History of Leprosy in the Republic of Madagascar
During the fifteenth to eighteenth centuries leprosy spread through Africa downwards from the East.
The coastal regions to the east, and particularly the south-east, of Madagascar have always carried the heaviest burden of leprosy.
Providing health care for communities in hard-to-reach mountainous and hilly villages presents a challenge. Many can best be reached by aeroplane followed by a difficult motorbike journey. In addition, many villages can be cut off for months by heavy rains and accompanying cyclones during November to April.
Norwegian Leprosy Missions set up a town, Ambohipiantrana, for people affected by leprosy in 1888. They moved it in 1916, when they renamed it Mangrano. These two towns were ground breaking in their time for their size and standards.
Madagascar came under French rule in 1895 and gained its independence in 1960. The second resident General, Joseph Galliéni, built more than a hundred hospitals, dispensaries, maternity units and leprosaria. The Fondation Raoul Follereau helped fund a number of leprosaria too.
In 1935 this country had an estimated 40,000 cases of leprosy.
The National Leprosy Program was set up in 1990. Initially health workers received training in leprosy and case-management tools were delivered to health centres.
In 1992 Madagascar introduced multi-drug therapy to treat people affected by leprosy. In the 1990s five Fianarantsoa health districts on the coast were found to be very endemic for leprosy the strong stigma associated with leprosy leading some patients to hide in the tropical forests of those areas.
Since 1996 the number of people with leprosy has continued to decline.
In 1997 and 1998 leprosy elimination campaigns and special action projects, which concentrated on highly endemic and remote areas, were carried out and the number of new cases reached a peak in those years.
By the year 2000 the National Leprosy Control Program was partially combined with tuberculosis at the peripheral level.
According to WHO at the end of 2001 all regions, except for Antananarivo, had more than four cases of leprosy for every 10,000 inhabitants. MDT was reaching 60% of the patients who needed it. An intensified strategy to eliminate leprosy was introduced for the period up to 2006.
Many of the activities of the National Leprosy Control Program were halted during 2002 due to the political crisis. Circulation was increasingly difficult as roads out of the capital were blocked, bridges destroyed and fuel stocks dwindled and the treatment regimens of many people affected by leprosy were interrupted.
Project activities returned to normal during 2003. At the beginning of 2004, WHO listed 3.35 cases of leprosy per 10,000 inhabitants in Madagascar.
During the International Leprosy Association African Congress in early 2005 it was thought that Madagascar might have the highest burden of leprosy in the African region. It was reported that community mobilisation and education activities would be intensified in efforts to reach as yet undetected cases.
WHO recorded less than one case per 10,000 population inMadagascar in September 2006. It had the thirteenth highest numbers of cases of leprosy in the world. At that time a meeting between representatives of the Ministry of Health, the World Health Organisation and the Fondation Raoul Follereau outlined a three-year programme of work up until the end of 2010 that included improving access to health care, promoting social reintegration of people affected by leprosy and providing care for people with disabilities.
Today much still needs to be done in Madagascar to change negative attitudes towards leprosy, which are kept alive through the widely believed myths and taboos about this disease.
Myths widely held in Madagascar about leprosy:
- Leprosy is believed to be the effect of sorcery.
- Every person with leprosy is capable of sorcery and is believed to have turned themself against their community and enemy.
- Individuals affected by leprosy should stay in the shadows.
- People who have leprosy during their life cannot be buried in the ancestral tomb.
Children’s games played in Madagascar demonstrating fear of leprosy:
- The Sakalava people in the north-west of Madagascar personify leprosy as an ogre called Kakà. He hunts out people and drags them away from their communities, leaving them to experience leprosy and social exclusion.
- Raboka is a game of tag. “It”, or “Boka”, has leprosy. They try to touch the other players on the back. A tap on the back is said to transmit leprosy. Those who do not have leprosy stick together in a circle, but become infected as soon as they leave the protection of this circle. Some times the children who have contracted leprosy dispel the circle indicating their intolerance of rejection.
Père Isodore Dupuy, a Jesuit missionary, was awarded the medal of the Légion d’honneur of France for the care and attention he showed towards people affected by leprosy at the colony of Marana and for being their teacher. He died 3rd April 1912.
Jan Beyzym died 2nd October 1912 in Fianarantsoa, known as the apostle of the lepers of Madagascar. Like Père Dupuy, he was also a Jesuit missionary. His experience of assisting those affected by a cholera epidemic may have shaped his wish to work for people affected by leprosy. In 1898 he was assigned to work at a leprosarium of Ambahivuraka near Antananarivo in the desert. 150 people affected by leprosy were living there far from others in such a state of abandonment that they often died of hunger. Jan Beyzym collected money from donors in Poland, Austria and Germany for example so he could improve their living conditions and help nurse them. He also tried to overcome widespread stigma of leprosy and like Father Damien on Molokai he lived with people affected by leprosy. Eventually he had sufficient funds to leave and build his dream hospital at Marana near Fianarantsoa. Building began in 1903 and was completed in 1911. This hospital still exists today, maintained by the support of Fondation Raoul Follereau and some contributions from St Francis Leprosy Guild. Pope John Paul II beatified Father Beyzym in 2002.