South Africa’s leprosy hospital, which dates from the Victorian era, will close next month, writes Dawn Blalock
MONICA MAZIBUKO, a beautiful young woman with a shy smile, sits knitting in a patch of sunshine next to her hospital bed. Though she doesn’t appear sick, decades ago she would have been a virtual prisoner in this hospital and denied any contact with the outside world. Her letters would have been passed through an autoclave. At her death, she would have been buried in a lead coffin.
Mazibuko is a leper.
The mention of leprosy evokes biblical images of disfigurement and exclusion, not the afflictions of a woman like Mazibuko, a 29-year-old waitress from Mpumalanga.
The first bacterium ever identified is by no means dead. There are an estimated two million lepers in the world. According to the World Health Organisation (WHO), leprosy is “an insidious, slowly developing disease”, which still flourishes in the globe’s poverty belt.
Leprosy lore is rife with myths. To answer a few: leprosy is not a skin disease, it’s not very contagious, it will not make limbs fall off and, most importantly, it’s curable.
In basic lay terms, leprosy is a bacillus, which is keen on the human nervous system. It spreads like a cold, but a cold that takes three to five years for the symptoms to show up. As it attacks the nerves, the sufferer gradually loses sensation. At first one would just feel a few numb patches on the arms or the face. Treated then, with a multiple-drug therapy cocktail, it’s easily and cheaply curable in about six months.
Left alone, however, the patient’s immune system responds to the bug and causes irreparable nerve damage. The first symptoms are skin lesions and numb patches. As sufferers completely lose sensation, their faces become flaccid, eyes don’t blink and they can eventually go blind. Hands and feet curl into gnarled claws and become senseless. Since they feel no pain, they unknowingly and constantly injure themselves. Their bones fracture microscopically, and fragment over many years. Bit by bit, battered and broken fingers and toes are “re-absorbed” into the body, giving the impression that they have fallen off.
Lepers, using railway vouchers issued to them by health services, make the trek from all over the country to the West Fort Hospital leprosy clinic outside Pretoria where Mazibuko is a patient. Dr Mari Beyers, the clinic’s only doctor, lives on the grounds of the Victorian-era hospital where she has worked for seven years.
She points out a wheelchair-bound old man, his nose and facial features sunken into his face, and much of his legs missing. She takes a stump that used to be his hand and runs her fingers along it.
“See that there,” she says, pointing out a small protrusion where one would expect to see a pinkie finger. “That’s actually his fingernail. His body has re-absorbed his fingers.”
The leprosy clinic will close next month as part of the government’s plan to decentralise the health-care system. The 125-year-old hospital is outdated, both physically and in its way of treating people, the Health Department says.
The “ostrich” mentality of a bygone era when lepers were locked away from the rest of society is no longer tenable, says Dr Adriaan Myburgh, a representative of the Gauteng Department of Health.
“You take all the lepers out of the community and hide them behind big walls and say we don’t have a problem with leprosy.”
Not everyone exposed to the disease will become lepers: it is impossible to contract leprosy without a genetically determined immune deficiency. “Most people are completely unaware of the fact that it’s not very contagious,” says Myburgh. Many nurses being trained to treat the disease in community clinics said their knowledge of it came from what they had read in the Bible.
Leprosy cases have been declining in South Africa, but officials expect a slight increase as immigrants from neighbouring countries plagued by war and instability such as Zaire and Mozambique bring it with them across the borders. These countries are among the 10 that have the most cases of leprosy internationally.
Though it’s now scientifically possible, complete eradication of one of the world’s most ancient diseases is not likely any time soon. According to a WHO report on leprosy, the disease is not a priority. Aids, other more deadly tropical diseases, poor health infrastructure, wars and social instability “make leprosy elimination seem like a luxury, an impracticable one at that”.
ENDS