SOCIO ECONOMIC AND LEGAL ASPECTS OF LEPROSY/PEOPLE

AFFECTED BY LEPROSY IN NEPAL

R. Shah, G. Pokhrel and I. Tamang

Raj Kumar ShahREAD NepalEmail: read.leprosy333@ gmail.com

G.Pokhrel & I. TamangLeprosy Mission NepalEmail: training@tlmnepal.org

Nepal

Mountain Fishtail

Nepal

Introduction• Landlocked country with 147,181

sq.km• Altitude ranging 300 ft to 29,028 ft

(Mountain Everest)• Total population of Nepal

26,494,504 • No of Government Hospital 91• No of Primary Health Care Centre

(DR. Service) 210• No. of Health post & Sub Health Post

(Service from Paramedics) 3,785

0.94

Introduction Cont..• Leprosy was officially integrated to general

health services in 1987• No of Endemic districts in Nepal (more than

1 PR) 17 District• No of Major Leprosy Hospital 3• Leprosy is a still Socially stigmatized problem • No of Leprosy Cases under MDT 2,430• No of Leprosy affected person cure from

MDT More than 170,000 till now• Having Disability grade II Approximately

40,000 existing

1.67

1.99

1.15 1.12 1.22

1.41

1.090.77 0.79 0.85

0

0.5

1

1.5

2

2.5

2007/08 2008/09 2009/10 2010/11 2011/12

Rates

Year

NCDRPR

Trend of PR and NCDR

ObjectiveExamining the existing misconceptions, legal aspect, disfigurement and stigma is the major causes in deteriorating the socio economic conditions of leprosy affected people in society of Nepal

Method and Materials• Literature review published in different journals• Discussion with Nursing staff and paramedical worker working in

Anandaban Hospital with key questions• Discussion with admitted leprosy affected people in Anandaban

Hospital with key questions• Consultation with book VASTU SHASTRA • Legal books of Nepal• Review the history of KHOKANA Leprosarium• Discussion about the religious, cultural and social codes with all

groups of people

6

Common causes of stigma still in leprosy are..

• Physical outward appearances• Progressive characteristics over time • Communicability and Disabling• Religious links• Discriminative legal aspects• Poverty related and food habit• Tradition of Isolation and Segregation

7

Cont…• Tradition (Unknown)• Priority level of leprosy programme in health• Frequency of coverage in media • Advocacy strategy and peoples involved• Corporate/social obligation being a service

provider, activist…

8

• Individual effects (physical problems)• Intra-family relations

• Within family and relatives• Within organization• Within community

• Emotional effects• Physiological effects• Social relationship and support

Common Problems in

Nepal

• Economically marginalized (poor) • Female and old age people• People with disability due to leprosy• Difficult to access in health facilities due

to geographical conditions• People from marginalize and ethnic

groups

Vulnerable People to Social

Difficulties

Results:• Misguide for conception:

(Misconceptions)• Believe in traditional causes &

methods of treatment• Prejudice opinion• Social/religious/Traditional

Dictum & Codes • Construction house site • Regular food habit

Emerging the Misconceptions

Results Con… • Legal aspects:• Bankruptcy (KANGAL)• Marriage and divorce

• Social Aspects:• Exclusion and discrimination in

different organization• Isolation and segregation

• Physical aspects:• Physical outward appearance

Emerging the Misconceptions

Key Questions:• Fact about leprosy

– Cause of leprosy– Transmission methods– Causes of Disability and Deformity– Consequences of deformity

• Traditional believes and treatment of leprosy

• Religious concepts about leprosy• Concepts about Leprosy Hospital• Legal concepts about leprosy and

rights

Area of questions

Discussions:• Awareness about leprosy facts• Strategy for the advocacy and

prejudices• Amendment of laws, bylaws and acts• Priority in health programme and

media• Human rights and social obligation • Community Based Rehabilitation and

socio economic development

Leprosy Related Circumstances

Mount Everest