Democratic Republic of Congo
History of leprosy in the Democratic Republic of Congo
During the fifteenth to eighteenth centuries leprosy spread through Africa downwards from the East.
Leprosy work started at the beginning of the twentieth century when the country was a Belgian colony. Then the official health services dealt with leprosy in a very organised way. Missionaries and private organisations had already been working locally, for instance in the Haut-Uele region. Several leprosy villages were built during the nineteen fifties.
In 1938, it was estimated that there were about 60,000 leprosy cases in the country, among a population of 10,217,000 inhabitants. Provinces with the highest endemicity were those of Coquilhatville (presently Equateur) and Stanleyville (presently Province Orientale) with prevalence rates of 1.4 % and 0.6 % respectively. In some Districts, such as Tshuapa in Equateur, or Uélé-Nepoko in the Province Orientale, prevalence rates reached 5.0 to 6.0 %. (Source: A. Dubois : La Lèpre. Diagnostic – Traitement – Prophylaxie. 108 pp. Bruxelles, 1939).
In 1963, three years after independence, the prevalence rate was still estimated to be 19.9 per 1,000. It dropped to 1.9 per 1,000 in 1983 and 0.4 per 1,000 in 1988. Several factors have been evoked to explain those dramatic changes: the effectiveness of the long-standing control programme based on dapsone; the reduction of detection activities; and the cleaning or updating of registers.
In 1972 the Ministry of Health of the RDC created the National Leprosy Control Programme. At that time, leprosy services were still vertically organised. It was during the nineteen eighties that those services were integrated into the Primary Health Care Services. During that same decade the National Programme started to introduce Multi-drug therapy as treatment. Specialised staff went from one area to another to detect and follow-up cases of leprosy. It was around 1993 that the organisation of the programme was combined with tuberculosis control at national and provincial levels. Provincial offices were lead by a medical doctor who was responsible for the management of these two diseases.
As with all other programmes in the Democratic Republic of Congo, the leprosy programme has been affected by the years of war, the economic situation and lack of security. Since the overthrow of Mobutu in 1997 more than three million people have died in civil wars. Many areas are difficult to reach because of lack of infrastructure. Health services are still not available in many remote areas of the country. In 1999, 56% of the population had access to leprosy services. The major obstacles to leprosy control were the persistent war and partition of the country.
While leprosy detection had been quite low during the civil strife, it increased significantly when peace was restored to most of the territory. Special Action Projects for the Elimintion of Leprosy (SAPELs) and Leprosy Elimination Campaigns (LECs) formed part of the disease management strategies from 1995. The Multi-drug therapy regimen was reduced from 24 doses to 12 doses by 1998, which had an impact on prevalence reduction.
In 2003 Dr Mputu Luengu, the National Co-ordinator for the Leprosy Control Programme, reported that increased numbers of leprosy cases had been recorded for the year 2002. He attributed the higher figures to war, poor hygienic conditions and people spending long periods in the forests. According to the latest figures, a total of 8,820 new leprosy cases were detected in 2007, or a case detection rate of 13.2 per 100,000 population. 12.6% of cases nationwide were children, and 8.4 % had grade 2 disabilities at diagnosis. A resurgence of leprosy had been noted in zones where it had been practically wiped out, such as the district of Bas-Uele and Orientale Province. The areas with highest endemicity are the Tanganyka District in Northern Katanka, Tshopo District in Province Orientale, and Thsuapa District in Equateur.
About 400 new cases of leprosy were discovered in Moba, in the north of the Katanga Province, during a screening programme, which began in May 2007. Specialists from ILEP Member Damien Foundation Belgium have been trying to study new care strategies for people affected by leprosy in the area. This area is the one with the highest endemicity for leprosy in the country, and probably in Africa.
Much effort is now being made to improve the prevention of disabilities and the rehabilitation of people affected by leprosy.
Today there are fewer old persons affected by leprosy or their descendants living in the old leprosy villages, which unlike in other countries, tend to be surrounded by villages that are not affected by leprosy. The current leprosy control programme is organised within 23 provincial co-ordination offices.
A national meeting is organised every year in September bringing together the field managers (24 field co-ordinations in 2008) with the national Bureau and the external partners: the World Health Organization, ILEP non-governmental organisations, bilateral co-operation agencies and other international organisations.
Dr Frans Hemerijckx, 19th August 1902 – 14th October 1969
Frans Hemerijckx was a specialist in tropical medicine and set up “clinics under the trees” in India with Dr Claire Vellut. However, he began his pioneering methods in the the Democratic Republic of Congo. Rather than isolating people affected by leprosy he treated them in their communities.
He left Belgium for the DRC in 1929 to help people affected by leprosy. He believed it would be possible to win the fight against leprosy. He built a leprosarium, where patients could live with their families. During the Second World War he founded Dikungu, the second village for people affected by leprosy in the DRC. He began to conduct regular tours of the area dispensing medical care where needed so that people affected by leprosy could remain with their families.
His work inspired people in Belgium to donate money to help care for people affected by leprosy and led to the creation of Damien Foundation Belgium in 1964.
Dr Stanley George Browne, 8th December 1907 – 29th January 1986
During his lifetime Stanley Browne became known as “Mr Leprosy” and sometimes “Bonganga”. He graduated with a degree in medicine from Kings College Hospital, London, in 1933. He undertook post-graduate studies and became a Member of the Royal College of Physicians in 1934 and a Fellow of the Royal College of Surgeons in 1935. He studied French and tropical medicine at the Institut de Médecine Tropical Prince Léopold in Antwerp and then travelled to the BMS Hospital in Yakusu to work to control trypanosomiasis and onchocerciasis in the surrounding area. A high incidence of leprosy was revealed in his studies and he decided to try and find the cause and a cure for this disease. Stanley Browne established a leprosarium at Yalisombo and during his time there oversaw an area of 10,000 square miles, in which he developed a programme of community care based on 18 health centres and 36 treatment centres. This model was adopted in Africa for the control of endemic disease.
From 1959 – 1966 Stanley Browne was Director of the Leprosy Research Unit, Uzuakoli, Eastern Nigeria. Whilst there he conducted pioneering studies into the anti-leprosy drug Clofazimine (at the time of the studies called B663).
He held many other advisory roles in leprosy including ones associated with ILEP and its Member Associations: he was Medical Consultant to the Leprosy Mission 1966-1978, and Medical Secretary of LEPRA Health in Action 1968-1973 and Vice-President 1984-1986. He was the Secretary-Treasurer to the International Leprosy Association 1966-1984 and their Honorary Vice-President 1984-1986.
The Wellcome Library for the History and Understanding of Medicine holds archival material on Dr Stanley Browne. Click here to find a description of these archives:
Professor Michel F. Lechat
Professor Michel Lechat is well-known and highly respected in the world of leprosy as well as being a successful statesman. He has been awarded both the Damien-Dutton Award (2001) and the International Gandhi Award (1990) for his services to anti-leprosy activities. He has also served as the President of the International Leprosy Association and the International Leprosy Union. Professor Lechat is a member of the Royal Academy of Medicine and the Royal Academy of OverHe was Chairman of the ILEP Medico-Social Commission from 1974-1978 and continues to have strong links with ILEP Members, especially Damien Foundation Belgium.
He was introduced to leprosy work in the Democratic Republic of Congo by Dr Franz Hemerijckx. As a student there he cycled the countryside looking for people affected by leprosy, who could be treated with sulphone - the anti-leprosy treatment at that time. He returned two years later in 1953 as a physician and Medical Director of the Yonda Leprosarium. He was conducting pioneering clinical research into many topics of leprosy when Graham Greene visited to gather material for his novel A Burnt-Out Case. Graham Greene dedicated this book to Professor Lechat. (See article: Diary – Prof. Michel Lechat writing in London Review of Books).
Click here for description of leprosy archives held by Professor Lechat:
The Burnt Out Case
More information can be found on the leprosy pages of the website of the WHO African Regional Office: http://www.afro.who.int/leprosy/index.html