27 Jan, 2017
Author/blogger Reggie Simpson
If you have seen the classic film Ben-Hur (1959) starring Charlton Heston as Judah Ben-Hur, a wealthy prince and merchant in Jerusalem, you will know that Judah was unjustly condemned to the galleys and his mother and sister imprisoned by the Romans. On his return, Judah finds his mother and sister had contracted leprosy in prison and had been banished to the Valley of Lepers. Indeed, the Bible has many references to leprosy.
But leprosy (also known as Hansen’s Disease) was not restricted to ancient Christians, nor is it an ancient disease. It continues today among many vulnerable people and religions around the world.
World Leprosy Day is celebrated on the last Sunday in January each year to coincide with the anniversary of Mahatma Gandhi’s death on 30 January 1948. Gandhi worked tirelessly to help those afflicted with leprosy.
The goal for World Leprosy Day is to raise the awareness of a disease that many people believe has been eradicated when in fact more than 210,000 new cases are diagnosed each year, more than half of these in India.
Leprosy is an infectious chronic bacterial disease caused by the bacillus Mycobacterium leprae (a relative of the tuberculosis or ‘TB’ germ).
It targets the nervous system especially the nerves in the cooler parts of the body – the hands, feet, and face. Numb patches on the skin are usually the first sign of the disease.
As the disease progresses it can lead to nerve damage and other complications. Numbness and lack of feeling can lead to injury and wounds that become infected. Changes to the skin leave those suffering with leprosy can lead to ulcers which, left untreated, can cause further damage, wounds and visible disfigurements such as collapsed noses or shortened limbs. Blindness can also occur.
In turn, this can lead to stigma towards those affected and their families, causing them to be shunned and even excluded from everyday life, much as the with the case of the fictitious Judah’s family.
However, leprosy is not hereditary nor can it be caught by touch. It is most common in places of poverty where overcrowding and poor nutrition and housing allow people to become more susceptible to infection. There are still some cases of leprosy in the United Kingdom, but they are often as a result of emigration from susceptible areas around the world and are often misdiagnosed as eczema.
Leprosy is curable with multidrug therapy (MDT), which was developed in the early 1980s. Early diagnosis and treatment usually prevent disability related to the disease.
For more information about World Leprosy Day and the charities who are engaged in its eradication, visit:
And for a Podiatry student’s account of her work with leprosy patients in Nepal copy the following link into your web browser
Rwanda is a small ambitious country known as the land of 1000 hills with a population around 12 million and a rapidly growing economy. It has rolling hills for as far as you can see, a rain forest, gorillas and volcanoes, making for quite the site to any visitor. However, it is also known for the 1994 genocide in which over 1 million people were killed in 100 days across the country.
This tragic event has led to some very big health issues, which the country still faces, but thanks to a range of donor funding and strong political leadership, the country is on its way to quickly becoming a middle-income country.
As countries shift from low incomes to middle income economies, health issues become complex, where the country can face a mix of communicable disease (ie. malaria, HIV, TB) and the introduction of non-communicable disease (ie. diabetes, high BP, cholesterol) with changes in lifestyles.
Now you are probably wondering what this has to do with podiatry?
Well, as clinicians we play a role in the overall wellbeing of every patient that walks through our door for treatment and we become advocates for a number public health issues. While our specialist area is focused on the foot and ankle, an understanding of the bodily systems is imperative for understanding the impacts on the lower limb. This allows us to transition from clinical practice to other work streams such as health policy, public health programmes, service management and research.
As a podiatrist with a public health background, the increase of diabetes and chronic conditions in developing nations has become of personal interest. In many of these countries, diabetes is poorly understood and without proper prevention and care, can lead to a large economic burdens on the healthcare system. In 2012, the UK alone spent a whopping £639 million on foot ulcers and £662 on lower limb amputations, so the prevention and monitoring of these conditions is of paramount importance in the developing world.
The quality of life for individuals with diabetes is also drastically affected if not controlled, impacting mobility, footwear and overall lifestyle. Additionally, chronic ulceration and limb amputation, creates an increases risk (approximately 80%) of mortality within the first 5 years post amputation.
How did all this lead me to Africa, I hear you say?
In April of 2016, I (sadly) departed from the Betafeet clinic to implement an mhealth project in Rwanda in partnership with the Ministry of Health. This project, allows patients across the country to speak with a doctor and receive a prescription via SMS through their mobile phone, reducing the travel time, wait time and expense of receiving care from one of the local physical hospitals. The system is also working on monitoring both communicable and non-communicable disease using artificial intelligence, engaging patients to take ownership of their health.
This could be a major milestone for a country with stretched resources. To put things into perspective, over 80% of the population lives in remote areas of the country and works in the ‘in-formal’ sector as subsistence farmers with an average income of 2-3 dollars per day, which is not very much. To receive care, a patient may travel over an hour to reach their nearest hospital where a doctor is present and then wait anywhere from a few hours to a few days to receive the care they need. However almost 80% of the population already has a mobile phone.
Appropriate access to clinical care is a large part of the prevention and management of many conditions and undertaking this project has been a great experience. As a clinician, I have had the opportunity to utilise my knowledge to develop operational pathways and input into the technology development to shape the way patients receive their care.
It is with
this experience I now look to move on to my next adventure focusing on Aboriginals
and the utilisation of technology in the prevention of major non communicable
disease such as diabetes.
Final comment from Reggie Simpson and Betafeet Podiatry
We wish Andre the very best in his future and thank him for this interesting blog account. We look forward to his next blog focused on his work with the Aboriginal population.