The World Bank /World Health Organization Spring Meetings 2016 “Out of the Shadows: Making Mental Health a Global Development Priority” Sharing the insights of leprosy and possible relevance to mental health services

Washington D.C., USA

When I received the invitation to take part in this symposium, I wondered if my participation might be inappropriate given that mental health is not my field of expertise. It was then explained to me that my approach in the fight against leprosy over the years could provide insights in the discussion of mental health, so I am honored to be here today and hope that my experience will be helpful.

I serve as WHO Goodwill Ambassador for Leprosy Elimination since 2003 in the 40 years that I have dedicated my life to the world without leprosy.

Since ancient times, leprosy has been feared as a curse or God’s punishment, and those affected by leprosy were isolated from the rest of society.

In the late 19th century, it was discovered that leprosy is caused by a certain type of bacteria, and in the late 20th century, effective treatment with medication became available.

Given this discovery and medical breakthrough, it should have been clear to all that past attitudes toward leprosy were based on misconceptions. Nevertheless, particularly in developing countries, with a large number of patients, leprosy remains a public health concern, and furthermore, misunderstanding of the disease and discrimination against those affected by it persist, even to this day.

Leprosy is not highly contagious. Nor is it directly life-threatening. As a result, leprosy does not appear to present an imminent problem. It is consequently given low priority and not explicitly included in the health policy of some nations. In addition, as leprosy is not a major disease, there are few specialists.

Today, I’d like to focus on three means that define our approach to eliminating leprosy, which are to directly appeal to political leadership, to expand public awareness, and to promote community involvement.

First, directly appealing to political leadership is a key method in seeking commitment to eliminating leprosy. As WHO Goodwill Ambassador, I visit endemic countries and meet with leaders of governments. I explain the urgent need to eliminate leprosy, the importance of solving leprosy-related issues, and seek commitment to giving greater priority to such efforts in policymaking. This approach has been somewhat effective. We have seen cases where nations have appropriated a larger budget to eliminate leprosy and rallied the nation behind the effort.

Our second focus is expanding public awareness. We believe it is important to inform the public that leprosy is curable and discrimination is unjust, and this is where the media plays a key role. Leprosy, a taboo subject in many regions, has received little coverage in the media. In other words, it has remained in the shadows. We therefore encourage those who have been cured of leprosy to talk about their personal experiences and the discrimination and misunderstanding that they have suffered. By sharing their experience, more and more people learn about leprosy issues. In this way, I take leprosy out of the shadows.

Our third focus is community involvement.
In leprosy, early diagnosis and prompt treatment are crucial.
Many patients still lack basic knowledge of the disease or fear being discriminated. This results in delayed diagnosis and treatment, which may lead to serious complications. Moreover, in many cases, there are no doctors specializing in leprosy in the region. Conducting activities that involve the entire community is an effective way to ensure that potential patients receive prompt treatment. For example, in India, people who have actually experienced leprosy are instrumental in forming self-help groups. If there are people in the area showing symptoms of leprosy, these self-help groups introduce the potential patients to an appropriate medical facility. The members of the groups are neither doctors nor medical staff, but because of their own experience, they are more aware of and attentive to early symptoms, and more capable of persuading others to seek treatment.

These sorts of community based activities have been enormously helpful in leading untreated people to seek early treatment. I have learned that when people in the community, both experts and non-experts, work together, this leads to diagnosis of undetected cases, and ultimately to treatment and medical care.

Today, I have presented my approach to eliminating leprosy and the importance of directly appealing to political leadership, expanding public awareness and community involvement. Perhaps you have found something that may be relevant to mental health, and I hope that I have provided some helpful insights.