Lessons from abroad

Hansen's disease, caused by Mycobacterium leprae, is a major cause of foot drop, neuropathic joint deformity and lower limb amputations. The general lack of knowledge and absence of preventative medicine makes this disease dreadful and debilitating. On a recent missionary trip, doctors and patients at a rehabilitation center in India shared their personal experiences with me to highlight the challenges they face every day. It included an understanding of the disease, treatment options available and the role of society. Multi drug treatment has been found to be effective. Custom footwear was developed at the center and, although effective, use of newer technology and materials will help to make them lighter and more durable. The broad clinical spectrum of the disease ranging from hypopigmented skin lesions to sensory loss are treated effectively with early chemotherapy while late neurological deficits are irreversible and account for major morbidity. This highlights the need for better therapeutic intervention at the initial stages of the disease. For the patients already in distress and suffering physical disfigurement, support provided by caregivers is of paramount importance. Only one to two hundred new cases are diagnosed each year in the United States, but the rise of drug resistant cases world-wide has led to a growing global concern. My discussion highlights how the lessons learned from a remote rehabilitation center in India can be used to implement similar low cost strategies for healing our uninsured and underinsured populations in Chicago who have also been marginalized and socially ostracized.