Under a flyover in Mumbai, India. An overcrowded home to a community of leprosy-affected people with nowhere else to go. Sanitation is poor, social distancing impossible. The environment is a perfect for Covid-19 transmission.
Health workers and human rights defenders are working tirelessly to protect the poorest communities of Africa and South Asia from a ‘Covid-19 human timebomb’.
Until now the worst of the outbreak has hit relatively developed countries, putting health systems like the NHS under great strain.
There are now cases recorded in all 10 of the countries where The Leprosy Mission England and Wales works across South Asia and Africa.
These countries are among the world’s poorest nations where many have no access to health care at all. Mozambique is one of these nations. It has 30 ventilators across the country for a population of almost 30 million, signalling that millions may needlessly die when the virus undoubtedly gains momentum.
Recognising this, governments of many of these countries have been swift to impose a lockdown. They know all too well the power of a highly-infectious virus; West Africa still bearing the scars of the Ebola outbreak of 2014.
These are countries where levels of literacy are low and digital communication, particularly in rural areas, is limited. Concepts such as social distancing are not only culturally alien but totally unattainable, for example in overcrowded slum communities. People are either unaware or very afraid.
While Covid-19 is a highly-contagious virus, leprosy is a mildly-infectious bacterial disease. Yet both are surrounded by superstition, ignorance and misunderstanding leading to the people affected facing stigma as well as isolation. And it is people affected by leprosy who are going to be among those most at risk as Covid-19 sweeps through their country.
Head of Programmes at The Leprosy Mission, Sian Arulananthan, said: “We must act now, at a time when the coronavirus is on the brink of ripping through the majority world, overwhelming fragile health systems.
“Devastatingly this is a human timebomb waiting to explode.
“As ever it is people living in leprosy-affected communities that will be hit the hardest. Well-off travellers have returned to developing nations bringing with them the Covid-19 virus. Yet these travellers are able to self-isolate, stockpile food and stay at home.
“Communities affected by leprosy are among the most vulnerable. Individuals are more likely to be disabled, have weakened immune systems and underlying health conditions.
“And like leprosy, malnutrition, overcrowded living conditions and poor sanitation make an ideal breeding ground for the spread of coronavirus.”
The Leprosy Mission is working with colleagues and partners across Asia and Africa to ensure the hundreds of thousands of people it serves receive clear messaging on Covid-19.
“These are communities who know only too well the suffering caused by fear and age-old myths, such as leprosy being a curse for sins committed in a previous life,” explained Sian.
“The truth is the greatest slayer of fear so it is vital that our communities, which all too often lie on the fringes of society, are reached.
“They must receive clear messaging on the symptoms of Covid-19 the importance of self-isolation, social distancing and the necessity for frequent handwashing.
“Social distancing and isolation is an almost impossible task in densely populated areas. So it is essential that governments engage in testing and active contact tracing of known cases in order to prevent the spread of the virus, something we are happy to support. Likewise, movement between communities must stop in order to contain the virus.”
In countries where lockdown has already been imposed The Leprosy Mission’s staff and partners are phoning individuals with key health information and setting up WhatsApp groups to share key messages.
Where lockdown has not happened yet, such as in Mozambique, staff and partners are working with community health workers and volunteers to relay health messaging to villagers.
Sian applauded the efforts of some countries, including the Indian government which announced food parcels to be made available to those affected by the Covid-19 lockdown.
“People in the majority world face very different challenges to the Covid-19 pandemic from us in the UK,” she explained.
” For those living hand to mouth, it is difficult to blame a day labourer for being tempted to work with a sore throat. If they stay at home, it is very likely their family will not eat that day.
“This is why The Leprosy Mission is advocating that these communities receive the state aid they are entitled to wherever possible, including food parcels. Where this is not available, we are praying for resources to be available so that we can help those most in need.
“We heard of a young woman who cannot work because of lockdown and she and her family had no food for days. Her three children were crying with hunger. Thankfully we were able to help. We can’t stand by and watch, we need to act.
“All too often people with visible scars of leprosy are refused medical treatment which is entirely illegal but tragically it happens. So, we are working hard to ensure anyone needing medical attention for symptoms of Covid-19 receives it.
“There are so many issues our teams are addressing currently. This includes finding solutions to practical problems like how to stop people congregating at water pumps. It is very hard to self-isolate and undertake frequent handwashing when you do not have running water to your home.”
The Leprosy Mission’s hospitals and the hospitals it supports across Asia and Africa all have isolation beds. Heat testing for fever and handwashing is taking place outside Outpatients’ departments. Necessary steps are being taken to ensure that Multidrug therapy, the treatment for leprosy, remains available so that people can receive the cure or have enough medication to last them for at least a few months.
The Leprosy Mission’s Anandaban Hospital in Nepal was designated a Disaster Response Centre by the Government of Nepal in the wake of the 2015 earthquakes which killed 9,000 people. Staff from Anandaban Hospital reached out to 18,000 people with emergency medical care, shelter and food parcels.
Work is being undertaken here to convert a building into an isolation ward for Covid-19 patients following a request from the Nepali government.
Sian said The Leprosy Mission is keen to work with the Department for International Development to ensure any UK Aid dedicated to curtailing the spread of Covid-19 reaches the communities most in need.
Last week Erik Berglof, director of the Institute of Global Affairs at the London School of Economics, warned against ‘sprinkling money from helicopters’ in developing economies as it would never reach the intended receivers.
He advised that carefully managed programmes and projects were required to prevent millions of deaths across the developing world and economic devastation from the coronavirus pandemic.
Working with health-focused charities already present in marginalise communities, in close partnership with national governments in the global south, can help limit the devastating effects of this potential human timebomb.