Bangladesh is one of the most densely populated countries on earth. Its lands are mainly fertile and flat, producing a large annual rice harvest, and its geography is dominated by three large river systems that flow through it. Although poverty has halved in the past 20 years, there are still major health issues including leprosy, with 4,000 reported new cases each year. The Leprosy Mission, with almost 600 staff and more than 20 separate projects, is the largest organisation working in leprosy in Bangladesh. Its projects include leprosy control in collaboration with Government health staff, community-based rehabilitation, advocacy that aims to influence attitudes about leprosy, a national leprosy referral hospital and training centre, and leprosy research projects of international significance. Annual expenditure is around £1.7 million. TLM’s country leader in Bangladesh is Salomon Sumon Halder.
Health programmes and research
TLM undertakes leprosy control programmes through much of the country. These programmes raise awareness, stop the transmission of leprosy from person to person, and prevent disability, all strengthening the Government’s health services. TLM’s referral hospital in the northwest of Bangladesh is the only dependable specialised leprosy treatment centre in the country. It provides services for leprosy complications including reconstructive surgery and assistive devices to patients with leprosy and other disabilities. Attached to it is a training centre providing leprosy and other training to health workers.
Research projects, closely connected to the leprosy control activities, make a major contribution to global understanding of the disease and its treatment. Major research projects include finding whether information from blood tests can give advance warning of leprosy; comparing two different approaches to leprosy prevention involving chemoprophylaxis; and measuring whether being in a self-help group has a sustained impact on the lives of leprosy-affected people living below the poverty line.
Community-based rehabilitation
Community-based rehabilitation activities ensure that TLM’s projects address more than just people’s physical needs. The main approach is through forming self-help groups that provide mutual support and improve health and livelihood opportunities for people affected by leprosy, disability and extreme poverty. TLM supports the groups with skills development for improved livelihoods, access to micro credit, food security and educational opportunities for children. One innovative programme encourages the people to form local associations to own and run their projects. These have multiple elements: disability care; raising awareness of people’s rights; improvement of social status; and economic and income development.
Advocacy
Advocacy is an essential component of the national programme. TLM aims to influence policies and practices of Government and other decision-makers and to build community awareness of leprosy through media. Currently, a key focus of advocacy is to get leprosy services started in southern Bangladesh.