Leprosy in India

As an epidemiologist and academic, I traveled to most corners of our globe. Eventually my passion for the arts shaped my life but I still keep in touch with the public health and medical literature. The past decade has seen the resurgence of infectious diseases and having worked in pulmonary tuberculosis research I have a propensity of reading the literature on infectious diseases.

Recently I came across a number of articles on the alarming trends of leprosy in India. I know a bit about the situation of this disfiguring and socially isolating disease as I have seen it in India. So I did a bit more reading and wanted to find the few pictures I had taken in Mumbai a few years back.

.. It was in the early 1990’s when I went to Mumbai and Hyderabad for academic work. I was in good hotels and the universities were competitive with their Western counterparts. While poverty was apparent in Mumbai, it was only during a drive through the city that I realized the extent of the social tragedy that public health challenges eventually struggle to keep under control when prevention becomes a herculean endeavor.

We drove through the center of Mumbai to an area called Dharave, which I was told was Asia’s largest slum. Fifteen years ago it was estimated that 600,000 people lived there but no statistics were reliable enough to trust that forecast. I was accompanied by a physician from the Bombay Leprosy Project which was, and I believe still is, the leading organization created by the government to identify new cases, document the relapsed ones, and provide medical treatment.

What was special about this slum is that it was also home to the “leprosy colony” (I dislike this terminology). Given the traffic jams in Mumbai, any car driving near the shanty shacks that make up Dharade is expected to come to a halt. And that is when one literally comes face-to-face with leprosy. Indeed, the moment our car stopped, I saw two hands, missing fingers, holding a tin cup, which made their way through my open car door window and asked for money or food. It was a teenager, half naked. He was a leper. I looked around and every car that had stopped was surrounded by young boys, sometimes even toddlers. Most cars had their windows up making the scene even more uncomfortable to experience.

I remember having second thoughts about taking photos from my car window. I eventually took a few to describe the scene without infringing on the identity and dignity of the young boys. I had a 1960s Yashica Electro 35mm camera with me that day.

In the above photo, a sliver of the slum of the leprosy colony of Dharave can be seen in the background, on the right.

… The rest of Mumbai and Hyderabad were similar to other developing countries --lots of color, street vendors, and heavy traffic consequent to the characteristic lack of driving rules.

Yet, the lack of basic public health behaviors continues to pave the way for infectious diseases, among others. Here is a butcher shop where refrigeration of meat is nonexistent in the depressingly hot temperatures of Mumbai.

Indeed, according to the World Health Organization, near 140,000 residents of India were diagnosed with leprosy in 2012-2013, representing about 60 percent of newly diagnosed leprosy cases in the world.

This trend is especially disturbing since in 2005 the government of India declared victory on leprosy and classified it as “eliminated”. As such, the resources dedicated to prevent, identify and treat leprosy were channeled to addressing the challenges of new epidemics such as HIV and the stubborn tuberculosis.

…Meanwhile, the social stigma of leprosy remains, even if Dharave, the largest slum of South Asia, is located in the center of Mumbai and no one seems to know how many people, disfigured and in extreme poverty, live there.

February 12, 2016

© Vahé A. Kazandjian, 2016