If you live in the United States (and haven’t traveled to any developing country), I bet you’ve never seen leprosy before. And, that’s fair; only about 150 cases are diagnosed in the US annually.
Leprosy is an age-old disease. If you’re familiar with the Bible or any literature from ancient civilizations, that’s probably the only time you’ve really heard of leprosy. And, in these texts, leprosy is described as a stigmatizing disease, one where the families and communities of those afflicted often ostracize and exile them. And, in the Bible, leprosy is often interpreted as a metaphor for sin itself.
But, what is it really? Is leprosy just an ancient disease?
Although it may be rare in the US and Europe, there are still an estimated 5.5 million leprosy patients around the world (Nordeen et. al). Leprosy is a chronic infectious disease caused by Mycobacterium leprae. There are different forms of leprosy determined by the number and type of skin sores one has. Tuberculoid leprosy is a more mild form of the disease characterized by patches of flat, pale-colored skin that feels numb to the patient because of the nerve damage underneath the skin. Lepromatous leprosy is more severe and contagious than the tuberculoid form; it causes widespread bumps and rashes on the skin, numbness, and muscle weakness. In addition, it can cause the nose, kidneys, and reproductive organs to become damaged.
In the United States, the skin conditions associated with mild leprosy may resemble psoriasis, vitiligo, or even common dermatitis. But, not many physicians check for loss of sensation–the main defining characteristic of leprosy. So, for those who do have leprosy, it can take years to get an accurate diagnosis because it’s such a rare thing to see here in the US.
In developing countries, leprosy is often spread as a direct result of socioeconomic factors, particularly poverty. According to one study in India with 200 leprosy patients, 46% were illiterate, 78% were manual workers, and 68.5% belonged to low social classes (Mahjabeen et. al). For those in such conditions, they may live in large households where the disease is likely to spread fast, as well as work in crowded conditions with manual workers from similar social classes where the disease will continue to flourish.
Stigma is heavily associated with leprosy, whether it be how society views someone with the disease or how they view themselves. This stigma can lead to avoiding the opportunity to get the diagnosis confirmed, encouraging patients to conceal their condition which can worsen the outcomes of the disease. In many situations, a diagnosis of leprosy will lead a family to exile the patient because of its historical reputation of being associated with a curse or the result of sin, as well as the physical deformities that result from the disease. Because of this, it’s often hard for public health officials to implement programs as efficiently as they’d like.
To even begin combating leprosy in the developing world, it’s important that we combat stigma first. The World Health Organization suggests addressing discriminatory laws, providing centers for social support and rehabilitation for patients with leprosy, and closely monitoring leprosy-related stigma in communities and intervening when needed. Leprosy is not an ancient disease; it’s a chronic condition that affects millions of people worldwide daily. As far as understanding how social factors influence the spread and treatment of disease, leprosy is a great example of these interrelations due to how it affects communities in poverty, as well as the how communities around the world perceive individuals with the disease.