History of Leprosy in Myanmar
The origin and spread of leprosy in Myanmar are not known exactly. However, it is possible that it may have been brought in at times of invasion by the Chinese and by visiting trade merchants from India. Those Chinese and Indians who settled in Myanmar tended to choose urban areas, where leprosy has tended to be more prevalent.
After 1885, the Roman Catholic Mission established four asylums for people with leprosy and the Mission to Lepers created three.
There were 11,000 cases of leprosy in Burma according to the 1931 census. Surveys carried out in nine districts of Burma between 1932 and 1941 indicated an average prevalence of 17.4 cases per 1,000 inhabitants. In 1951 a WHO Consultant estimated the prevalence of leprosy throughout the country to be about 5 cases per 1,000 inhabitants.
Before 1939 there was only one leprosy officer in the Department of Health and he had responsibility for the leprosy campaign in the whole of the country.
By the 1950s, Myanmar had one of the highest prevalence rates of leprosy in the world. A Burma Leprosy Campaign was begun in 1952 and registered an increasing number of people with leprosy. By 1969 this Campaign had probably reached most of the country and 209,706 people were registered with this disease.
In 1952-3 The Central Leprosy Institute (known as the “Special Skin Clinic”) was established in Rangoon near Rangoon General Hospital. Courses were devised to provide leprosy training to medical and paramedical workers. A Government Leprosy Sanitorium was set up in 1953 at Htauk Kyant for 450 persons affected by leprosy.
Co-operation between the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) resulted in an intensive programme to control leprosy, which was initially implemented in the pilot areas of Shwe Bo, Myin Gyan and Shan during 1957-1958 and later expanded to other endemic areas. UNICEF gave additional support to the leprosy campaign from 1956 onwards.
The International Committee for Assistance to Leprosy of the Order of Malta, Aide aux Lépreux Emmaus-Suisse (now FAIRMED Health for the Poorest) and the Deutsche Aussätzigenhilfswerk (now Deutsche Lepra- und Tuberkulosehilfswerk) channelled a sum of money through WHO sufficient to support a five year programme 1963-1968. The Burmese Government established two leprosy hospitals in 1966 to serve as the main centres of the anti-leprosy campaign.
Before the Second World War, the Burma branch of the then British Empire Leprosy Relief Association (now LEPRA Health in Action) provided a grant which stimulated the creation of District Leprosy Associations and led to the setting up of leprosy colonies in nine districts.
After the War, missionaries and voluntary associations re-established the leprosy colonies. By 1963, there were 3681 people affected by leprosy living in colonies, about 1.5% of people known to have leprosy. The Government decided to limit the admission of new patients into the colonies from 1963, as isolating people with this disease brought no significant benefits to leprosy control and created social and rehabilitation problems.
Multi-drug therapy was introduced into the country as the means of treating leprosy in 1986 and was available to patients in hyper-endemic areas by 1988, when there were 155,857 cases registered, equating to 39.9 cases for 10,000 inhabitants. Leprosy case-finding activities and treatment with MDT were fully integrated into the Basic Health Service in 1991, supported by technical supervisors. Midwives played a crucial role in rural health centres as they were able to help detect and treat leprosy during their regular home visits. They became known as the “red angels”.
As many as three to eight times as many people with leprosy were detected during Leprosy Elimination Campaigns in 1997 and 1998 than during routine activities. The success of these prompted a Nationwide Leprosy Elimination Week in 1999, which included a country-wide awareness campaign and huge media exposure. In 2001 there was a Special Action Programme for the Elimination of Leprosy (SAPEL) and an Improving Geographical Coverage Programme, whose aim was to achieve 100% coverage with MDT. These were followed up by a Focus-LEC in hyper-endemic areas with the aim of reaching patients that had not yet been detected. 1238 new cases of leprosy were detected during a Nationwide Leprosy Elimination Awareness Week in October 2002.
Since then, members of the International Federation of Anti-Leprosy Associations, Novartis and The Nippon Foundation have supported the efforts to ensure control of leprosy, with the emphasis on such activities as rehabilitation.
Approximately 300,000 people have been treated for leprosy as part of the Myanmar National Leprosy Control Programme, of whom between 40,000 and 60,000 have been left with some kind of disability. Although they are now free from the disease, social stigma prevents them from leading a normal life and many still live in communities such as the Mayanchaung Welfare Centre, Yangon, operated under the Department of Social Welfare.