Development Ratings

Nepal Leprosy Trust, NLT, was originally registered in 1972. NLT Nepal is now a local NGO managed by Nepali professionals. NLT UK supports the work of the local operation.

Nepal is one of only 3 countries classified as having endemic rates of leprosy (Source: WHO). Leprosy elimination means a prevalence of less than 1 in 10,000 people. At the beginning of 2008, the prevalence in Nepal was 1.18 in 10,000; the 2007 new case detection rate was nearly 1.6 in 10,000.

Leprosy was untreatable until the 1940s. It can now be cured with multi-drug therapy (MDT). Leprosy is a slow onset disease, caused by a bacterium, which typically affects the nerves, exposed skin or eyes. In late diagnosed cases, it often causes nerve damage that reduces motor function and deadens feeling. Reluctance to admit to symptoms delays treatment. Not being able to feel pain in limbs can lead to disability as daily living becomes very difficult. Wounds can become infected causing ulceration and deformity. Deformity leads to marginalisation from society which increases the likelihood of worsening poverty and further physical problems. The transmission mechanism of leprosy is now thought to be by airborne droplets. Despite fear, stigma and preconceptions, ~95% of people worldwide are immune to the disease. Genetic factors may be involved in susceptibility to contracting leprosy as there are often family clusters (which reinforce fears and stigma.) Malnutrition (compromising the immune system) and prolonged exposure to those affected also contribute.

Leprosy-affected people are no longer infectious after the early doses of treatment (which lasts 6-12 months). Novartis currently pays for the free medication for endemic countries (previously supplied by the WHO and the Nippon Foundation). This will continue at least until the end of 2010. NGOs affiliated to national programmes are provided with free supplies. Complete drug treatment costs around $10/person. It is estimated that early detection and treatment has prevented about 4 million people worldwide from becoming disabled since 2000.

Despite being ‘cured’ of the disease bacterium, any deformity or nerve damage will remain and still inspires fear. In Nepal, social exclusion is highly traumatic as the concept of family is very strong. A patient’s perception of what it means to be cured is often to be able to work and live with dignity and acceptance.

A 10 year civil war in Nepal ended in 2006. Democracy has been implemented but parliament and the country’s economy are still in a fragile state. This is illustrated by the 16 hour/day power cuts currently imposed.

NLT operates the only leprosy centre in southeast Nepal in an area with endemic rates of leprosy.