JAKARTA, KOMPAS — Indonesia is ranked third globally in the number of leprosy cases. Although it is difficult to catch, the ancient disease remains highly prevalent in the country, indicating minimal access to health care in several regions and the persistent stigma against people with the disease.
A 2017 World Health Organization (WHO) data reported that Indonesia had 17,441 case of leprosy, the third highest in the world after India and Brazil. The disease has not been eradicated in nine of Indonesia’s 34 provinces, including Papua, West Papua, North Sulawesi, South Sulawesi and North Maluku. The prevalence of leprosy in these provinces is less than one in 10,000 people.
The lack of awareness about hygiene and people with untreated leprosy mingling in the general population are the reasons behind the high prevalence of leprosy, or Hansen’s disease, especially in isolated villages in Papua. A survey on 12-17 Aug. by the Papua health research and development body, led by researcher Hana Krisnawati, discovered two villages in Asmat that have a leprosy prevalence rate of above 50 percent.
These remote villages receive limited health services due to their difficult access, resulting in the persistence of the leprosy transmission cycle.
Somnak hamlet head Tadius Juto, 60, said that people infected with leprosy mingled with healthy people. As not all infected people were treated, the disease spread, especially to children.
The Agats diocese in Papua has posted nurses in several hamlets to provide leprosy treatment. Pastor P. Hendrikus Haga, who chairs the Alfons Suwada Asmat Foundation, said that the diocese became involved with the discovery of the first case of leprosy in 2009 in Mumugu hamlet, Sawaerma district, Asmat.
“In January 2015, the government launched intensive treatment following a visit by Health Minister Nafsiah Mboi,” he said in Asmat on Sunday (8/9/2019).
Many of the cases present skin lesions, rigidity in the hands and some physical deformities. Most do not know that they have leprosy because they feel no pain. “Persuading them to take medicines is a difficult struggle,” said Hendrikus.
Lack of knowledge about leprosy also persists in several regions. Abdus Syukur of Sampang regency, for instance, believed that he had merely contracted an ordinary skin disease in 2014, when he found a white spot on his heel. The white spot then spread to other parts of his body.
After he was diagnosed with leprosy, he received one year of multidrug treatment. His knees and soles are currently swollen.
Not easy to catch
Leprosy is caused by the Mycobacterium leprae microbe, which attacks the nerves and skin, and other cells. The chronic infectious disease spreads through persistent and repeated direct contact with infected persons who present skin lesions and through nasal secretions.
Prima Kartika Esti, who chairs the Sitanala Hospital medical committee in Tangerang, said that leprosy had an incubation period of two to five years. Symptoms, including white spots on the skin and a persistent tingling sensation, may appear after five years. Left untreated, the disease could cause permanent damage to the skin, nerves, limbs or eyes.
Health Ministry disease prevention and control director general Anung Sugihantono said that the challenge in disrupting the cycle of leprosy transmission in Indonesia was early detection and treatment. Other than educating the public, workers at puskesmas (community health center) were encouraged to diagnose the disease quickly.
Although the disease was not easy to catch, repeated physical contact between sufferers and healthy individuals was the reason behind the disease’s prevalence. Many people with the disease were also undisciplined in taking medicine, even though the government provided free medicines for treating leprosy.
Cipto Mangunkusumo Hospital-University of Indonesia medical school research assistant Anis Fitriana said the social stigma against leprosy made some people with the disease reluctant to undergo medical checks. (NIK/FRD/AIK)