Quotes : habokana

Werner David : Where There is no Doctor
page 191

Leprosy (Hansen's disease)

This mildly infectious disease develops slowly, often over many years. It can spread from persons who have untreated leprosy, to persons who have "low resistance" to the disease. In areas where leprosy is common, children should be checked every 6 to 12 months -- especially children living with persons who have leprosy.

Signs: Leprosy can cause a variety of skin problems, loss of feeling, and paralysis of the hands and feet.

The first sign of leprosy is often a slowly growing patch on the skin that does not hitch or hurt. At first, feeling inside the patch may be normal. Keep watching it. If feeling in the patch becomes reduced or absent, it is probably leprosy.

Later signs differ according to the person's natural resistance to the disease. Watch out for

  • Tingling, numbness or loss of feeling in hands or feet. Or deformities or loss of feeling in skin patches.
  • Slight weakness or deformities in the hands and feet.
  • Swollen nerves that form thick cords under the skin. Nerves may or may not be painful when you press on them.

Advanced signs may include:

Treatment of leprosy: Leprosy is usually curable, but medicine must usually be taken for years. The best medicine is dapsone, if possible combined with rifampin and clofazimine. If a "lepra reaction" (fever, a rash, pain and perhaps swelling of hands and feet, or eye damage) occurs or gets worse while taking the medecine, keep taking it but get medical help.

Prevention of damage to hands, feet, and eyes: The large open sores often seen on the hands and feet of persons with leprosy are not caused by the disease itself and can be prevented. They result because, when feeling has been lost, a person no longer protects himself against injury.

For example, if a person with normal feelings walks a long way and gets a blister, it hurts, so he stops walking or limps.
But when a person with leprosy gets a blister, it does not hurt So he keeps walking until the blister bursts and becomes infected. Still without pain, the infection gets deeper and attacks the bone. In time, the bone is destroyed and the foot become more and more deformed.

1. Protect hands and feet from things that cut, bruise, blister, or burn them.

Do not go barefoot, especially not where there are sharp stones or thorns. Wear shoes or sandals. Put soft padding inside shoes and under straps that may rub.

When working or cooking meals, wear gloves. Never pick up an object that might be hot without first protecting your hand with a thick glove or folded cloth. If possible, avoid work that involves handling sharp or hot objects. Do not smoke.
2. At the end of each day (or more often if you work hard or walk far) examine your hands and feet very carefully -- or have someone else examine them. Look for cuts, bruises, or thorns. Also look for spots or areas on the hands and feet that are red, swollen or show the beginnings of blisters. If you find any of these, rest the hands or feet until the skin is completely normal again. This will help callous and strenghten the skin. Sores can be prevented.
3. If you have an open sore, keep the part with the sore very clean and at rest until it has completely healed. Take great care not to injure the area again.
4. Protect your eyes. Much eye damage comes from not blinking enough, because of weakness or loss of feeling. Blink your eyes often to keep them wet and clean. If you cannot blink well, close your eyes tightly often during the day, especially when dust blows. Wear sun glasses with side shades, and may be a sun hat. Keep eyes clean and flies away.
If you do these things and begin treatment early, most deformities with leprosy can be prevented.
page 363

Medicines for leprosy

When treating for leprosy, it is important to know which of the two main types of leprosy the person has. If there are light-colored skin patches with loss of sensation but no lumps or thickened skin, then the person probably has tuberculoid leprosy and only 2 medicines are required. If there are lumps, then the person probably has lepromatous leprosy and it is best to use 3 medicines. If possible, medicines for leprosy should be taken with the guidance of an experienced health worker or doctor, according to the national plan.

Treatment of leprosy must usually continue for at least 6 months and sometimes for life. To prevent the bacteria (bacilli) that causes leprosy from becoming resistant, it is important to keep taking the medicines regurlarly, without interruption. Be sure to get more medicine before your supply runs out.

Recommended treatment:

For tuberculoid leprosy, take both of these for at least 6 months
  Dapsone daily
  Rifampin each month

For lepromatous leprosy, take all of these for 2 to 5 years
  Dapsone daily
  Clofazimine daily and a larger dose each month
  Rifampin each month

Note: although the cure of leprosy is quicker using dapsone together with other medicines, sometimes only dapsone is available. When taken alone, it often gives good results, but more slowly, so treatment must continue for at least 2 years and sometimes for life for lepromatous leprosy.

Occasionally, a person may develop a serious problem called "lepra reaction" while taking leprosy medicines. There may be lumpy and inflamed spots, fever, and swollen, tender nerves. It may also cause joint pains, tender lymph nodes and testicles, swelling of the hands and feet, or red and painful eyes which may lead to loss of vision.

In a case of severe "lepra reaction" (pain along the nerves, numbness or weakness, eye irritation, or painful testicles), it is usually best to keep taking the leprosy treatment, but to also take an anti-inflammatory medicine (cortico-steroid). Seek experienced medical advice about this because the cortico-steroid can also cause serious problems.

Dapsone (diaminodiphenylsulfone, DDS)

Often comes in tablets of 50 and 100 mg.

Dapsone sometimes causes anemia or skin rashes. If severe skin peeling occurs, stop taking the medicine.

WARNING: DDS is a dangerous drug. Keep it where children cannot reach it.

Dosage for DDS -- (2 mg./kg./day) -- using tablets of 100 mg. -- Take once a day.

  adults: 100 mg. (one 100 mg. tablet)
  children 13 to 18 years: 50 mg. (half of a 100 mg. tablet)
  children 6 to 12 years: 25 mg. (a quarter of a 100 mg. tablet)
  children 2 to 5 years: 25 mg. (a quarter of a 100 mg. tablet) 3 times a week only.

Rifampin (rifampicin, rifamycin)

Often comes in tablets or capsules of 150 and 300 mg.

Rifampin is a very expensive medicine, but only a small amount is needed to treat leprosy, so the total cost is not great. Take rifampin only with the advice of an experienced health worker or doctor.

Side effects: Urine, tears, feces (shit), saliva, mucus from coughing (sputum), and sweat are colored red-orange by rifampin. Rarely, rifampin can cause fever, loss or increase of appetite, vomiting, nausea, confusion, skin rash, and menstrual problems. Rifampin reduces the effectiveness of oral contraceptives. So women taking birth control pills should get medical advice about increasing the dose. Or, use another method such as condoms, IUD, or a diaphragm while taking this medicine.

Dosage of rifampin for leprosy -- (10 to 20 mg./kg.) -- using tablets of 300 mg. --

For leprosy, give rifampin once a month. It should be taken either 1 hour before or 2 hours after eating.

In each monthly dose give:

  adults: 600 mg. (two 300 mg. tablets)
  children 8 to 12 years: 450 mg. (one and a half of 300 mg. tablets)
  children 3 to 7 years: 300 mg. (one 300 mg. tablet)
  children under 3 years: 150 mg. (half a 300 mg. tablet)

Clofamizine (lamprene)

Often comes in capsules of 50 and 100 mg.

Clofazimine is also an expensive medicine. Although it is less effective in killing leprosy bacteria than rifampin, it has the advantage that it also helps to control lepra reaction to some extent, particularly in persons with lepromatous leprosy.

Side effects: causes the skin to become a red-purple color. This is only temporary and will disappear 1 to 2 years after stopping taking the medicine. May cause stomach or digestive problems. Not recommended for pregnant women.

Dosage for clofazimin -- (1 mg./kg./day) -- using capsules of 50 mg. --

Give one dose of clofazimine each day and a second, larger dose once a month.

In each daily dose give:

  adults: 50 mg. (one 50 mg. capsule)
  children 8 to 12 years: 37 mg. (3/4 of a 50 mg. capsule)
  children 3 to 7 years: 25 mg. (1/2 of a 50 mg. capsule)
  children under 3 years: 12 mg. (1/4 of a 50 mg. capsule)

In each monthly dose give:

  adults: 300 mg. (six 50 mg. capsules)
  children 8 to 12 years: 225 mg. (four and a half 50 mg. capsules)
  children 3 to 7 years: 150 mg. (three 50 mg. capsules)
  children under 3 years: 75 mg. (one and a half 50 mg. capsules)

Note: the larger dose of clofazimine, which can also be used daily to control lepra reaction, is best given with the advice of an experienced health worker or doctor.