France, which holds its own elections early next year, has already made its position clear. "When it comes to the Stability and Growth Pact, we need new rules," said Bruno Le Maire, France's minister of the economy and finance, at the meeting in Slovenia. "We need simpler rules that take the economic reality into account. That is what France will be arguing for in the coming weeks."

The economic reality for eurozone countries is an average national debt of 100% of GDP. Only Luxemburg is currently meeting the two central requirements of the Maastricht Treaty: That national debt must be less than 60% of GDP and the deficit should be no more than 3%. For the moment, these rules have been set aside due to the coronavirus crisis, but next year national leaders must decide how to go forward and whether the rules should be reinstated in 2023.

Europe's north-south divide lives on

The debate looks set to be intense. Fiscally conservative countries, above all Austria and the Netherlands, are against relaxing the rules as they recently made very clear in a joint position paper on the subject. In contrast, southern European countries that are dealing with high levels of national debt believe that now is the moment to relax the rules.

Those governments are calling for countries to be given more freedom over their levels of national debt so that the economy, which is recovering remarkably quickly thanks to coronavirus spending and the European Central Bank's relaxation of its fiscal policy, can continue to grow.

Despite its clear stance on the issue, Paris hasn't yet gone on the offensive.

The rules must be "adapted to fit the new reality," said Spanish Finance Minister Nadia Calviño in Brdo. She says the eurozone needs "new rules that work." Her Belgian counterpart agreed. The national debts in both countries currently stand at over 100% of GDP. The same is true of France, Italy, Portugal, Greece and Cyprus.

Officials there will be keeping a close eye on the German elections — and the subsequent coalition negotiations. Along with France, Germany still sets the tone in the EU, and Berlin's stance on the brewing conflict will depend largely on what the coalition government looks like.

A key question is which party Germany's next finance minister comes from. In their election campaign, the Greens have called for the debt rules to be revised so that in the future they support rather than hinder public investment. The FDP, however, wants to reinstate the Maastricht Treaty rules exactly as they were and ensure they are more strictly enforced than before.

This demand is unlikely to gain traction at the EU level because too many countries would still be breaking the rules for years to come. There is already a consensus that they should be reformed; what is still at stake is how far these reforms should go.

Mario Draghi on stage in Bologna

Prime Minister Mario Draghi at an event in Bologna, Italy — Photo: Brancolini/ROPI/ZUMA

Time for Draghi to step up?

Despite its clear stance on the issue, Paris hasn't yet gone on the offensive. That having been said, starting in January, France will take over the presidency of the EU Council for a period that will coincide with its presidential election campaign. And it's likely that Macron's main rival, right-wing populist Marine Le Pen, will put the reforms front and center, especially since she has long argued against Germany and in favor of more freedom.

Rome is putting its faith in the negotiating skills of Prime Minister Mario Draghi, a former head of the European Central Bank. Draghi is a respected EU finance expert at the debating table and can be of great service to Italy precisely at a moment when Merkel's departure may see Germany represented by a politician with less experience at these kinds of drawn-out summits, where discussions go on long into the night.

The Stability and Growth pact may survive unscathed.

Regardless of how heated the debates turn out to be, the Stability and Growth Pact may well survive the conflict unscathed, as its symbolic value may make revising the agreement itself practically impossible. Instead, the aim will be to rewrite the rules that govern how the Pact should be interpreted: regulations, in other words, about how the deficit and national debt should be calculated.

One possible change would be to allow future borrowing for environmental investments to be discounted. France is not alone in calling for that. European Commissioner for Economy Paolo Gentiloni has also added his voice.

The European Commission is assuming that the debate may drag on for some time. The rules — set aside during the pandemic — are supposed to come into force again at the start of 2023.

The Commission is already preparing for the possibility that they could be reactivated without any reforms. They are investigating how the flexibility that has already been built into the debt laws could be used to ensure that a large swathe of eurozone countries don't automatically find themselves contravening them, representatives explained.

The Commission will present its recommendations for reforms, which will serve as a basis for the countries' negotiations, in December. By that point, the results of the German elections will be known, as well as possibly the coalition negotiations. And we might have a clearer idea of how intense the fight over Europe's debt rules could become — and whether the hopes of the southern countries could become reality.

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