05 February 2008

What in the world is Leprosy?!?

Ah, yes. Leprosy.

We can thank Charleton Heston for putting Leprosy in it's rightful place in pop-culture, right there on the shelf with Nessy and Big Foot. Surely Leprosy doesn't really exist any more!!

Quite the contrary actually. While present day Leprosy is not the same "Leprosy" we see in the Bible (thank you Ben-Hur), it is just as real and isolating as it was back then. Leprosy, formally known as Hansen's Disease, is actually a bacterial disease. This bacteria breeds in areas of poor sanitation and is spread through prolonged contact.

WHAT?!? SPREAD THROUGH CONTACT?!? DEB. WON'T YOU CATCH IT IF YOU GO WORK WITH THEM?!? Well, sure, it's a possibility . . . but pretty unlikely. 95% of the world's population in naturally immune! Plus, once a patient is placed on multi-drug therapy (about six months of three different antibiotics) they are no longer contageous after two weeks.

So, if one has to have a genetic susceptiblity to get leprosy, and it's curable, how come people still have it? Ah, good question. About 150 people are diagnosed every year IN THE US! While we can afford antibiotics in this country, those in developing nations don't have access to the medication.

BUT WON'T YOUR FINGERS FALL OFF?!? While it is true that many of those living with leprosy have deformed hands, feet, noses, and suffer from blindness, it is not true that appendages simply "fall off." Brace yourself, we're going to have a pathology lesson: the leprosy bacteria like to colonize in the cooler regions of the body (ie: finger extensors -- the forearm, ankle dorsiflexors -- the shin, nasal cartilage, and tear ducts). The bacteria burrows into the myalin sheaths (the insullators) surrounding the nerves in these regions. The body then sends in the troops (also known as The Inflammatory Response -- white blood cells, extracellular fluid, an increase in temperature) which in turn creates swelling. What is happening then, is the body is trying to kill off the bacteria, but really suffocates its own nerves in the process. This results in numbness and loss of muscle function. As we see with diabetics and persons with spinal cord injuries, where there is a lack of sensation there is skin break down which results in infection. It is as a result of continual infection and general wear-and-tear on the body that many of the deformities in the hands and feet occur. Believe it or not, pain was God's gift to the body! It tells us when something is wrong. In His wisdom, God chose to bless us with an alarm system!! (For more on this, check out The Gift of Pain by Dr. Paul Brand and Philip Yancy)

It is because of these deformities that those suffering from the silencing of their nerves are often isolated from their families and communities. Many are hidden away, shunned, or forced to beg in the streets.

While the bacteria can be killed by medication, the other effects of leprosy, such as the numbness, deformities, and blindness, cannot always be reversed. There are advances being made such as muscle translocations (hand surgeons can weave the deep finger flexor muscles through the arm to replace the extensors) and reconstructive surgery (plastic surgeons can take a pathway through the soft palate into the nasal cavity and restructure the nose with plastic); however, for many who suffer from leprosy, these are not realistic options.

SO DEB. WHERE DO YOU COME IN? As an Occupational Therapist I will get to teach these fantastic people how to avoid further infection and injury. I also hope to be able to develop special tools and devices to help those infected participate in their lives . . . help them to do all the things they want and need to do.

For more information on leprosy check out the Leprosy Mission International: http://www.leprosymission.org/
The American Leprosy Mission: http://www.leprosy.org/
For specific information the work with those with leprosy in Niger: http://www.leprosymission.org/web/pages/worldwide/africa/leprosy_niger.html

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