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Northern Territory Department of Health Library Services Historical Collection
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Current Notes on Leprosy Control in the
NORTHERN TERRITORY
DL HIST 614.546 HAR 1980
August
1980
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CURRENT NOTES ON LEPROSY CONTROL IN THE NORTHERN TERRITORY
WHAT IS LEPROSY?
Leprosy is an ancient disease caused by a bacillus which is very similar to the tuberculosis bacillus. The main difference is that the leprosy bacillus attacks the skin and the nerves of the limbs and face. Because the nerves are sometimes destroyed, patients lose sensation in their hands and feet and can therefore unwittingly burn or injure themselves.
Destruction of the nerves also causes paralysis of muscles in the hands and feet, and, if good care and treatment are not available, this leads to the deformity classically associated with leprosy. It may be several years after the infection is contracted that signs and symptoms of the disease appear.
THE HISTORY OF LEPROSY IN AUSTRALIA
Leprosy is common throughout the tropical world, the largest number of cases being found on the African Continent and on the Indian sub-continent.
However, there are also large numbers of cases in South America and in South-East Asia. Australia has comparatively few, most of whom live within the tropical region of the continent. As far as we know, Australia was free from leprosy until the middle of the last century. It first appeared in the Northern Territory in the 1880's around Darwin, Pine Creek and the Alligator Rivers district. It affected Aboriginal tribes in the region and then spread slowly to neighbouring tribes without check until 1947 when new and effective medication was discovered. The new medicines - sulphones - were first used in trials in the United States of America in 1942/43. They
revolutionised the whole approach to the disease.
A CHANGE IN ATTITUDES
Before the sulphones were discovered it was impossible to cure leprosy.
Now, the sulphones can quickly render patients non-infectious so that they can be discharged from hospital to continue treatment at home without danger of infecting relatives and friends. Previously the only conceivable way of controlling leprosy had been by isolating patients in leprosy hospitals.
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TERRITORY HEAL TH SERVICES
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This was totally ineffectual since infection had already spread to others long before the diagnosis was made. In addition, isolation without cure, prior to 1947 was very frightening to all patients and relatives.
Aboriginal patients who rightly doubted its wisdom retreated into the bush to avoid it. In this way, the very means that were used to control the disease enhanced its spread. Therefore, when the sulphones appeared on the scene it was possible to treat patients effectively so that the patients themselves could see the benefits of treatment and so that others around them could also see the benefits.
In this way they could receive treatment in their own tribal territory or at home. It totally altered the approach to leprosy throughout not only the Northern Territory, but Australia and the world as a whole. In other words, leprosy was being cured by the sulphones.
What the sulphones did not do, however, was to cure deformity which already existed. This has been a major problem. When people see deformity caused by inactive leprosy they tend to confuse it with active leprosy. This is a common misconception and causes tremendous hardship to people who have previously had leprosy. These non-infectious patients have been cured but are labelled as leprosy patients with all the stigma previously ascribed to patients of the pre-sulphone era. To overcome some of these problems a new approach to the subject was necessary.
HELP WITH DEFORMITY
One of the most important advances has been the repair of deformity.
Paralysed muscles in the hands and feet can be replaced by grafts that restore function; ulcers that were thought to be incurable can now be healed; people who were previously disfigured can now appear normal.
Patients themselves and near friends and relatives can not fail to see the change. It encourages others to present themselves for medical as well as surgical treatment. The Northern Territory Medical Service can rightly consider itself in the forefront in the repair of leprosy deformity in Australia.
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NEW MEDICINES
There are new and potent drugs which are extremely effective in rapidly rendering leprosy non-infectious, namely - Clofazimine and Rifampicin.
These are used as well as the sulphones. They are used initially together with the sulphones and then the sulphones are continued by themselves on a long-term basis for outpatients. The most commonly used drug used in the Northern Territory is called Hansolar, which is long-acting sulphone injection. It can be given anywhere throughout the Northern Territory. It is easy to administer and is well within the capabilities of the Aboriginal Health Workers, who use it all the time. In this way, patients in quite isolated parts of the country are assured of regular treatment. The most important part of leprosy control lies within the hands of the Aboriginal community and is most effectively dealt with by the Aboriginal Health Workers.
RESEARCH
There is no diagnostic test for leprosy and there is no effective vaccination or immunization. Two research programmes are therefore being carried out. The first is an immunology programme to monitor the spread of leprosy. This is being done in the Northern Territory with the help of the Department of Immunology of the University of Sydney.
Research on peripheral nerves is done at East Arm Hospital. As well, research into the restoration of sensation to insensitive limbs is part of an ongoing programme of the Northern Territory Medical Service.
Another research programme is designed to develop an immunization against leprosy and this is being done by the World Health Organization and by the National Institute for Medical Research, London. The Slade Hospital, at Oxford, provides information on diagnostic problems of the disease.
These three areas of research are applied to the three problems that at present hamper total leprosy control.
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MAIN AREAS WHERE LEPROSY IS FOUND.
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South Australia
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THE CONTROL PROGRAMME
There are two facets to leprosy control. One itself and the other is outpatient control.
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is the leprosy hospital Both these areas are co-ordinated by Dr J. Hargrave, Director of Leprosy.
EAST ARM HOSPITAL is run by the Department of Health under the Medical Superintendent, Dr A. Dyrting. The nursing staff comes from the religious order of the Daughters of Our Lady of the Sacred Heart, under the Matron, Sister Annette Barron. These sisters have looked after leprosy patients now for more than thirty years and exemplify continuous, devoted care of a previously neglected disease. Mr Melville Furness is in charge of physiotherapy and was involved in the pioneering work on tendon transfers in India in the 1950's. There are also on the staff several well-trained Nursing Assistants and Aboriginal Health Workers, the most senior of whom is Mr Ronnie Lindsay . Gama rang, who has had wide experience in training Health Workers from the bush.
The functions of East Arm Hospital are:
1. To provide care for sick and disabled patients.
2. To repair deformity.
3. To cure infection.
4. To conduct research.
5. To train doctors, nurses and health workers.
THE OUTPATIENTS: The central leprosy control programme is run by three widely-experienced nursing sisters in Darwin. Sister Patsy Chalmers oversights the total review and outpatient medication programme. Sister Joan Fong and Sister Eileen Jones run the rural programmes. They work in close co-operation with the staff of the various regions and ensure regular review of patients and check on all people at risk. One of their most important functions is to train Aboriginal Health Workers. We believe that there are rarely new cases that we do not see promptly since we have good relationships with the Aboriginal communities and with the Aboriginal Health Workers, who are the first people to see these cases.
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We also believe that repair of deformity and quick discharge of patients from the leprosy hospital has led to greater co-operation so that patients are seen as early as possible and that few now fear isolation.
THE WORLD PICTURE
According to the World Health Organization (January, 1979), the total number of registered cases in 154 countries is 3,599,949. This does not give an accurate picture of the true situation. No mention is made of which cases are infectious, which are cured and whether there are other, undetected cases. My personal experience throughout the world tells me that there is, at present, no valid comparison between one country and the next. There are, for instance, more than one million registered cases in India, but the World Health Organization believes that the estimated number is over three million. A similar situation exists in most of the African countries. Just how many are either active or infectious cases is unknown.
There are about 800 people alive in the Northern Territory who have had leprosy but are now cured.
LEPROSY INCIDENCE IN NORTI-IERN TERRITORY ABORIGINES.
1951 1979
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There are less than thirty active cases in the Northern Territory in 1980.
Figures for the Northern Territory are as accurate as any, anywhere around the world. To compare the situation in Australia with that in India or Africa, because of the differences, is very difficult. New, active cases, average less that O. 4 per thousand and the number of active cases has dropped from 13 per 1000 in 1951 to 0.8 per 1000 in 1979.
Minor differences in the number of diagnoses from year to year are of no significance since leprosy has a very long incubation period. In addition, much leprosy is self-curing. The Northern Territory picture can rightly be seen as a success story. This does not mean that the Department of Health means to relax its vigilance. On the contrary, we believe that an enlightened control programme with a sincere attempt to work in close and continued co-operation with Health Workers throughout the Northern Territory is a "MUST", both now and for the future.
J.C. HARGRAVE
(Director of Leprosy) for SECRETARY FOR HEALTH August 1980
