History of Leprosy in Sri Lanka
Leprosy was prevalent among the European (Portuguese) as well as the local Ceylon population when the Dutch began building the Leprosy Asylum at Hendala, six miles north of Colombo, in 1701. It was completed in 1708 and became the government leprosy hospital. People affected by leprosy were banished to this Asylum and were banned from all public places.
On 1st January 1902, the Government of Ceylon passed the Lepers Ordinance which specified rules for the segregation and treatment of persons affected by leprosy and replaced the expression “leper asylum” with “leprosy hospital”. Anyone who failed to report someone they suspected of having leprosy would have to pay a fine. People affected by leprosy would not be able to leave leprosy hospitals without the permission in writing of the Director of Health Services, as no member of the public could enter the leprosy hospital without lawful authority.
Segregation remained the main mode of control until the introduction of dapsone monotherapy in the 1940s and the development of the Anti-Leprosy Campaign from 1954. Field activities were further strengthened during the period 1971 – 1990, especially with the introduction of multi-drug therapy (MDT) in 1982, which was available nationwide by 1983.
In addition to the Hendala Hospital, the Anti-Leprosy Campaign administrates the Mantivu Leprosy Hospital and the Central Leprosy Clinic in room 21 at the National Hospital. This Clinic has been functioning as the main referral centre for patients with complications and for those who need rehabilitation. In addition, it is the main operational centre for field activities. The Central Leprosy Clinic also maintains the register of leprosy patients and disseminates leprosy statistics and other information.
Since the introduction of MDT in 1982 there have been no admissions to the two leprosy hospitals. But patients who were admitted before then have been allowed to stay for the rest of their lives in line with government policy in many countries to look after people affected by leprosy who were admitted to such hospitals against their will.
In 1989, social marketing campaigns were launched with the aim of raising awareness about leprosy and educating the public about the early signs of leprosy and to dispel misconceptions around this disease. It was hoped these campaigns would help remove the stigma around leprosy and reduce the number of cases of leprosy. At the end of the second year of social marketing there were an average 17 cases of leprosy per 100,000 inhabitants.
Anti-leprosy activities were integrated into the Sri Lankan general health services in 2001. At the end of the first year of integration of leprosy services there were 11.2 cases per 100,000 inhabitants.
A Leprosy Elimination Monitoring (LEM) was carried out 24th July to 6th August 2005 at the request of the Ministry of Health so as to assess the progress in the fight against leprosy. It was found that the number of cases of leprosy with grade-two disability at the time of diagnosis was around 6% and the average delay in diagnosis was thirteen months. One of the conclusions was that the initiative taken by some teaching, general and base hospitals to admit patients with leprosy into dermatology wards was helping to reduce stigma. By the end of 2006 almost 90% of new cases of leprosy were registered at skin units of teaching and base hospitals.
Sri Lanka has reached a plateau in leprosy control, reporting over 1,900 new cases of leprosy in the years 2004-2008, and topping 2,000 in 2007 with 2,024.
In 2008 an independent evaluation of the leprosy programme was undertaken with the support of Netherlands Leprosy Relief and FAIRMED.
The current plan of action of the Anti-Leprosy Campaign for the period 2008-2010 includes the following key points:
- to improve case detection (with a focus on contacts and high endemic areas)
- to monitor and report the good functioning of the system
- to ensure uninterrupted drug supply for all patients
- to ensure treatment guidelines and manuals are being used
- to follow-up patients being treated through the primary health care system in Polonnaruwa
- to keep leprosy at the top of the agenda among health workers and the general public
- to provide medical, social and economic rehabilitation for those who need it
Report of the Independent Evaluation: The Anti Leprosy Campaign Sri Lanka 2008
Prof. A Pathmeswaran, Prof. D B Nugegoda, Dr Erik Post
Leprahilfe Emmaus Schweiz, Netherlands Leprosy Relief
Strengthening Integration: 15 Years of Leprosy Work in Sri Lanka
October 2009, Dr Kasturiaratchi
Update on Leprosy Control in Sri Lanka
October 2009, Dr Tilaka Liyanage