MRTV aired a live program on the “Roundtable Discussions on Myanmar National Conference on Combating Leprosy” in which Dr. Tin Shwe, Deputy Director (Retired), Department of Health of the Ministry of Health; Dr. Kyaw Nyunt Sein, Deputy Director-General (Retired), DOH of MH; Dr. Chan Tun Aung, Leprosy Elimination Project Manager and Deputy Director of Public Health of the Ministry of Health and Sports have participated in the program.
Moderator: The roundtable discussion is to mark the National Conference on Combating Leprosy to be held on 12 and 13 of December 2018. Dr. Tin Shwe may kindly explain the past situation of leprosy that occurred in Myanmar.
Dr. Tin Shwe, Deputy Director (Retired), Department of Health of the Ministry of Health, Myanmar Leprosy Elimination Project Manager, American Leprosy Mission Country Representative: Please allow me to talk on the situation before I took charge of the anti-leprosy campaign. In 1891, it was recorded that (8.6) per cent of leprosy patients was among (10,000) population. In 1932, the number of leprosy patients was recorded as (11,127), and that in 1951, the experts of WHO had estimated (100,000) patients existed in Myanmar.
In 1993, we surveyed the number of leprosy patients and estimated as (242) patients among (10,000) population. Back in 1952, the countries in the world were eliminating the disease with the popular method of DDS treatment.
In 1964, the leprosy elimination project had been launched and expanded through the cooperation with the basic health care department, including research works.
In 1978, the first public health project was launched for the leprosy elimination through the cooperation of basic health staff members.
In 1981, the WHO had announced to supply Multidrug Therapy (MDT) free of cost to leprosy patients in all endemic countries and the regimen has successfully treated the leprosy patients. Therefore, in 1987, we started using MDT regimens in leprosy prone areas. As the MDT regimens found to be effective, it had been widely used.
In 1991 at the UNGA, the WHO had adopted the resolution marking leprosy as the public health issue, and urged all nations including Myanmar to treat the disease with MDT method.
In 1994, the Hanoi Conference was held in Hanoi and urged to work out in the elimination of leprosy by the year 2000, where we participated in the resolution. After that, Myanmar held “First Donor Meeting” in 1995 in launching Leprosy Elimination Project with the assistant of the WHO and other partner nations. With the help and assistance of the partner countries, we started in launching with the MDT treatment in the whole of the country.
Moderator: Kindly explain the tasks during your period in office.
Dr. Tin Shwe: With the cooperation of the WHO and the partner countries, we started the Leprosy Elimination Campaign (LEC) by searching new patients at the villages, along with awareness raising tasks. The LEC programs were being implemented at the districts level in conjunction with the Special Action Program for Elimination of Leprosy (SAPEL).
Moderator: We would like to hear the UNDP HDI Project and the Community Based Rehabilitation.
Dr. Tin Shwe: We treated the patients with MDT method, and at the same time we looked for the new patients, while solving the accompanying issues of the patients under the UNDP assisted HDI Project. We deployed the village health workers and the community health workers among the community in the search for new patients.
At that juncture, the tasks including the necessary exercises for their mobility and the socio-economic rehabilitation were provided through the Township Training Equipment Fund Committee. The benefits included material aids to the patients, soft loans for economic rehabilitation, and imparting relevant physical training courses through the CBR program, covering (40) townships in the country.
Moderator: Kindly explain the First Donor Meeting.
Dr. Tin Shwe: At the First Donor Meeting, we were supported by interesting partner countries in the leprosy elimination campaign, where we sought assistances. Among them, four organizations namely the American Leprosy Mission, the Netherlands Leprosy Relief, Sasakawa Health Memorial Foundation, and the Leprosy Mission International extended their assistances with the vehicles, equipments for the training courses, cash assistances, and skill trainings.
Moderator: Please explain the Leprosy Elimination Campaign.
Dr. Tin Shwe: As we believed in the suggestion of the WHO, we deployed LEC field staff and the basic health workers to the villages and conducted awareness raising talks. When we found some people in the village and ward with suspected nature of leprosy, we explained them our LEC program.
Moderator: Kindly tell us on SAPEL Project.
Dr. Tin Shwe: It is Special Action Program for Elimination of Leprosy, especially eradicating the health issue of the people. These programs were mainly carried out in remote areas and far reaching places, where our health workers searched for the new patients, registered and treated them on annual basis. We termed the plan as Special Action Program.
The work programs are expanded, and that I retired on superannuation term in 1998 entrusting the task to my colleague Dr. Kyaw Nyunt Sein.
Moderator: Dr. Kyaw Nyunt Sein may kindly share your view on the most vital aspect of elimination task.
Dr. Kyaw Nyunt Sein, Deputy Director-General (Retired), Department of Health, Ministry of Health: “The most basic task in fighting leprosy is to seek out those persons who have contracted the disease and ensure they receive treatment to become free of the malady, and also to prevent them from becoming disabled, while supporting them through rehabilitation” including the prevention in becoming disabled person.
In the past, the cases of leprosy patients were high as the scenario could be recalled in plain example. When a public bus or a coach of railway train pulled in, at least one patient may stepped out of it. It could be interpreted that there was one leprosy patient out of (50) persons. There are (68,000) villages in the country, and that it is very difficult to identify and find out a patient with the illness.
The main problem was that the person himself did not know that he had been infected with the disease.
The public themselves had no knowledge why this infectious disease occurred. They had wrong perception. Another factor was that the patients had no knowledge that full recovery could be made through treatment, and they do not know that the treatment was free of charge. When they knew that they had been infected, their morale was down and dare not come out and take treatment.
They had no idea where to take treatment. With four stages of ignorance of “no idea”, the situation was difficult in eradicating the disease. The lack of knowledge of “no idea” needs to be rooted out.
Moderator: Please explain the strategy being laid down.
Dr. Kyaw Nyunt Sein: In line with the guidelines laid out by Dr. Tin Shwe and our mentors since 1952, we could step up and improve the tasks with momentum. We focus on the tasks such as searching patients, providing treatment, and preventing not to become disabled.
Moreover, we are on the path of providing effective treatment with good pace under the guidance of National Elimination Steering Committee, which is chaired by the Director-General of the Department of Health with the composition of various ministries and departments. The administrative pattern has wide range; including the formation of task force which conducted research, development, monitoring, and control.
Moreover, we have communicated with the international donor countries in the course of partnership made through the First Donor Meeting. We are also cooperating with the local NGOs and relevant ministries. With a view to streamlining the tasks, such as the exploring of resource, implementation of LEC and SAPEL, we successfully formed a Leprosy Elimination Committee in April 2000.
We tried to wipe out the four stages of ignorance by adopting (10) Specific Objectives and (14) Strategies, and we are moving ahead. In these strategies, we included the vision in securing the commitment and support, and in cooperating with the partner countries on individual basis as well as collective manner through responsibility and accountability.
Furthermore, the strategies included that the appalling image of leprosy patient is to be changed into a suitable and humane nature in the eyes of the public, and that to convince the disease could be treated to full recovery among the patients.
We have included the plan for monitoring and surveillance as well as MDT service as close as possible to the public in the whole of the country without interrupted and shortage of medicine.
The role of midwives is very much instrumental in this issue as they are being imparted and equipped with the skills in examination, identifying and providing treatment to the patients. We also conducted research on some new unknown areas to fill in the gap for treatment. We pay attention for the prevention of patients from becoming disabling, and that all the strategies are put together for implementation.
(To be continued)
Translated by UMT (Ahlon)