"The field is where my heart is", Dr Pieter Feenstra told me. Health workers' dedication and passion for taking care of people affected by diseases, frequently in dire conditions, have been constant motivating factors throughout his career. Every situation he has encountered he has tried to consider from the point of view of a district medical officer. To have been able to interface between peripheral health workers, patients and health services has been the most enjoyable and rewarding part of his work.

As a child he had dreamt of being a surgeon. His first position overseas was as a hospital doctor in Tanzania, which coincided with the measles' epidemic of the nineteen-seventies. During that time he realised that it would be more effective to introduce a vaccination programme rather than performing surgery on individual patients. It was a pivotal thought. It inspired him to specialise in control of disease and become an expert in health services' management. He spent the last eighteen months of his time in Tanzania with an additional responsibility - that for the tuberculosis control programmes in the Kwimba and Magu Districts.

 

How did you become involved with leprosy?

Then leprosy patients were being diagnosed and given Dapsone by a strictly separate vertical programme under trees some fifty to sixty metres' distance from health clinics. I was acutely aware of the stigmatising affect of treating persons with leprosy separately. Responsibility for them was not always taken. I felt strongly that there should be provision for their care through the main health care system. So when the Netherlands Leprosy Relief offered me a position as the Leader of an assistance project to the National Leprosy Control Programme in the provinces of North and Central Sulawesi, Indonesia, in 1979, I accepted. I have been working in leprosy ever since!

You were selected to be the Chair of the ILEP Technical Commission (ITC) when it assumed a new form and name in 2004. What has been the key achievement of the ITC during your chairmanship?

It was good to have had the opportunity to focus on the medical aspects of leprosy. The ITC has achieved all that it intended to do. If I were to single out one development worthy of special mention, it would have to be the restoration of a good working relationship with the World Health Organization's (WHO's) Global Leprosy Programme. The members of the Commission were instrumental in shaping the current Global Leprosy Strategy, spanning the period up to 2010, with other partners. In addition they have played a vital role in drafting the accompanying Operational Guidelines. Stimulating leprosy health workers, who are working with such dedication and passion and, very often, in extremely difficult conditions, has always been a vitally important aspect of my work. So personally I am thrilled that we are supporting them in their work through this set of Guidelines. During field visits I have been shown examples of manuals that are being developed based on the guidance in the Operational Guidelines.

The move from a vertical to an integrated approach to leprosy control has largely been achieved. What is the future for NGOs whose focus is on leprosy and particularly those which are engaged exclusively in anti-leprosy activities? What is the case for a more holistic approach?

I firmly believe that leprosy should be an integral part of the general health services. The current Global Leprosy Strategy is being implemented around the world, the speed of its adoption depending on local circumstances. There is still scope to improve quality within health services, but this does not prevent us from looking beyond these matters and considering the future. There is a need to look to society as a whole and embrace a more holistic approach. Across the world we are already witnessing a shift in which civil society is actively campaigning and advocating for health. Indeed, some ILEP Members have been proactive in addressing areas of leprosy work, that are linked to other issues such as general disability and rehabilitation, issues related to poverty and pursuit of the Millennium Development Goals.

What are your thoughts on the direction of the next ITC? What should it aim to achieve?

16 good candidates were nominated for appointment to the next ITC, whose areas of expertise correspond more or less to the current trends and concerns. This is positive, because the moment is propitious for a new generation of people, who are committed to this new way of thinking. A way of thinking which focuses on development, society and individuals. My successor in KIT, Dr Wim van Brakel, to cite one example, has been moving into very important territory with his studies of stigma and his work in the field of disability and rehabilitation. He is proving to be a catalyst for change. I strongly support him in his work.

It would be beneficial if the programme of work the new Commission set, in consultation with ILEP Members, draws on their specialist knowledge and reflects a broader, more holistic approach to leprosy control.  

How easy will it be to embrace a more holistic approach?

It will be a huge challenge! As it involves extending far beyond the leprosy purview, I imagine that it will be difficult to be influential. Stimulating debate and being politically active may be required. It is always best to start small and extend scope of new activities over time. Everything will need to be done with sensitivity to environments and cultures. There should be wariness of not committing a Bush in Iraq! There will be no blueprint.

In your opinion are there any technical "unknowns" about leprosy?

There are still many "unknowns". We have a lot to discover, for example, about the dynamics of nerve damage. Much research is currently ongoing into prevention of disability, nerve function impairment, treatment of nerve function loss and treatment. We do not yet fully understand the epidemiology of leprosy. However, being aware of our partial knowledge does not hinder us in the meantime from doing the control work we are doing. We have the clinical criteria to diagnose and effective medicines to treat patients. Incidentally, the skin smear devised by Armauer Hansen in 1897 is, together with clinical examination, still our best diagnostic tool!

You'll soon be retiring - tell us about your plans.

I have known many changes in my life. On the whole, though, I have mainly worked in leprosy and mostly in the field. I have viewed every change positively. I see retirement simply as the next episode in the chain of my life. I am really looking forward to it, particularly as it will mean that my wife and I will be together full-time! We have a camper van parked outside our home. It is ready and waiting to hit the road! We hope to travel in it extensively... I would like to study philosophy... Reading, too! On my shelves are so many books I couldn't resist buying - as yet unread... Whilst travelling for work I have always carried a book of poetry or short stories with me - usually by Dutch poets or authors - so the prospect of the time in my life when all of these pleasures are fast approaching, and the possibility to read at leisure, is alluring to say the least!  

Contact: p.feenstra@kit.nl   

 

 

• Dr Pieter Feenstra will be retiring at the end of 2007 after twenty-five years' service for the Royal Tropical Institute in Amsterdam. He is an international expert in leprosy and regularly offers advice on the planning, monitoring and evaluation of health services, particularly leprosy and tuberculosis control programmes. He co-ordinates KIT's medical advice to Netherlands Leprosy Relief.

• This autumn Dr Feenstra will be handing over chairmanship of the ILEP Technical Commission. He will attend the Meeting of the WHO Technical Advisory Group in Myanmar in early November together with Mr Douglas Soutar, the General Secretary of ILEP, and if possible the new Chair of the Commission, who will be appointed by the members of the ILEP Board when they meet on 21st September from the eight persons they select to be on the ITC for the 2008-2011 term.

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