Leprosy Settlement Research Articles

Experience of people living with leprosy at leprosy settlements in Nigeria

AbstractBackgroundAlthough Nigeria achieved the national leprosy elimination target of less than 1/10,000 population in 1998, factors such as culture, behavioural patterns and social determinants, among others, continue to contribute to an increase in leprosy cases and a poor state of living for individuals with leprosy in Nigeria. This study delves into the experiences of individuals residing in leprosy settlements in Nigeria.MethodsThis study employed a community‐based cross‐sectional design, utilizing a concurrent mixed‐methods approach for comprehensive data collection. Questionnaires, focus groups and interviews are conducted simultaneously. The research involves participants from seven leprosy communities across Nigeria's six geopolitical zones and Federal Capital Territory. Qualitative methods, including 14 focus group discussions and 6 key informant interviews, are complemented by quantitative questionnaires, engaging residents, leaders and nongovernmental organization (NGO) representatives. Respondents comprised 35 leprosy patients, 21 family members, 7 community leaders, 7 settlement officers and 2 organizational heads involved in leprosy control.ResultsThe results indicate significant access to healthcare (93.7%) and interest in self‐care practices (95.2%), with a considerable proportion (74.6%) receiving free healthcare. Interview data underscore the limited government support, with NGOs and partners assuming a more substantial role. Qualitative insights from persons living with leprosy highlight financial struggles, stigmatization and substandard living conditions in settlements, exacerbated by limited government funding. This reliance on private and NGOs is further compounded by declining funding, hindering individuals’ ability to start businesses and provide self‐care.ConclusionThis study underscores the pressing need for increased government support, funding and better living conditions for individuals affected by leprosy in Nigeria. It highlights the significance of education, awareness campaigns and human rights promotion to combat stigma and enhance the quality of life for those living with leprosy. Moreover, the study advocates for the reintegration of affected individuals into their communities to foster societal inclusion and well‐being.

A Multidimensional Welfare Status of Leprosy Patients Living in a Suburban Area

Leprosy has a high incidence of physical complications that will impact directly the physiological, economic, and social status of patients. Indonesia has a high burden of the disease, and several leprosy settlements are still spread in the country. Neglasari Village, Sitanala, Tangerang serves as one of the places of residence of people who have had leprosy. A health service initiative known as Identifikasi Tanda-Tanda Mata, Ekstremitas, dan Kulit pada Kusta (KATAMATAKU) was launched as a collaboration of health services among multi-departments (ophthalmology, dermatovenereology, and medical rehabilitation). Sitanala has a relatively high incidence of people who have had leprosy with disabilities of the hand, foot, and eye. As a continuation of this health service and combined with the efforts to improve the welfare of leprosy patients, in November 2019, a multidisciplinary program titled KATAMATAKU Universitas Indonesia, was conducted. This program aimed to determine the demographic data regarding the health, psychological, social, and economic status of the leprosy population at Sitanala The project consisted of a collaborative anti-stigma program by the Faculty of Psychology, Public Health, Social and Political Sciences, Cultural Sciences, Administrative Sciences, and Vocational Educational Program; thematic health program, which supports the improvement of physical abilities and empowerment of former leprosy patients, by the Faculty of Medicine, Dentistry, Nursing, and Pharmacy; thematic economics program, which aims to increase the economic capacity of the leprosy community, by the Faculty of Economics and Business, Mathematics and Natural Sciences, and Engineering. This program enabled the construction of a multidimensional management model, in which every aspect plays important roles to improve the patients’ quality of life.

How Colonial Power, Colonized People, and Nature Shaped Hansen’s Disease Settlements in Suriname

According to the Dutch colonizers in Suriname, leprosy (or Hansen’s disease) was highly contagious and transmitted from human-to-human. A “cordon sanitaire” was constructed around the patients, mainly African slaves and Asian indentured laborers and their descendants. They were tracked down and incarcerated in remote leprosy settlements located in the rainforest. Some patients obeyed the authorities while others resisted and rebelled. Their narratives, revealing conceptual entanglement of the disease with their culture and the Surinamese natural environment, contain important information for understanding their world and their life inside and outside of leprosy settlements. They combined traditional health practices and medicinal plants from their natural habitat with biomedical treatments (practicing medical pluralism). They believed in a diversity of disease explanations, predominantly the taboo concepts treef, tyina, and totem animals associated with their natural habitat (the Surinamese biome). Some of their imaginary explanations (e.g., “leprosy is carried and/or transmitted through soil and certain animals”) show a surprising analogy with recent findings from leprosy scientists. Our research shows that nature contributes to shaping the world of Hansen’s disease patients. An ecological approach can make a valuable contribution to understanding their world. Comparative historical and anthropological research needs to be conducted to map the influence of different biomes on local explanatory models. The now deserted Hansen’s disease settlements and their natural environments are interesting research sites and important places of cultural heritage.

A social approach to preserve difficult heritage under neoliberalism – a leprosy settlement in Taiwan and beyond

ABSTRACTLeprosy settlements have never been a priority in historic preservation due to their assumed lesser architectural value and marginalized historical significance in nation-building. Furthermore, they are considered ‘difficult heritage’ for their history of pain and shame. Recent external and internal factors have prompted significant opportunities for these settlements. However, either preserving or demolishing a leprosarium is a sensitive decision that is complicated by the influence of neoliberalism with its emphasis on a market oriented economy. The demolition of Losheng Sanatorium in Taiwan and the questionable conduct shown to its residents spurred a call for human rights that culminated in dramatic demonstrations led by youth activists and leprosy-affected residents. In this paper, I present the case of Losheng Sanatorium to illustrate three points: how difficult heritage can work as a catalyst to agitate social movements when national public projects are in conflict with historic preservation, how the bottom-up social approach to historic preservation of leprosy settlements includes both a people’s history and the physical environment, and how the preservation dilemma shared between Losheng Sanatorium and Sungai Buloh Leprosarium in Malaysia facilitated a transnational collaboration.

Health care service for leprosy patients in Sitanala Tangerang
 (A proposed approach of comprehensive health care for Leprosy patient)

Based on WHO data, Indonesia has the third largest leprosy burden in the world, afterIndia and Brazil. Although leprosy was declared to be eliminated in severalprovinces, there are still several leprosy settlements spread in Indonesia. Oneof these settlements is Neglasari village in Tangerang City, West Java, whereleprosy patients have been living since 1981. There is a scarcity ofinformation regarding the features of leprosy in Indonesia, especially aboutthe description of the patients’ posttreatment condition in terms of bothclinical sequelae and health services provided. A collaboration betweenmultiple departments of Ophthalmology, Dermatovenereology, and MedicalRehabilitation from the Cipto Mangunkusumo Hospital/Universitas Indonesia,Jakarta, was established in the form of a health service program to determinethe number and features of disabilities of ex-leprosy patients. We providehealth services, including physical examinations, extend free medication andeye glasses, and impart knowledge about the chronic complications to patientsand local cadres. A nonroutine health service program for leprosy patients wasconducted in Neglasari village, which performed four primary activities ofpromotive, preventive, curative, and rehabilitative. The program included atotal of 260 patients, with a mean age of 50.45 ± 10.15 years and most of thembeing males (60.4%). A duration of >5 years of leprosy was found in 47% ofsubjects, and 96% of them have been released from treatment. Disabilitiescomprised 52.5% in the eye, 87.7% in the hand, and 92% in the foot. In total,65% of the patients had an uncorrected visual acuity of normal to mildimpairment, whereas 5.8% were blind. Eye abnormalities included madarosis(43.9%), entropion (41%), cataract (26%), corneal hypoesthesia (20.6%),trichiasis (17.8%), and lagophthalmos (15.1%), and examination of theextremities revealed that 16% of the subjects had an amputated foot. Spectacleswere successfully distributed to 100% of patients who were visually correctable.This proposed model for leprosy health care program involving multidisciplinaryexpertise is effective for screening numerous disabilities in leprosy patientsat one time. This enables caretakers to determine a holistic management that atthe end is intended to improve the quality of life of patients.

Mikomeseng: Leprosy, Legitimacy and Francoist Repression in Spanish Guinea.

SummaryThe Mikomeseng leprosy settlement in Spanish Guinea (present-day Equatorial Guinea) was widely promoted during the 1940s and 1950s as the embodiment of the Francoist ‘civilizing mission’ in Africa. Its prominence reflected the important role which colonial health and social policy played in establishing the legitimacy of the Franco regime, and particularly in helping to overcome its international isolation in the immediate post-war era. But a major protest by leprosy sufferers in 1946 revealed the everyday violence underpinning life in Mikomeseng, showing how the language of welfare and social justice which pervaded Francoist propaganda masked the reality of a coercive colonial system. The image of Mikomeseng as the embodiment of benevolent colonial rule was constructed by Francoist experts and officials around a brutally repressive institution, one which encapsulated the violence of Spanish colonial rule in West Africa and of the Franco regime as a whole.

Nā hoa o ka pilikia (Friends of Affliction): A Sense of Community in the Molokai Leprosy Settlement of 19th Century Hawai‘i

ABSTRACT On the northern coast of the island of Molokai, Hawaiian Islands, lies the Makanalua Peninsula. Inhabited for centuries by Native Hawaiians, by the mid-1800s the peninsula was set apart to be a place of quarantine for those afflicted by the disease of leprosy. Board of Health officials began to purchase the lands of Makanalua for their purposes of isolation, but many of the Native residents refused to leave their homes and their lands. Thus during its first few decades, the leprosy settlement (1866‒98) developed into a community of patients, their helpers, and Native residents. Furthermore, Native residents provided food and shelter to those who were sent into exile, and the boundary between those with disease and those without remained quite permeable. Utilising Board of Health records, as well as Hawaiian language newspaper sources, this paper examines the development of this unique community and explores their connections to land and home.

Moloka‘i Kannon

Moloka‘i Kannon John Clark (bio) In 2004, while researching a book I wrote called Guardian of the Sea: Jizo in Hawai‘i, I interviewed Rev. Shugen Komagata several times at the Wahiawa Rusenji Soto Mission. During one of our talks he told me his grandfather, Bishop Zenkyo Komagata, then the head of the Soto Mission of Hawai‘i, had established Guzeiji Soto Mission of Moloka‘i in 1928. Rev. Komagata also mentioned that the Guzeiji temple had opened a satellite chapel at the leprosy settlement in Kalaupapa with a special statue called the Moloka‘i Kannon. In 2015, while I was researching a book on Kalaupapa, I visited Rev. Komagata, now Bishop Komagata, at his office in the Soto Mission of Hawai‘i headquarters on Nu‘uanu Avenue. When I asked him to tell me about the Moloka‘i Kannon, he provided the information that follows. When the first Pan-Pacific Congress of the Young Men’s Buddhist Association was held in Honolulu during the summer of 1930, one of the delegates from Japan was Rev. Chiyu Misawa. A representative of Tsurumi Girls High School in Yokohama, he boarded for three weeks at the Soto Mission of Hawai‘i in Honolulu. During his stay in Hawai‘i Rev. Misawa visited the leprosy settlement at Kalaupapa to pay [End Page 141] his respects to the memory of Father Damien, who was well known in Japan. While he was there, he met Japanese patients who asked him to send them a statue of Kannon from Japan to help fulfill their religious needs. Kannon is a Buddhist deity, a bosatsu, or bodhisattva, who, as a model of love and compassion, is special to those who are suffering. Click for larger view View full resolution On November 9, 2010, Bishop Shugen Komagata and his wife Faye visited Tsurumi High School in Yokohama, Japan, the home of the Moloka‘i Kannon. Courtesy of Bishop Shugen Komagata. When Rev. Misawa returned to Japan, he conducted a successful fund raising campaign at Tsurumi Girls High School and used the donations to commission a statue of Kannon from Zuiun Yamamoto, a prominent Buddhist sculptor. When Yamamoto finished the statue, Dr. Daijo Ohinata delivered it to Hawai‘i. Earlier on April 25, 1928, the Soto Mission of Hawai‘i had opened a temple in Kaunakakai, the Guzeiji Soto Mission of Moloka‘i, with a full-time minister. The minister and members of his congregation delivered the statue of Kannon to Kalaupapa and installed it in a building that served as a satellite [End Page 142] chapel. It is now known as Buddhist Hall. During the years that followed the enshrinement of the statue, successive Buddhist ministers and visiting ministers continued to provide services to the patients. In the absence of a permanent minister Kalaupapa staff member Sachihito Kamemoto and his wife took care of the chapel and the statue, while the Guzeiji temple in Kaunakakai continued an annual tradition of presenting New Year’s mochi to the Japanese patients. When the need for Buddhist services at Kalaupapa finally ended, the statue was returned to Guzeiji Soto Mission of Moloka‘i, where it remained for 15 years. In October 1996, it was moved to the Soto Mission of Hawai‘i in Honolulu. Due to the statue’s extraordinary value, which was estimated then to be $100,000, the headquarters decided to return it to the original donor, which is Tsurumi High School today. It was sent back to the school in March 1997, where it was enshrined in their auditorium. It is still known as the Moloka‘i Kannon. [End Page 143] John Clark John Clark is co-editor of The Hawaiian Journal of History. He is also the author of a series of books on Hawai‘i’s beaches and shoreline place names published by the University of Hawaii Press. Copyright © 2016 The Hawaiian Journal of History

“One’s Molokai Can Be Anywhere”: Global Influence in the Twentieth-Century History of Hansen’s Disease

In 1897 the first International Leprosy Congress was held in Berlin. Delegates came from all reaches of the colonized world, where leprosy (now known as Hansen’s disease) was of great concern and thought to be an “imperial danger” by some. By this time, the settlement on Molokai had become well known; most notably the service and death of Father Damien de Veuster had brought much notoriety to the small peninsula on Molokai’s northern shore. At the conference, the Norwegian model of voluntary quarantine was held up as a means to stop the spread of the disease, but it was the model of the leprosy settlement of Molokai and its policies of compulsory isolation that was most often followed by those in the colonized world. Thus, similar forms of quarantine for leprosy—isolation, separation, geographical boundaries—were soon found in many parts of the world, many citing Molokai as their inspiration. But what was the “truth” of Molokai, and was this a model of success? Why did so many others look to Hawai‘i as the example to follow? These and other questions are explored in this paper, illuminating an ironic twist of Brother Joseph Dutton’s words that “one’s Molokai can be anywhere.”

Health Workers and their Retention: The Situation of Health Care Work in Leprosy Settlements in Abia, Ebonyi and Oyo States of Nigeria.

Introduction: Retention of trained, qualified and motivated health workers is a key component for health system strengthening and achieving world health organization’s (WHO) global strategy for reducing leprosy burden and sustaining leprosy control activities. Study aimed to elucidate the factors and conditions that influence health workers’ job satisfaction in settlements. Materials and method: A total of 31 health workers employed in the three settlements were studied. Data were collected using semi-structured focus group discussion and in-depth interview. Further, situational analyses and informal observation of the activities in the settlements were done. Also Nottingham’s life satisfaction index was used to assess job satisfaction of health workers. Data were analyzed qualitatively and quantitatively. Results: There was acute shortage of highly qualified health staff in the settlements. Two factors, personal factors and institutional factors affected health workers’ retention negatively. Workers remained in one post for prolonged periods of time before earning promotion. In all, 10 (76.9%)of health workers in Abia and 8(72.7%) in Ebonyi States stayed 6-9 years respectively on one post before earning promotion while 4(57.1%) from Oyo stayed 3-7 years. Conclusion: the study showed that retention of health workers in the three settlements was associated with better conditions of service like increased allowances and salaries. Key words: health care, motivation, leprosy, incentive, settlement, and salary

Medical Rehabilitation of Leprosy Patients Discharged Home in Abia and EbonyiStates of Nigeria

To examine the extent to which medical coverage is available to discharged leprosy patients in communities. Evidence has shown that after care services, follow-up visits and national disease prevention programs are important components of medical rehabilitation to leprosy patients discharged home after treatment. Denying them accessibility to these services could expose them to multiple disabilities as well as several disease conditions including HIV/AIDS. These adverse health conditions could be averted if health workers extend healthcare services to discharged leprosy patients. This study was conducted to examine the extent to which discharged leprosy patients have access to healthcare services in the communities. All 33 leprosy patients who were fully treated with multi-drug therapy (MDT) and discharged home in the two leprosy settlements in Abia and Ebonyi States of Nigeria were included in this study. The list of discharged leprosy patients studied and their addresses were provided by the leprosy settlements where they were treated. Also, snowball-sampling method was used to identify some of the leprosy patients whose addresses were difficult to locate in the communities. Instruments for data collection were questionnaire, interview guide and checklist. These were administered because respondents were essentially those with no formal education. Analysis of data was done quantitatively and qualitatively. Findings showed that 20 (60.6%) of discharged patients did not receive health programs like HIV/AIDS prevention or family planning. Also, follow-up visits and after-care services were poor. About 14 (42.4%) of the patients live in dirty and overcrowded houses. On the whole, discharged patients were poorly medically rehabilitated (mean score: 4.7±1.1 out of total score of 7). Denying discharged leprosy patients opportunity of accessing health care services could increase prevalence of infectious diseases including HIV/AIDS among them. There is need to extend national prevention programs, follow-up visits, after-care services and free treatment to discharged patients in the communities.

Role of positive deviants among Leprosy self-care groups in Leprosy settlement, Zaria, Nigeria

Background: Positive deviants (PD) are described as a group of individuals having similar risks or conditions, but with few of the members doing something different from the main group to avoid the effect of the common condition or perform better under the same condition. The aim of this paper is to describe the possible roles of PD among Leprosy self-care groups. Methods: A prospective descriptive study was conducted among Leprosy self care group for a period of six months. Results: A total of 26 ex-Leprosy patients agreed to form a self care group, 15 (58%) were females. Six (23%) of the group members had ulcers, out of which two had two ulcers on the feet, making a total of eight ulcers among the six ex-patients. Twenty one (81%) of them had visible deformity either on their eyes, hands or feet (defined by W.H.O as grade 2 disability). Using the total sum scores of impairment and deformity for all the three organs (Eyes, Hands & Feed) the EHF sum score, 50% of the patients had scores between 1-4. Six months later, a total of four ulcers (50%) were healed at home with the support of self care group members, of which two patients healed their ulcers (33%). There was no change in the disability grading among all the patients, even though two (15%) patients with EHF score between, 1-4 had zero score at the end of the six month period. The group observed general improvement in hygiene, protective foot wear utilization and willingness to support each other in the group within the period of the six months. Conclusion: Patients could heal their ulcers at home using group support and practicing different approaches that were not necessarily taught to them by health care workers.

Assessing Psychological Rehabilitation of Leprosy Patients Discharged Home in Abia and Ebonyi States of Nigeria

Aim: Study aimed to examine the extent to which discharged leprosy patients were psychologically rehabilitated in communities. This study intends to reduce rejection, distress and others, which discharged leprosy patients experience in communities due to recurrent psychological damage. Method: Study used all the 33 leprosy patients who were discharged home after being treated from the two leprosy settlements in Abia and Ebonyi States of Nigeria. The list of the discharged leprosy patients studied with their addresses was collected from these settlements. Result: There was no difference in the results recorded in both states. Sex, age and marriage affected psychological rehabilitation. Males with higher mean depression score 7.7±1.8 were less psychologically rehabilitated than females with lower mean depression scores 7.2±2.0 (t=22.9 p=0.00000). Among the patients studied, those aged 40-49 years, with the least mean depression score 6.2±3.1 were more psychologically rehabilitated than others (t=22.9, p=0.00000). Married patients had the least mean depression score 5.8±1.5 and were better psychologically rehabilitated than others. Loneliness, depression and isolation were noted as the main complaints of the patients especially those with leaking ulcers. Conclusion: To minimize loneliness, rejection, depression and others, increased care and support for discharged patients should be encouraged.

Services available to children of leprosy patients in leprosy settlements in Abia, and Oyo States of Nigeria

Aim: Study investigates extent to which services like free education, health care including HIV/AIDS prevention and others are available to children of leprosy patients in settlements; To find out the risk factors children of leprosy patients are exposed to in the settlements. Methods: Study was carried out in 3 purposively selected leprosy settlements, Uzuakoli in Abia State, Ohaozara in Ebonyi State and Ogbomoso in Oyo State using 86 children from 10 years and above who are available during study. Structured questionnaire, and interview schedule were instruments used. Data were analyzed with Stat Pac Gold package. Results: Provision of social services to children of leprosy patients studied is limited. Only a total of 13 (16.5%) of the children in both States enjoyed free education. The rest 66 (83.5%) paid school fees. Despite the fact that greater number of children in Oyo State 34 (94.4%) than in Abia State 32 (74.4%), enjoyed free education, higher proportion of children in Abia State 43 (95.6%) than in Oyo State 36 (87.9%), was in school. About 42 (97.7%) of children in Abia State and 30 (83.3%) in Oyo State lacked knowledge of HIV prevention. Neither reproductive health services including HIV/AIDS prevention nor prophylactic treatments for leprosy were available to them. Finding showed that out of 33 females studied, 7 (21%) in Oyo and 4 (12%) in Abia, without being properly married, were living and making babies with the opposite sex in the settlements. Conclusion: In view of above results, increased social services including HIV/AIDS prevention, prophylactic treatments and health promotions are recommended.

Rod Edmond, Leprosy and empire: a medical and cultural history, Cambridge Social and Cultural Histories, Cambridge University Press, 2006, pp. x, 255, illus., £50.00 (hardback 978-0-521-86584-5).

In an ambitious work that seeks to bridge the disciplinary divide between cultural studies and medical history, Rod Edmond illuminates the connections between leprosy's enduring metaphorical power and medical efforts to contain and cure the disease in the modern age of empire. Edmond seeks to avoid both the over-generalities in studies of disease produced by cultural theorists and the overly narrow focus of site-specific medical histories that fail to recognize continuities among various colonial settings. Providing an innovative integration of both medical and literary texts, Edmond demonstrates that neither physicians nor writers in the nineteenth century consistently defined leprosy and those who suffered from the disease as infectious agents. Such disagreements about the nature of leprosy failed to produce a single isolationist model of treatment as previous scholars have claimed. When the germ theory gained predominance by the early twentieth century, however, so did more coercive policies of segregation, a result that reflected broader anxieties about the imperial project and the impulse to establish fixed boundaries between the colonizer and the colonized. The recognition that such a boundary proved permeable only heightened European fears of contamination and helped shape calls for compulsory segregation that emerged in various colonial settings throughout the late nineteenth and early twentieth centuries. Edmond's comparison of regulations in a distinctive array of geographic settings is a welcome effort to illustrate that no common colonial policy toward leprosy emerged in these years. Differences in racial populations, national identity, and attitudes toward the intermingling of European and indigenous colonials shaped distinctive chronologies and regulations regarding the containment of those with leprosy. Yet these comparisons remain cursory, in part because they lack any in-depth exploration of the archival sources specific to each institution. Despite his stated intention to challenge the “top-down nature” (p. 177) of previous theoretical models, this archival absence means the voices of those with leprosy or family members intervening on their behalf are largely absent from Edmond's account. More impressive is Edmond's effort to draw clear connections between domestic and imperial policies toward leprosy, addressing the call from such scholars as Ann Stoler to examine the ways in which metropole and colony are mutually constitutive. He effectively uses Paul Gilroy's conception of the “camp” to examine the wide variety of institutions constructed by Europeans to isolate those viewed as contaminants. In Edmond's conceptualization, such colonial sites as concentration camps and native reservations, and such domestic facilities as lock hospitals and tuberculosis asylums shared a common imperative to “enclose and isolate the primitive, the diseased, and the backward” (p. 216). His comparison provides a historical context for leprosy that demonstrates how segregationist impulses emerged within domestic settings and were not simply tools of empire. Yet mapping the intersections among these various encampments, while valuable, ultimately does little to explain the particular power of leprosy to inspire a degree of revulsion disproportionate to its infectiousness, or to account for its hold on the literary imagination. In his concluding chapter, Edmond briefly examines a series of authors to illustrate how leprosy settlements served as a source of both fascination and fear from the 1860s to the 1960s. He attempts to link this literary study to the preceding chapters by demonstrating how each author transgressed and challenged established imperial boundaries; however, the connections between this cultural analysis and his medical context remain elusive. While one wishes that this work could draw more specific conclusions to bring together the composite parts of his interdisciplinary study, this book will prove rewarding to scholars interested in literary and medical accounts of disease and their complicated imperial genealogies.

No doubt, no any government world over can be able to provide all necessary

Christian Missionary activities have often been criticised by scholars in different fields of study. More often than not, the missionaries were considered as imperialists who aided and abated the colonization of Nigeria. However, few other scholars considered them as those who contributed to the socio- economic and political development of Nigeria. This paper airs the views of those who argued that the Christian missionaries contributed to the development of Nigeria. The paper discusses briefly the contributions of the missionaries to the wellbeing of the leprosy patients in Northern Nigeria. They were able to set up leprosy settlements, established wards, villages, laboratories, vocational services, physiotherapy services for the treatment and socialization of the patients. Several of these patients who availed themselves at the settlements were not only healed and discharged, but were reinstated to their societies. LWATI: A Journal of Contemporary Research Vol. 5 2008: pp. 331-340

Healing Water: A Hawaiian Story (review)

Reviewed by: Healing Water: A Hawaiian Story Karen Coats Hostetter, Joyce Moyer; Healing Water: A Hawaiian Story;. Calkins Creek/ Boyds Mills, 2008; 217p ISBN 978-1-59078-514-0 $17.95 R Gr. 7-10 It's the late 1800s, and Pia relishes life playing in the environs of his native Hawai'i with his lifelong friend Kamaka, until the morning when his mother discovers the dreaded marks of leprosy on Pia's neck and shoulders. The tragedy of his disease is nothing compared to the pain of being abandoned by Kamaka, who stays away from the moment he hears that his friend has been afflicted. Pia's world is shattered by the anger he feels toward Kamaka, and he carries that anger with him as he is sent to the leprosy settlement on Moloka'i to live out his life without friends or family. His anger keeps him alive but turns him into a criminal, as he steals food and allows himself to be adopted by the local thug. Things become even more complicated when Kamaka arrives with his wife, another victim of the dreaded and little understood disease, and he seeks Pia's forgiveness for his behavior. For readers who've only ever imagined Hawai'i as a vacation paradise, this is a riveting look into its history and people during a dark period. Pia's perspective provides dimension to the values of native Hawaiians; he is distressed to find the qualities of family, sharing, and compassion largely absent in the leprosy village, and yet he finds those qualities strained to the point of breaking in himself. The portrait of Father Damien, the Belgian priest who dedicates his life to helping the villagers, is rendered so compassionately (and realistically) that it doesn't carry the taint of the stereotypical white man's rescue; instead, he reminds the people of the values they carry inside them already and draws them away from the despair and grief that have [End Page 388] temporarily kept them from helping and caring for one another. An extensive author's note, glossary, and resource list are included; readers will find their compassion stirred and their interest piqued through this truly fine historical novel. Copyright © 2008 The Board of Trustees of the University of Illinois

Availability of childhood social services in leprosy settlements in Southern Nigeria

Children of leprosy patients deserve social services such as free education, health care services including HIV/AIDS prevention like others. The extent to which these children benefit from such services is not clear. One expects that since they are exposed to health hazards in settlements that they would benefit immensely from preventive health care and other services. Study investigates the extent to which such services are available to them. Study was carried out in 3 purposively selected leprosy settlements, Uzuakoli in Abia State, Ohaozara in Ebonyi State and Ogbomoso in Oyo State using 86 children from 10 years and above who are available during study. Structured questionnaire and interview schedule were instruments used. Data were analyzed with Stat Pac Gold package. Provision of social services to children of leprosy patients studied is limited. Only 13 (16.5%) of the children said their parents did not pay school fees. The rest paid. However, despite payment of fees, higher proportion of children in Abia State 43 (95.6%) more than in Oyo State 36 (87.9%) went to school P = .03. About 42 (97.7%) of children in Abia State and 30 (83.3%) in Oyo State lack knowledge of HIV prevention. Neither reproductive health services including HIV/AIDS prevention nor prophylactic treatments are available to them. In view of above results, increased social services including HIV/AIDS prevention, prophylactic treatments and health promotions are recommended.

Lid surgery in patients affected with leprosy in North-Eastern Nigeria: are their needs being met?

Corneal blindness is second only to cataract as a cause of blindness in leprosy patients. Eyelid surgery provided by trained paramedical staff can often prevent blindness in these patients. We sought to determine the extent to which paramedic personnel are meeting the eyelid surgical needs of these patients and to investigate the barriers that may be preventing them from seeking surgery. A total of eight leprosy settlements in north-eastern Nigeria were selected for this study. In these villages, 480 residents who were 30 years of age or older who had been diagnosed as having leprosy had their eyes examined for the presence of lagophthalmos, entropion/trichiasis and evidence of surgery for either of these conditions. Patients who had not been operated on for either of these conditions were questioned to determine their reasons for not seeking surgery. One hundred and sixteen (12.1 %) eyes were in need of surgery while 5.1 % of eyes had been operated upon. The surgical coverage for eyelid surgery was 30%; lagophthalmos had a better surgical coverage of 44.4% compared to entropion/trichiasis, which had 24.7% coverage. Lack of awareness about the treatment available was the most common reason given for not seeking surgery. This study shows that despite the presence of trained paramedical staff in the community, the eyelid surgical needs of these patients are not being met primarily because the level of awareness about the availability of effective treatment still remains low. In addition, the readiness of eye-care staff to visit these settlements was disappointing. Extra efforts will have to be made.

Ocular leprosy in Nigeria: a survey of an Eku leprosorium

To determine the ocular morbidity, visual disability and potential for blindness in leprosy patients recently released from treatment. In-patients from Eku leprosy settlement were interviewed and examined for ocular disease from leprosy and other causes. They were examined using the Snellen's chart, pentorch, Kowa portable slit-lamp, direct ophthalmoscope and the pulsair non-contact tonometer. The patients were also refracted. In all, 60 inpatients who were recently released from treatment, comprising 39 men (65%) and 21 women (35%), were examined. Fifty-eight patients (96.67%) had ocular symptoms, the most common being blurred vision in 23 patients (38.33%). Nine patients (15%) were blind. Cataract was the most common cause of blindness occurring in three of the nine patients (33.33%). The most common types of ocular lesions were madarosis (31.67%), lagophthalmos (16.67%) and cataract (16.67%). Potentially blinding conditions due to leprosy were seen in 42 patients (70%). The incidence of ocular involvement, blindness and potentially blinding conditions are high in leprosy patients recently released from treatment. Regular ophthalmic evaluation and integration into Vision 2020 programmes are recommended.