History of Leprosy in Mali
Some of the key developments from the 1920 onwards are:
- In Bamako people affected by leprosy who had been kept in seclusion in Djikoroni, were freed in line with Emile Marchoux’s* recommendations to humanise treatment of people affected by leprosy made during the 1923 International Leprosy Congress. Thereafter, people with leprosy were encouraged to report on a daily basis to the outpatient clinic for continuation and monitoring of their treatment.
- In 1931 the Leprosy Prophylactic Service of French Western Africa was established in Bamako with responsibility for keeping a register of leprosy patients, treating them and monitoring the outcome of their treatment. However, each colony had its own health service and had to adhere to the directives of its local Supervisor so full co-ordination of anti-leprosy activities through Bamako was not possible.
- In 1945 what had been the Autonomous General Service against Sleeping Sickness (SGAMS) became The General Service of Mobile Hygiene and Prophylaxis (SGHMP) so that care could be taken of other diseases including leprosy. The leprosy section incorporated the Marchoux Institute** which had been created in 1931.
- Between 1945 and 1960 physicians of the Colonial Medical Corps, who were heads of districts of the General Service of Mobile Hygiene and Prophylaxis, carried out the majority of anti-leprosy control activities. In 1956 nurses were given the task of distributing sulphone tablets to leprosy patients by bicycle following a “daisy-shaped round” following methods used by Jamot to provide versatile itinerant treatment. They also helped to keep patients’ records up to date and they had to refer to the doctor any suspected new cases of leprosy. From 1960 onwards national doctors began to take over these duties.
- Outbreak of resistance to sulphones developed in the 1960s and impeded leprosy control. Around the same time, however, the adoption of sterilisation of lesions helped improve hygiene and living standards.
- During the 1980’s leprosy was highly endemic in Mali. For example, 35,000 cases of leprosy were recorded in 1986. The introduction of multidrug therapy was very successful. In 1991 there were around 28,000 cases and by 2001 the number of new cases of leprosy had dropped to 686.
Reducing the number of cases in this country to less than one case per ten thousand population by 2000 has been attributed to:
- the integration of leprosy activities with other health activities;
- the use of technical guides on case-finding and treatment and community mobilisation;
- regular supervision and continued training of staff involved in leprosy elimination activities; and
- the political commitment of deciders and financial and technical support from partners.
* See entry on Emile Marchoux below
** See entry on Marchoux Institute/CNAM
Emile Marchoux, 24th March 1862 – 19th April 1943
Emile Marchoux was a researcher respected throughout the world for his work on tropical diseases. He spent his early life in the French colonial medical corps serving overseas for example in Senegal, where he created the first African laboratory for microbiology. Marchoux wrote a report on malaria, which served as the medical reference text for a generation of naval doctors and doctors working in French colonies. Between 1901 and 1905 he was part of study group investigating the role of a type of mosquito spreading yellow fever in Rio de Janeiro, which managed to rid the city of this disease. Rio de Janeiro named him an honorary citizen in 1927 for his role in combating yellow fever.
From 1905 to 1942 he worked as Head of the Tropical Microbiology Services of the Institut Pasteur in Paris. He specialised in leprosy. His observations deepened understanding of this disease long before the introduction of treatment by multi-drug therapy. Marchoux was determined to find out as much as possible about mycobacterium leprae. In the course of his life he wrote numerous papers, articles and communications on leprosy. He did not succeed in cultivating mycobacterium leprae, but he managed to inoculate white rat, which could contract leprosy similarly to humans, against this disease. He also studied modes of transmission to humans. He concluded that healthy skin provides a barrier to mycobacterium leprae, but any lesion in the skin acts as a port of entry.
Marchoux also played an important role in fighting against the policy of segregating people affected by leprosy. He defended the idea that people affected by leprosy should visit their doctor of their own free will and those who were no longer infectious should be allowed to stay at home whilst under treatment. Only those who were infectious should be housed in leprosy villages and those with disabilities should be hospitalised. Leprologists attending the International Leprosy Congress in Strasbourg in 1923 widely supported these ideas and elected him their President. In 1935 Marchoux was made President of the Leprosy Commission for the Ministry of Colonies. Marchoux’s influence helped to change attitudes slowly and gradually coercive segregation was abandoned in some places and ambulatory treatment became standard practice.