COMMENTS
The following observations can be made on the information collected from the various reports and on the findings made at the various places visited.
(1) Fortunately the public health problem created by leprosy in Korea is a limited one. On the results of the Pilot Project carried out in the Wolsung Gun in the Kyongsang Pukdo Province from April 1963 to the end of 1965, Dr. Trappmann found the prevalence rate to be only 2 per thousand. On that basis he estimated the total number of cases of leprosy in the whole country at about 80,000
Moreover, the age-distribution of the detected cases -the prevalence being much higher in older age group -would indicate that the disease is perhaps not on the increase.
(2) The main problem posed by leprosy in Korea today is the socio-economic problem created by a large number of disease-arrested bacteriologically negative cases. About half of these patients are able-bodied without any deformity and capable of doing normal work, while the other half have various degrees of deformity, from slight to marked crippling.
It has to be recognised that this huge socio-economic
problem is the result of accumulation of the bacteriologically negative cases in the leprosaria and colonies over years, because of the policy that was being followed up to 1962. According to that policy, once a patient with leprosy was detected. he or she was compulsorily sent to a leprosy colony or a leprosy village, and was to spend the rest of the life there.
(3) A considerable amount of anti-leprosy work is being done in the country by the Government, Christian Mission Organisations, and the Korean Leprosy Association. However, there is a need for further intensifying certain activities, modiying some others, and introducing some new activities in other directions. The main points on which these changes appear to be necessary are considered below.
(i) ´Release from control´ of the inactive cases. It should be recognised that patients who have remained without signs of clinical activity and bacteriologically negative for the specified period of time, should no longer be included in the list of leprosy patients. They should be released from control.
The criteria for `release from control´ as established by the WHO First Western Pacific Regional Seminar on Leprosy Control (Manila 1965), and accepted by WHO Expert Committee on Leprosy in its Third
Report (Geneva 1966) are quoted below:
A leprosy patient without any sign of clinical activity and with negative bacteriological examinations should be considered as an inactive case.Once inactivity is achieved full treatment should be continued
for varying periods of time before the patient is released from control. These periods should be one and a half years for tuberculoid, three years for indeterminate, and five years for lepromatous and borderline cases.
Those inactive patients who are still in the leprosaria have of course to be included in the list of patients for administrative reasons. But this consideration should not apply to the cases who are outside the leprosaria.
(ii) Mobile teams. The results of the case finding programme of the eight mobile teams visited has been summarised in table. The performance of some other rehabilitation. Whatever measures are taken for the rehabilitation of other displaced persons should apply to such persons also.
There is considerable amount of industrial development and construction work going on in Korea. This industrial development is progressively increasing and is bound to increase considerably. The bacteriologically negative, able-bodied, released from control cases sho￢uld be given opportunities to take their share in this industrial development as unskilled and skilled labourers.
Undoubtedly there are a large number of other displaced persons to be taken care of, but the persons under consideration should be considered as part of the same problem. It is essential to first change the line of thinking in this direction, and then the right solution will be gradually found.
To enable these people to take part in skilled labour, it is essential to provide to them facilities for vocational training. If these facilities can not at present be provided in any existing institute for vocational training, a special centre for this purpose should be established at some suitable place. In addition to a training center, it may be necessary for some time to establish a kind of `sheltered´ workshop, and the responsibility of disposal of the finished products in the workshop should be taken by the Government or some suitable organisation. The training centre could perhaps serve both the purposes, and it could function as a "work
cum-training centre".
It is considered essential that, for real rehabilitation, at least a beginning be made in this direction, any be in a small way at the start.
(b) Rehabilitation of leprosy patients in general. In the rehabilitation in leprosy in general, the attempt should be to try to prevent de-habilitation, so that as ´far as possible, the. need for rehabilitation does not
arise, or is at least kept at the minimum.
In order to achieve this objective it is essential to recognise that the main reasons for dehabilitation are (1) public prejudice and attitude (2) deformities produced by the disease, and (3) stay of the patients for long periods in leprosaria and colonies etc, away
from home and relations.
For removing public prejudice education of the
healthy people is essential so that they can adopt a rational attitude towards the disease and persons suffering from it. (This matter has been considered separately)
To take care of the other two causes, efforts at rehabilitation should start early, right from the day the disease is detected, and not left over till the treatment of the patient has been completed. It should be appreciated that in most cases deformities in leprosy are preventable, if proper care of the anaesthetic parts is taken from the start.
To prevent deformities, and to avoid loosing contact with the family and society, steps in the following directions are necessary.
(i) Early detection of cases, so that treatment can be started early. For this purpose it is essential that the general medical profession is encouraged to take interest in the disease, so that a diagnosis can be made at the earliest stages, and treatment can be started early.
(ii) Treatment should as far as possible be domiciliary, so that while taking treatment the patient continues to live in his home and normal surroundings.
(iii) If during treatment hospitalisation is found necessary for any reason, it should be temporary and for the minimum period required. This will ensure that there are no long periods of break of family contacts and ties.
(iv) Simple methods of physiotherapy and teaching the patients regarding the care and protection of their hands, feet, and eyes should form an essential part of routine treatment both in the institutions and in the field. For this purpose leprosy workers should get adequate training in the matter, and facilities for simple methods of physiotherapy should be made available at all treatment centres for leprosy.
(v) If deformities develop or are already present, suitable arrangements should be made for the reference of such patients to centres where facilities for reconstructive surgery are available.
(vi) While the patients are under treatment, arrangements should be made for vocational training of those who are suitable for such purpose.
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