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Leprosy a future threat

By Aaron Smith

RESEARCHERS are concerned that failings in the PNG medical system could result in an “untreatable strain of leprosy” developing in Daru, which has become a hotspot for the disease.

While the risk of imminent infection in the Torres Strait is minimal, the prospect of super strain of leprosy developing could have huge impacts for the region down the track.

There has only been 20 cases of the disease in Australia in the last 20 years, including nine Torres Strait Islanders, the last confirmed case being a 28-year-old Torres Strait Islander woman diagnosed in 2009.

However leprosy remains a significant problem in PNG.

In 2015, 388 new cases were notified, and the annual number has changed little over the past decade, despite the hundreds of millions of dollars the Australian government spends to tackle the disease.

Dr Allison Hempenstall from Queensland Health, who diagnosed a PNG patient with the disease last week on Saibai, recently published a paper about the problem.

She told Torres News this week there is a lack of adequate funding to clearly identify the prospect of a new multi-drug resistant strain of the disease developing on Daru.

“We don't know really how much is out there,” Dr Hempenstall said.

“People think of leprosy as a disease of olden days so we don't need to focus our attention on it, yet cases in PNG have not reduced despite the funding the Australian government continues to provide PNG and it's really hard for us to speculate how much of the disease there is multi-drug resistant.”

“The treatment takes several months and involves a combination of medicines, a little bit like TB treatment, so that makes it really difficult, especially if the packs distributed through Daru by the WHO (World Health Organisation) only supply a week of a month at a time.

“This means PNG nationals have to come back quite often to Daru to pick up the next supply of their medication - which logistically can be quite difficult,” Dr Hempenstall said.

This is potentially creating the perfect conditions of creating a new super strain of leprosy.

“This problem goes beyond the remit of what Torres and Cape health can do,” Dr Hempenstall said.

“On the ground PNG nationals need education about this disease and other infectious diseases, the need readily accessible medication and educated to complete their course of multi-drug regime and then further support from the PNG government to these health services so we can try and prevent something such as an untreatable strain of leprosy.”

Natalie Smith, the country leader of the NGO, the Leprosy Mission PNG told Torres News: “It's not yet proven there is drug resistance to the disease, yet, but it is a very likely threat because of the MDR TB (multidrug-resistant TB) prevalent in Daru and leprosy is quite high there.”

“It's because TB and leprosy are both bacteria and both are treated with one of the same antibiotics – so if it's going to happen, it's going to happen in Daru.

“We are looking at getting some researchers to start testing if this actually happening or not – but funding for this is tight.

“What is happening in Daru is people are catching leprosy and their immune system is compromised and, because TB is so prevalent in the community, they are catching TB too”

“So it means if their leprosy comes back, or someone else in their house whose being treated for MDRTB, it could mean the disease has developed some resistance.

“So there is a chance the medication won't work a second time around.

“But it's hard to know if people with MDR TB have caught leprosy as they will either be cured of TB, and possibly any leprosy in their system or die of TB before leprosy has had a chance to take hold.

“It's generally happening the other way where people get leprosy first, then they get TB,” Ms Smith said.

Member for Leichhardt Warren Entsch, who is also on the board of the Global Tuberculous Caucus and has been to Daru several times, told Torres News: “The whole (PNG Health) system is broke.”

“I am aware of the leprosy problem.

“It is up in our area and even though we are putting money in, the Western Province is still one of the most under-resourced areas and providing treatment there is very, very difficult and is still not consistent.

“That's why through the RRRC we've established a ranger program to build platforms for delivery of services in all 13 of the Treaty villages, which is fantastic.

“But there is still a long way to go – they have built a clinic on Mabaduan but it needs beds and medical staff.

“While there have been improvements on Daru overall, they have been pretty mediocre – there's still a long way to go – but its unfortunately dependent on PNG's broken health system, and the further away you get from Port Moresby the more broken it becomes.

“I don't think we need to become alarmist in terms of leprosy, but it does flow over into our backyard,” Mr Entsch said.

Dr Hempenstall said: “This is a concern for PNG, but less of a concern for Australia.”

“Other news outlets came out last week with sensationalised headings saying Australia fears a leprosy outbreak, it's far from it.

“The purpose of the paper I wrote wasn't for news but rather for the medical profession to realise that this disease isn't gone, and many doctors don't know about it or how to recognise it – so we need to remain vigilant and that we do have cases coming across the border,” Dr Hempenstall said.

Ms Smith said: “Leprosy is a slow moving disease, it has a long incubation period, similar to TB but not as infectious and 95 per cent of people are naturally immune to it.

“To catch leprosy you have to be in the same household for a long period of time and be breathing in whatever they are coughing out, and that carrier has to be untreated to still be infectious.

“The main thing is to protect your immune system and stay healthy.

“I have worked in leprosy-affected communities for over 20 years and never caught caught the disease, it may be because I am in the 95 per cent that can't catch it, or it's because I don't live in the same household as the infectious person and also I keep myself healthy.

“The other thing is once an infected person starts on the antibiotics, they are no longer infectious within 48 hours.”

Poverty creates an environment more prone to catching leprosy.

“If you are living in overcrowded living conditions, have poor sanitation, you don't eat well, this is all going to contribute to someone getting leprosy,” Ms Smith said.

“Anybody living in these conditions would be at risk if there was an infected person living in their household.

“If you catch leprosy today, you probably won't even know you've got it for three to five years to get enough bacteria in your system to show as coloured skin patches.

“The good thing about leprosy is because it takes so long to develop and if you get to it early when the first systems appear you can get treatment straight way and cured.”

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