Leprosy used to be associated with mutilation, isolation and suffering. Even today, the disease is still sometimes considered as God’s punishment in some developing countries, and people who have it are considered "unclean". But now the disease is curable and drugs are available free of charge. However, in many developing countries, the disease is often not even diagnosed because there are not enough treatment centres. One German doctor has worked wonders in Pakistan.
Dr Ruth Pfau in Karachi standing next to a beggar who suffers from leprosy
Ruth Pfau came to Pakistan in 1960 to work as a leprosy doctor and set up the Marie Adelheit Leprosy Centre in Karachi. She has since helped the government set up a series of leprosy clinics all over the country -- 156 in total.
One of her patients, Mohammad Anwar, discovered he had leprosy when he chopped off his hand while cutting wood and didn’t feel any pain.
"I’ve been Dr Pfau’s patient for 30 years," he said. "She’s always very kind to me and she’s been working hard to cure me. She really helps us and treats everyone as equal."
Dr Pfau recalls that at the beginning, she "couldn’t sleep at night" because of the misery she saw. But she soon realised that "something had to be done as quickly as possible. And that’s how we began to treat patients, without any planning, using things we had."
40 years ago in Pakistan, people with leprosy were strictly isolated. Often they were even driven into the desert in Sindh province and left to die.
Even twenty years ago, leprosy was widely considered to be a death sentence, recalls Chris Schmotzer, another German leprosy doctor who works at the Leprosy Centre in Rawalpindi.
"When I came to Pakistan, if a leper needed an appendix operation he was operated on -- which was a huge progress at the time -- but the nurses would draw a skull and crossbones above his bed in order to scare the other patients off."
At the time, leprosy could not be prevented but multi-drug therapies have since been developed and offer effective treatment for the bacterial infection.
Approximately 500 people contract leprosy every year in Pakistan, which has a population of 150 million. 20 years ago, the disease killed thousands every year.
Leprosy is now curable but the treatment is rather protracted -- it normally takes between six and twelve months to recover fully from the disease.
Work not over yet
The leprosy centres have contributed greatly to reducing the numbers of those infected in Pakistan but Pfau and Schmotzer think they will still be around for a few decades more to prevent the disease from spreading.
It is widely agreed that the disease is transmitted from person to person by droplets from coughing or sneezing. Its incubation period can last up to 30 years.
Another patient from the Marie-Adelheit Leprosy Centre, Zamir Khan, complained that not many doctors in Pakistan know about leprosy. He said his health only started improving when he came to Dr Pfau’s leprosy centre.
"When my leprosy started, I was living in a small town in the north-west of Karachi," he explained. "Nobody there knew anything about the disease. They sent me to Peshawar where I was treated in a leprosy centre for three months. Then they sent me here to Karachi and my treatment has so far been successful. Before I felt really bad but today, I am feeling OK."
Need of training
Chris Schmotzer says the Pakistani government should do more to train doctors in rural areas in treating leprosy.
Dr Pfau has been organising further education programmes on leprosy treatment and skin disease for doctors since 1989.
Dr Schmotzer also hopes the government will do more to get rid of the stigma, which is still "rooted in people’s minds" -- he thinks people should be educated to think of leprosy simply as a skin disease and not a punishment from God.
There is some hope, Ruth Pfau says brightly, recalling an incident that happened a few years ago in Sindh: "A 13-year-old girl called Adina was walled up in a cave by the villagers just because she had leprosy. She couldn’t get out -- they brought her only bread and water. We got her out of there when we found out. Today, Adina is married with four children."
January 28 is World Leprosy Day.