Turkey

General Information:

History of Leprosy in Turkey:

Leprosy on the Anatolian peninsula has a long history, with leprosaria dating back to pre Roman times. Probably an ancient tribe of Hittities were the first to recognize leprosy and they build the first leprosarium in their city of Paflagonia (Kastamonu).

In the following centuries, with migrations from Palestine and the Middle East, leprosy became established in Anatolia and during the rule of the Byzantine Empire it became endemic. Byzantium built five leprosaria in Constantinople (Istanbul) alone. During the rule of the Ottoman Empire the situation did not change very much and the new rulers of Anatolia built leprosaria in many cities. According to historical evidence leprosy patients who lived in these institutions received enormous aid from local people. Historical sources tell us that during the last decades of the Ottoman Empire there were 600,000 or more leprosy patients in the whole country. 

Within the first years of the Turkish Republic, in the middle of the 1920s, the patients in leprosaria of Istanbul were taken to a special leprosy hospital in Istanbul’s neighbourhood of Bakirköy. In 1923 systematic attempts to screen and record cases of leprosy were introduced. In 1941 a new leprosy hospital was built for Eastern Anatolia, in the city of Elazig. During the period of the 1930s-1960s practices to strengthen the central structure of public health institutions and to develop health policies with social content were developed.

Anti- leprosy programmes in Turkey:  

A systematic fight against leprosy began in the early 1960s. The Ministry of Health and Social Assistance established a study group with the help of the World Health Organization (WHO). This group discovered many new patients, especially in Eastern and South Eastern Anatolia. After 1965 the figures began to decrease towards today’s level of six new cases a year and geographic distribution.

The prevalence of leprosy is usually higher in the Eastern Anatolian provinces than in the Western regions. The distribution of leprosy in the country has some peculiarities. Within these provinces a few regions or groups were focal points of the disease whereas some neighbouring areas showed very low rates.  In general, most of the leprosy patients in Turkey lived in rural areas and those living in the suburbs of the big cities of the Western parts of the country had come there by immigration.

During the last decades the number of leprosy patients in Turkey has been declining. The statistics say that in 1987 there were 3,851 leprosy patients, in 1991 there were 3,319 registered cases. (Leprosy Review, 1997, 44.). The Ministry of Health of Turkey reported in yearly Turkey Health Report 2,514 registered cases in 2000 and 2,475 registered cases in 2002.  Along the sources of the WHO Goodwill Ambassador for leprosy, there were only six new cases in 2006. As a consequence of this long term positive development of the epidemiological situation of leprosy in the country, the health programmes operating in the field of leprosy are increasingly dedicating more attention to the social, economic and psychological conditions of the disease.

However, the development of disabilities remains to be a problem. The recent statistics show that the physical deformity ratio is approximately 25% in other countries, whereas it is more than half in Turkey. Also the physical disability rate is high (75%). (Turkish Journal of Psychiatry: 2004:236). Disabilities of leprosy affected patients often lead to their stigmatization and social discrimination and have strong social and economic consequences. 

Social aspects:

According to some sources social stigma related to leprosy continues to be a serious problem in Turkey.   In 2004 took place a research project on social and psychological conditions of people affected by leprosy. This project reveals that despite the decline of number of leprosy patients in the country, the social stigma connected to leprosy still persists. Even nowadays people affected by leprosy have to often leave their village or are socially isolated. The prevalence of mental disorders among leprosy patients is higher than that among the general population and depression is the most common psychiatric condition among leprosy patients. (Turkish journal of psychiatry, 2004). Another important finding is that the long duration of the illness and physical handicaps raise the risk of psychiatric disorders.

Leprosy is more common among people with low socio-economic status in Turkish society. The incidence of deformities of the patients is high and result in high unemployment rate of people affected by leprosy which further deteriorates their socio-economic status and excludes them from education, regular employment and a source of income.

In response to this situation Prof. Turkan Saylan (1935 – 2009), medical doctor, feminist and stakeholder in the field of leprosy in Turkey established many projects helping leprosy affected people to overcome their social and psychological burden and establish their full valued life.

One of the projects Saylan was involved in was the 'Society for the Struggle Against Leprosy’, based in the Istanbul Leprosy Hospital at Bakirköy. The society developed a programme enabling patients to continue sending their children to school, whilst at the same time asking the mothers to seek advice and guidance on family planning. Under this programme, during the years 1995 to 1998, a total of 545 children have been supported at an overall cost of US$107,378. The scholarship project has so far been remarkably successful in Turkey and it is hoped that it may provide a model for similar approaches in other countries. An unexpected and extremely encouraging finding has been that females now exceed males in this project and are increasing at all levels, including university entrance. (Leprosy review, 2000.)

Prof. Saylan focused on the problems of women’s life in Turkey. In addition to common problems of women, female leprosy patients have to deal with issues related to physical and social consequences of their health condition. As most of the leprosy patients come from rural areas with strong traditional believes and conservative social practices, women affected by leprosy suffer more than others by prejudices and conservative thoughts.

According to a survey done in the 1990s, women disabled as consequence of leprosy were often rejected by their husbands and had to tolerate a second wife or were forced to divorce. They were often dismissed from houses they were renting or isolated by their neighbours. For their children it is hard to attend school and participate in the social life of a village community.

In response to this situation of women living in conservative milieus of rural society Prof. Saylan established the Association to Support Contemporary Life which focused primarily on the education of young girls. The programme was aiming at providing access to education for young girls, establishing their economic independence and helping them to deal with the burden of their illness.

Bibliography:

Indian Journal of Leprosy, 1993, 65:1, 59-79.

Leprosy review, 2000, 71, Vol. 2,  212-216.

Leprosy Review, 1997, 68, Vol.1, Mar, 43-49.

Leprosy Review, 1986, 57, Vol.3, Sep, 243-249.

Leprosy Review 1988, 59, Vol 3, Sep, 231-234.

Turkish Journal of Psychiatry, 2004; 15, Vol 3:236-43.

Turkey Health Report, Ankara, February 2004, source www.saglik.gov.tr, accessed 27.7.2009

WHO Goodwill Ambassador for leprosy bulletin. 2007, December, 29.

Leprosy hospitals in Turkey:

Istanbul Leprosy Hospital (Bakirköy Hospital)

Elazig Leprosy Hospital

Established in 1940, Elazig Leprosy Hospital is the oldest of three leprosy hospitals in Turkey. Dr Turkan Saylan provided following notes on the hospital in July, 1996. "It has 110 beds and 35 residents in July, 1996. These 35 patients (11 females and 24 males) are single elderly individuals. The number of patients in this hospital increases during the winter. There are 20 families permanently living in the vicinity of the hospital. In all but one case, both the husband and wife have leprosy. In Elazig, there are two ex-patients supported from Istanbul. One is a wound dresser, the other repairs shoes."

Ankara Lepra Merkezi (Ankara Medical Facilities Leprosy Unit), (1965), has 30 beds, but is usually half empty. There were 8 permanent residents (7 male, 1 female) as of July 1996. The number doubles in winter. This unit is also used for teaching purposes. (Information provided by Dr Turkan Saylan and Dr Ayse Yuksel in July 1996).