In August, 1970, a mobile treatment scheme was introduced in Luapala Province, modelled upon a successful scheme employed by LEPRA and the Zambian Government in the Eastern Province.

Initially LEPRA provided two landrovers and the services of Mr I Rogers, an experienced Leprosy Control Officer who was transferred from the LEPRA project in Malawi. One vehicle - based in Mansa, the provincial capital - was to provide services for the southern part of the Province; the other - based at Kabalenge Leprosy Settlement – was to serve the northern part of the Province. The Zambian Government contributed the funds to run and maintain these vehicles, and also paid for two Medical Assistants, one for each of these regions, under the overall charge of Mr Rogers. The staff of the Rural Health Centres in Luapula Province remained responsible for the treatment of leprosy patients in their respective clinics, but they were under the strict supervision of the LEPRA teams. Dr B Jogan, a leprosy specialist, was in charge of the leprosy unit at the headquarters. His duties included routine administration, processing of monthly reports coming in from the provincial headquarters, supplying the shoe making materials to various leprosaria, and reporting back to LEPRA.

During the early stages of the project the two teams visited Rural Health Centres in the Province in order to obtain an idea of the current leprosy situation. However, the records proved inadequate for this purpose. The leprosy registers were in complete disorder, and included numerous patients who had not taken treatment for years. The diagnosis and treatment of leprosy patients had often been left to staff with an inadequate knowledge of the disease. Many patients listed on the registers were without any personal records at all and, therefore, no data were available about the type of leprosy or when the patient had started treatment.

An intensive survey of leprosy in schools was more successful. Here health examinations were more stringent and attendance for these was always very high. With this type of survey it was comparatively easy to assess a valuable and reliable prevalence rate of leprosy in the chosen group. 241 Primary and Secondary Schools in the Province were surveyed. Between 1970 and June 1972, 63,913 school children were examined and 381 new cases of leprosy discovered. Over the same duration, 1,065 new cases of leprosy were discovered in Luapula Province as a whole (out of a population of 360,000).

As the scheme developed, the teams extended their services into the remotest parts of the Province where roads and heath services were non-existent, carrying out extensive village and group surveys as part of the ‘seek and find’ method of case finding to ensure early detection and treatment of the disease. All cases were followed up at clinics as were contacts of infectious cases; tracing of defaulters was also a high priority, as was the release from control of long standing non-active cases. In the early days there were sporadic reports at certain clinics that those with leprosy were made to wait for many hours for their treatment in while those general cases received preferential treatment, but as the teams spread their message this situation improved. Work was initially slow on the Lake Bangwulu Swamps due to the unreliability of good small speed boats at Samfya to reach some clinics and schools, but this was improved upon as the project progressed.

Nine Landrovers and a motor boat were provided by LEPRA between 1968 and 1972. Many new patients reported to the Landrover whereas previously they had feared to show up at clinics because of the old tradition of being referred to Kabalenge. School children especially benefited from these runs which stopped at their school, instead of these small children having to walk 50-60 miles to the nearest clinic.

Outpatients were treated on 4-weekly intramuscular injections of Dapsone, except those in the remotest and hardest to reach areas, where they were put on Dapsone tablets distributed by their Headmasters, and received visits every three months to keep them under surveillance. Disposable syringes and needles were used.

Public health education lectures were given to villages, schools, health personnel and other groups. Lectures on aspects of leprosy and its management were given at Mansa to staff. Talks were also given at the Luapula Province Medical Club, attended by doctors, nurses, and others in the medical field. Patients from Kabalenge were sometimes used to demonstrate the different types and severity of leprosy.

Once the LEPRA project was well established, many patients resident in one of the two Provincial leprosaria could be discharged to outpatient treatment. It soon became very clear that one leprosarium was sufficient to cater for all inpatients from the entire Province. In March 1972, only three of the 12 inpatients at St Margaret’s Leprosy Settlement, Kasaba, were deemed to require hospital care. These were transferred to Kabalenge and the others discharged. The St Margarets was closed in 1972. The Luapula Leprosy Settlement at Kabalenge remained open, but primarily as a reference centre for cases of reaction, or ulcer care. Patients with ulcers had plaster casts applied where appropriate, and sandals supplied once healed. Those needing X-rays or operations were treated by Dr de Kyzer at Mbereshi Hospital, where he encouraged the free admission of leprosy patients in general surgical wards. There seems to have been little resentment to this course of action by the general patients.

Information provided by LEPRA.

This entry was created 28 September 2006.