In 1971, as young medical graduates Sam and I left Christian Medical College, Vellore, to work in what we thought was the most challenging of medical fields, Leprosy, now christened Hansen’s disease. To many, it still meant tattered, huddled-up bundles of rags at roadsides that occasionally shuffled to beg.
For several years we worked in leprosy hospitals in India, Bangladesh, Bhutan, Nepal and Africa. As part of our training, we visited several leprosy hospitals the world over. The hospitals were different, the landscapes were different, the medical facilities variable. Only one thing was constant. The sad, betrayed, sometimes sightless, eyes of the patients we met.
I remember many patients. One particular lady was a bag of bones with a putrid maggot ridden lower limb, brought in from a pigsty on the Nepal-Bhutan border and abandoned at the hospital gate. She begged us to let her die. The hospital team in turn begged God at morning prayers to let her live and to restore hope and peace to her fragmented life.
Reconstructive surgery, face-lifts, prosthetic limbs, restoration of function and loving acceptance gave them a new lease of life. Only the sadness in their eyes remained. Away from the comfort zone of the hospital wards they were discarded remnants of the human race. Many refused to be discharged and to leave the hospital grounds. Some made their homes around the hospital campus in satellite settlements.
Leprosy, is a chronic disease caused by the Mycobacterium leprae, a cousin of the tubercle bacillus that causes tuberculosis. The tubercle bacillus has been grown in the lab and has been studied well enough to develop a vaccine to prevent the spread of the disease. The M. leprae unfortunately has not been grown in the Lab and therefore has not been studied well enough to develop a vaccine to prevent the spread of the disease. M. Leprae can be grown in animal models like the 9 banded armadillo, nude thymectomised mice and the chimpanzee.
Leprosy, is a disease of the peripheral nerves, with tell tale skin signs. The M. leprae, causes damage, both sensory and motor in the affected nerves. When it causes sensory damage the area supplied by the nerve becomes anaesthetic, with loss of sensation, leading to damage to the affected parts. Even if the limb passes through a fireball, it will not wince or pull away as there is no feeling. Even if rodents gnaw at the toes and fingers, the patient will sleep through it all as he cannot feel.
Sometimes, patients would tell me that when they went to sleep they had all ten toes. In the morning only some would be missing after the rodent had done its worst. Many of the patients had to wade across rivers to get to the hospital and they would swear that they had all their toes when they started off from one bank to the other. When they reached the other side, blood would be streaming from injuries, bites and gaps.
With no sensation on the soles of their feet, they would sport ill fitting shoes, walking for hours to develop pressure sores on the soles of their feet. This would very often lead to florid infections, teeming with maggots.
When it affected the motor part of a nerve, the muscles supplied by the nerve would be paralysed. Every joint has two sets of muscles that pull in opposite directions. For example a joint would have a set of flexor muscles that flexed the joint and a set of extensor muscles that extended the joint. If the flexors ore paralysed, the extensors would act unopposed and vice versa.
In leprosy the flexors of the fingers are paralysed and the extensors contract unopposed and cause the characteristic claw hand deformity. This interferes with all the fine movements of the hand including grip and writing. With a claw hand, the palm is turned inside out and when the patient tries to pick up anything he actually pushes it away from him.Reconstructive hand surgery cleverly uses good muscles and inserts their tendons into paralysed muscles restoring movement.
In the early Seventies, sharing of experiences between the two hemispheres was lopsided. One had patients, the other had resources and both fumbled for knowledge, in an era, where communication was just another expensive and difficult word to spell and never boasted of speed. Research and development with this backdrop was difficult. There were no internet communications and no conference calls.
Everything took time.