Dr M S Nilakanta Rao, ‘An Autobiographical Sketch’ (transcribed from an oral account) in S S Naik (ed) The Indian Leprologists Look Back. Bombay, 1990. pp. 89-103, posted online with revisions by E H Price, 31 August 2006.
The life of Dr. M. S. Nilakanta Rao especially in relation to leprosy in which he has worked for 30 years since 1962, and made by him personally on 24 January 1989.
I was told that I was born on 5 April, 1927. It was in a family wherein the father was a medical man and the mother was the daughter of an astrologer who was known practically all over the state of Mysore. That gentleman had advised even the then Maharaja of Mysore about his progeny. On the father’s side my grandfather was supposed to be an ayurvedic physician to the Maharaja of Mysore and according to my understanding his income was very limited. My father studied in Madras for medicine and then joined the service. I was the second son of my parents and third child. My school education was uneventful. It was easy for me to remember things taught in the class, a second reading was almost not necessary. But my father’s life influenced me considerably because he was a very popular medical man and he worked very hard. Looking at the number of people that were coming to him seeking his help, I decided to become a medical man when I was about 10 years old. My scholastic career was reasonably good. I was getting first classes without much difficulty. My pre-university education, called in those days as the “Intermediate”, was completed in the year 1944. That was the period when the Independence movement had been launched with great gusto and the slogan of “Britishers, Quit India”. My participation in the movement was very limited but I felt very strongly about the events that were happening around me. This influenced [me] to a considerable extent and even to this day influence[s] me in many ways. And when I realised at that time that the Bengal famine of 1943-44 where millions died [was] on account of a man-made famine, the only course left to me was to serve our people to the best of my ability. But at the pre-university (Intermediate) level, when the colleges had closed I had done extensive general reading. This enlarged my vision considerably and I can say without any hesitation that it helps me even to this day. At that time I also decided to be strong in my subjects.
My B.Sc. from the University of Mysore was completed in the year 1946, with a double first class. In those days it was not very difficult to get into engineering college but I had decided to get into medical college. At that time there was only one medical college in the state and out of the 45 seats available 34 had been reserved for those who had passed Intermediate, 11 for graduates - out of them 8 were for those who had taken chemistry, botany and zoology as their optional subjects. My optional subjects were physics, chemistry and mathematics. And of the 3 seats meant for PCM students, one was reserved for a lady candidate, only 2 for men B.Sc., candidates. I was third in order of merit. Ultimately it was possible somehow to get into the Medical College.
Life in the Medical College was devoted entirely to medical studies, so much so, it could be said that I had a fairly good grasp of the basic medical concepts by the time I became a doctor; that means by the time I passed my MBBS. Unfortunately my medical studies were interrupted for 18 months because I developed pulmonary tuberculosis when I was in the 4th MBBS. At that time the treatment was artificial pneumothorax, which I received for three years. Streptomycin was a new drug that had come, and I was given a large number of injections; and I had to swallow a large number of INH and PAS tablets which treatment continued for 18 months. Inspite of all this I was a University merit scholar in my 4 th MBBS, and I was also able to pass my medical exams in the first attempt which was a big thing in those days.
I had pleurisy in December 1952 when I was admitted in the Hospital. Inspite of all these handicaps I was able to pass my Final MBBS examination in March 1953. After one year of Housemanship (which is called nowadays internship), I joined the Kasturba Medical College in 1954 as a demonstrator in anatomy for 6 months; and a demonstrator in pathology for 2 ½ years. Because of my previous illness I had decided to become a pathologist which would give me a reasonable amount of rest. But things did not turn out to be as I had thought out. I had also wanted to take up academic and research work. That was the thought at that time. For postgraduate studies I went to Britain in September 1957. I met there a very well known cancer specialist, Dr. Bonser by name. Somehow she discouraged me from becoming a pathologist and, as a sort of challenge, I took up general medicine as my subject. In fact, it may look rather odd that I refused to work for the Ph.D. in Pathology of London University. It was offered to me by the Assistant Director of British Postgraduate medical education. During my work in Britain, I appeared for the MRCP examination in Edinburgh and I lost the examination. I again appeared, lost it. But closer scrutiny of the way the examination was conducted disappointed me very much. Hence I did not persist in getting MRCP. But I worked in various Hospitals both in Scotland and England. Initially I concentrated on working in hospitals for chest diseases and in the course of three years I can say I had a reasonable amount of knowledge and experience in this particular speciality. Later for about a year I worked in general medicine especially in a hospital where the work was heavy and brisk in Salford Royal Hospital, Manchester. These experiences in the hospitals were and have been very valuable to me throughout my life.
I must say that even while doing my leprosy work these form as a big background and help in an overall analysis of leprosy as such and understanding. I returned to the country at the end of 1961, but had decided to work in the villages. But the need to earn a living was also there, especially because I didn’t want to be a general practitioner. I applied for various jobs and wherever I applied I was called for the interview. Somehow many of these didn’t suit me. My application to the Gandhi Memorial Leprosy Foundation was the beginning of my work in the field of leprosy. I was called for interview in Wardha and at the time when went there the Director was Dr. Wardekar and the discussion which we had, for about an hour seems to have decided my professional course of life. Our discussion centered around the total problem of leprosy in the country and how one could probably fight it out. Dr. Wardekar mentioned to me about the use of Survey, Education and Treatment programme and how it could bring down the prevalence. He also told me that the National Leprosy Control Programme had been instituted but it still had to go a long way. He mentioned that I had to go to a small village in Andhra Pradesh where I would get the necessary training for a period of 4 months. He was not sure that I would continue in the field of leprosy for a long time, because that was his experience with regard to many doctors. He also realised that my stay in the field of leprosy, would be probably, I would say improbable, especially because I had come from an urban setting and had worked in a foreign country for quite some time. So he told me that he would like to know my responses at the end of one year of work. Till I went to Chilakallapalli I did not realise that our country was so backward in so many respects, especially in the rural areas. It was hard for me initially because I was brought up and had my education in sophisticated urban settings. All the same I decided to continue the work because of the conditions of the people whom I saw in the Chilakallapalli Control Unit. After 2 months Dr. Wardekar happened to come there and he told me that my training was sufficient, whatever I had, and he asked me to take over as Officer in charge of the Training Centre. I had the work of running the Clinics, teaching the medical and paramedical people who were coming there, and trying to develop the work to help the patients as much as was possible.
At this point of time it might be better for me to say what my earlier experiences in relation to leprosy were. As I trace back my life I remember an uncle of mine (my father’s brother), who was working in the Stores Department of the Magadi Leprosarium. (It is now called the Magadi Leprosy Hospital situated in Bangalore). The whole Leprosarium was completely covered with high walls, presumably held a large number of patients and emanating a sort of fear to all the people in the surrounding areas. Sometimes we used to think that my uncle was very brave in going there to work. Another thing that comes to my mind was while staying in a suburb of Bangalore, in an extension of Bangalore every night at 8 or half past there would be a call from a leprosy beggar in the street asking for food. He would shout at the top of his voice asking for food. When he came into the street the entire street would be almost empty. People would just lock themselves inside and look at him through their windows. I wondered how many really gave him food. But since he was there night after night I presume that some people did give him food. He was a very emaciated person, aged about 30-40 years, and until he turned the corner of the street almost all the people would remain indoors. This was around 1940. During the early years of my work, particularly in Chilakallapalli, I noticed the human misery, the ennobling human actions of some patients, some close relatives, and some workers.
As I had specialised in chest diseases in Britain, it was possible for me to draw comparisons between leprosy and tuberculosis. Inspite of this I felt that the Lepra bacillus is a great challenger, as it is even now. And in those days it was felt that it would be possible to eradicate leprosy by proper use of Dapsone and the SET set-up of work. But I told Dr. Wardekar personally that this was too optimistic a view of things, because I had noticed in Scotland that to control tuberculosis was quite a difficult problem. In an area where we had controlled tuberculosis in Scotland, suddenly one day a report came to us that about 30-35 new patients had been detected and that the disease had spread to so many people through infected milk. Apart from this it was also clear that there would be always a hard core which would not be easy to overcome. In addition I had mentioned that dapsone resistance could be expected as the tubercle bacillus had shown resistance to the drugs that used against it. I had not known at that time that dapsone-resistant cases had already been reported in Carville.
Another point of significance at that time, apart from absenteeism and other things, I was greatly conscious of the stigma attached to leprosy; hence my mind was working to find out ways and means of overcoming the stigma. Dr. Wardekar had also begun health education programmes in GMLF. So I took every opportunity of associating myself with all that was going around me in the field of leprosy, so that I could have an all round view of the whole medical, social, economic and psychological aspects of the disease and its effects. I worked in Chilakallapalli for one year, and at that time to a limited extent prepared the ground for the chemoprophylaxis project in the Bobilli area. From there I was transferred to Mararikulam in Kerala, where I worked for 2 years. In these centres I conducted limited trials using CIBA 1906 and the long-acting sulphonamide, Fanasil, which was known to be useful in leprosy at that time. My studies indicated to me clearly that they were not superior to dapsone in any way, but the papers concerning these were not published.
Similarly I undertook a study of the prevalence in the 2 sexes. Usually males have more diseases than females. The prevalence of the sex ratio was different in one small area in Mararikulam. I tried to study all the aspects as far as could think of, especially the socio-economic and cultural factors. I couldn’t come to any definite conclusion. The data I collected at that time with regard to this work has been lost. It was my fault because I didn’t preserve those papers.
My earliest experience in the field of leprosy was with regard to ulcers. I realised that the tissues of the patients had to he handled with great respect. It was gross injustice to use scissors and knife indiscriminately. It would be extremely wrong to allow dressings to be done by an untrained worker. I also noticed that giving rest to the part by using a simple thing as a metatarsal bar would help in healing of the foot ulcer quickly. That even extensive ulcers and extensive spread of purulent material in the tissues would not cause great constitutional disturbances as in a normal individual. Later I was to learn that the majority of these individuals did not require even antibiotics.
We were handicapped in many respects in the village clinics but with whatever help was available we could give a lot of relief to the patients. It was satisfying.
During the period 1962-65 I had learned about the work of various important people in the field of leprosy….the work of Dr. Cochrane, Dr. Paul Brand, Dr. Wardekar himself, Dr. Dharmendra, Dr. Antia and a host of others. It was quite encouraging to see that a number of eminent people all over the world were giving a great attention to this much neglected cause and trying to break the barriers, advance patients and, if possible, to root out the cause. Before I forget I must say that before the end of one year after I joined GMLF Dr. Wardekar did come to Chilakallipalli and ask me what I thought and how I felt working in the field of leprosy. My answer was that I had not thought, but I was just working! I can say it has been a satisfying piece of work.
From Mararikuram I was moved to Wardha to help in building up a hospital of GMLF, to organise it and to use it as a base Hospital for those in need of hospital care. We had a limited staff but a very devoted group… the paramedical and subordinate staff. Even my wife used to help me in a very big way in various things and we used to work from almost 8 o’clock in the morning to almost 11 or half past at night. Many of the workers used to come even on holidays; they enjoyed themselves, saying “This is holiday work”. I think even now that we were able to give a good base. Another point of significance is that, until that time, in many hospitals the stay of the patients used to be always in periods of months or years. I suppose that we were able to show very clearly that in many cases it was not necessary to keep the patient for such a long time and the average period of stay in the Hospital of the GMLF where we were doing at a later date reconstructive surgery also, worked out to 9 days, later on 12 days or probably 15 days. This is because many of the ulcer cases who came had clean granulation tissue, and all they required was proper dressings and POP casts, which could be removed later on; and as soon as the cast was dry the patient could be sent home and be asked to come after 3 or 6 weeks as the case may be.
In the case of reconstructive surgery patients, of course there was a need to keep them for a much longer period. But in the case of reactions it was easier to send many of them within a week or two. The number of admissions in the 30 bedded hospital of GMLF was around 220-250 per year, and the outpatients used to be around 40 to 50 per day. Of the outpatients, many were general patients and they would come even for complaints other than leprosy. This was a very welcome development because it helped to break the barriers between leprosy and other diseases. To that extent leprosy stigma was being reduced.
Inspite of these things I had the feeling that our care to the patients was far from satisfactory. Dispensation of tablets once a month across a counter or through a window would not establish a rapport with the patient. In busy clinics there would not be time even to ask one or two questions. What was important in those days was the so-called attendance of the patient. It used to be said that if the patient attended the clinic 12 times in a year, once a month, and collected all the tablets, he was supposed to be “regular”. More than 75% (i.e. 9 months, 9 collections) would be very satisfying. But what was lost sight of was the importance of recognising whether the patient was taking the tablets or not. I have always maintained that leprosy patients are a lot who are very kind to the leprosy workers, because they collect the tablets and then keep them at home; come to the next clinic, on the proper date, collect the tablets, and then keep them at home. Obviously this was not a satisfactory situation. What was necessary was to base a rapport with the patient and see that he was taking the tablets. In those days at that point of time there was still, to the best of my knowledge, no test for detecting DDS in the urine. Anyhow, we were not conducting any tests and this was a big lacuna.
Around 1967 it was decided to have a reconstructive surgery unit also attached to the hospital. They tried to get outside surgeons and, ultimately, Dr. Wardekar as the Director was able to coax a surgeon from Nagpur to come and operate in our hospital. The gentleman didn’t know reconstructive surgery as it was being done for leprosy patients, we didn’t have the necessary instruments and so on, so he went to the Kothara Leprosy Hospital of the Leprosy Mission wherein he took the help of Dr. Gude. When the Surgeon saw Dr. Gude working, doing surgery on a few patients and he felt that be could do the surgery very easily. With regard so the necessary equipment required, I had requested Dr. Gude to give us a list. Fortunately, with the help of whatever list he had and the instruments he was using, my wife and I, working together, were able to make a good list of all the instruments required. Later, Dr. Wardekar, the surgeon, and Dr. Gude went to Madras with the list we had prepared and placed the orders for the necessary instruments and other equipment required. So one fine morning we were able to start the reconstructive surgery unit. By that time we had also trained a physiotherapy technician. Alter some months this method was not working out properly because the surgeon was found to be wanting in many things, and it was difficult to carry on the arrangement of periodical visits of the surgeon from a distant place. Ultimately it was decided that I should undergo training in surgery and I agreed. I went to Karigiri for 9 months where Dr. Shakuntala Karat helped me in understanding the reconstructive surgery aspects and in guiding me in many of the surgical procedures. During all this period from 1962-69 I was continuing to learn about various aspects of leprosy as I am doing even now and I have found that unless one keeps his eyes open and remains humble one would not really be able so do much. In fact I feel very grateful to a number of friends in the field of leprosy, both seniors and those who are of roughly of my age, and even some of the youngsters who have come later on who have given new ideas and new thoughts for better work in the field of leprosy.
I was basically concerned, or interested in the clinical aspects, but I was also participating in a number of conferences held outside GMLF and also the conferences that were held in GMLF for the workers of GMLF. Apart from the medical angles, health education was a very strong subject in the Gandhi Memorial Leprosy Foundation, and paramedical officers used to have almost an annual conference each time (Health Education Officers as we call them now). Dr. Wardekar was kind enough to allow me to attend all these things.
By the time I came back from Karigiri in 1969 there was already the thought of Dr. Wardekar leaving the Directorship. It had been very difficult to find a person to take over his position. My name seems to have been discussed at great length by the governing body of the Foundation, and they had decided that ultimately I was to take over. I was not aware of it at all. When I learnt about it I felt distressed because I was not very keen on administration, whereas I was very keen to continue my clinical work. Inspite of my effort to wriggle out of it I couldn’t. And ultimately, in September 1969, I had to take over as Joint Director and, in April 1970, as Director of GMLF. Inspite of my best efforts that I was trying to put on to continue my interest in clinical aspects, I couldn’t keep in touch.
Wardekar’s was a towering personality. When I took over the administration, he had built up the Foundation into a national institution. Whether it would slide down was everyone’s concern. Smt. Kamala Nimbkar asked me not to change anything suddenly. The loyalty of the workers to Dr. Wardekar was immense. That again could prove helpful or disadvantageous to me. The lines of action were Health Education, SET work, support to voluntary organisations, epidemiological studies, chemoprophylaxis project, preparation of the lines of action of the Second, Third and Fourth Plans, encouraging research work through the Indian Council of Medical Research and otherwise preparation of health education material like films, posters, pamphlets: preparation of books like, Leprosy, Everyone’s Concern, and Hints on the Diagnosis of Leprosy, encouragement of more intensive study of leprosy in medical colleges, lectures to general medical practitioners and other groups, orientation classes for school teachers and holding of annual conferences of the workers of GMLF, encouraging other conferences, formation of and later supporting the National Leprosy Organisation (NLO) as Secretary; maintaining dialogue especially with the Central Government about leprosy work: writing articles, more important, bringing all the leprosy workers all over the country together with a certain amount of idealism. These were legacies left to me by Dr. Wardekar. Obviously it was a heavy mantle because he was working on various fronts. There was one big difference; he was the innovator and initiator for many problems. I was the inheritor. I put it succinctly years later while speaking to GMLF workers in the following words, “You were young when Dr. Wardekar commenced work. You could be moulded. When I took over, you had grown up.” Initially the work continued as before. Gradually problems and new approaches were coming up and they were built up.
The programme of orientation to the professors of medical colleges materialised - the professors of government medical colleges of Maharashtra and Gujarat were sent in batches and each batch consisted of the Professor of Pathology, the Professor of Medicine, Professor of Surgery, and the Professor of Preventive and Social Medicine. Each batch was given a good orientation about leprosy, its various facets of work and how the whole thing attended to in the National Leprosy Control Programme which commenced in 1955. These programmes were found by the professors of the medical colleges to be very useful.
In 1973 the All India Leprosy Workers Conference was held at Sevagram. Dr. Sushila Nayar was the Chairperson of the Organising Committee and I was the Organising Secretary. Dr. Sushila Nayar took a lot of interest in making the Conference a big success. She was able to get a lot of donations from various Governments and other agencies, on account of which we were able to charge only a nominal delegate fee. More than 500 delegates attended this Conference, and a number of them were from other countries. In this particular conference, 2 points which I remember which were important were made. One was Dr. Srivastava, DGHS at that time suggested that we could take 2.5 per thousand prevalence as the point at which the vertical programme could be combined into the horizontal programme. The second was the point made by Dr. Godal that sub-clinical infection was very common. Dr. Godal assured that many of these infections would not manifest into disease because of the natural resistance that the human body had.
Another important development that took plate in 1973 is of great significance. Perhaps it is well known that Dr. Wardekar started the SET Programme and the meeting of the experts in formulating the Second, Third, Fourth Plans as mentioned earlier and gradually leprosy work was being extended all over the country. But the progress of this extension was rather slow. During this period I was informed by the Secretary of the Gandhi Smarak Samiti, Mr. Devendra Kumar, that the Planning Commission had sanctioned only about 20 million rupees for the next 5 year plan and that we should take up the issue very seriously. I wasn’t very sure that the Planning Commission would change their minds even if we took up the issue. But Dr. Wardekar who was our Chairman at that time suggested that I should do my best. So I called in a group of experts based on leprosy and allied fields, to discuss what should be our approach to the whole problem of leprosy in the whole country. After discussion for 2 days in Poona an approach paper for the Fifth Plan was prepared and this was distributed extensively to various Members of Parliament and also the Ministry. I had requested the Prime Minister to give us time to discuss the subject with her. She was good enough to do so. A delegation consisting of Dr. Wardekar the Chairman of the foundation, Shri Devendra Kumar, Dr. Jivraj Mehta the Vice-Chairman of the Foundation, Mr. Pai, and myself met the Prime Minister on July 20, 1973. It had been decided earlier that the Leprosy Advisory Committee which met on that day should discuss the issue and. come to some conclusions. Fortunately for us the then DGHS Dr. Srivastava took up the points mentioned in our approach paper and stressed that these were of vital importance and put forward that these should be accepted. Therefore my job with the Prime Minister became easier. Even though Dr. Wardekar and Dr. Jivraj Mehta and others were there I was asked to speak to the Prime Minister, it is well known that Smt. Indira Gandhi was taking a lot of interest in the problem of leprosy. I was under the impression that she would give us about 10 minutes but she spared her time and we spent about 20 minutes with her explaining the various points.
It came to he understood later on that the Government of India was prepared to spend 330 million rupees in the Fifth Five Year Plan: another important change that occurred at that point of time was that the Government more or less took the attitude saying, “Don’t bother about the money, go ahead and do the work; that is important. Money will automatically be sanctioned.” This was a very big change and it was essentially because of the intervention of the Prime Minister, Smt. Indira Gandhi.
After this was more or less approved I discussed with Dr. K. C. Das, then ADG dealing with leprosy and we worked out more details of the Fifth Five year Plan, and we decided on the encouragement of Dr. Wardekar that the Plan should suggest covering up all the country with SET Centres, Leprosy Control Units. Therefore by the end of the Fifth Year Plan more or less the whole country was covered even though there were many handicaps and many difficulties in the implementation and it became clear that such an approach was helpful at a later date even for introduction of follow-up measures.
I fell ill at the end of 1973. At that time I was believed to have sub-endocardial infarction, and this naturally led to a certain amount of restraint in my work. When I began to recover I knew I had to be careful and I had to reduce the load of work that I had. Admittedly all the workers of the Foundation were giving me good cooperation. We worked as a team. But inspite of it, it was my job as the team leader to chalk out the lines of work, and many a time to take the initiative and show the way. It became very clear that I couldn’t put up with the strain. I informed the Chairman and other members of the Foundation Committee that I should be relieved of the Directorship of the Foundation. They were not very happy with my suggestion. They suggested that they would give all the help I required but I was not very sure how I could manage even with a new hand coming to help me. Even by 1970 or 1971 I was a member of various responsible bodies, like the expert committee of the ICMR, the Leprosy Advisory Committee of the Government of India, the Leprosy Advisory Committee of the Government of Maharashtra, the Secretary of the National Leprosy Organisation etc. Therefore I insisted that I should be relieved of my duties. They very reluctantly agreed to it and the day of release for me from the Directorship was to be in 1976.
During this period of my Directorship 1970-1976 the work of the Foundation went on as vigorously as before. In a period of 6 years our paramedical officers who came to be known as health education officers had given orientation to more than one lakh sixty thousand teacher trainees.
I left Wardha on March 31, 1976 and came over to Bangalore. For the next 6 months I was the Hon. Director of the Foundation and I used to visit Wardha periodically to attend to important work. Also some important papers used to be sent to me for decision or for approval. During this period and subsequently I was the Consultant to the Bangalore Baptist Hospital. The leprosy work had been started earlier and the Medical Officer I/C had to go away to take up an assignment abroad. I trained another doctor there and also gave a series of lectures. Similarly a series of lectures was arranged in different parts of Bangalore in the next 2 or 3 years by various organisations including the Indian Medical Association so that a large number of medical people came to be cognisant of the problem of leprosy as it existed in Bangalore, in Karnataka, and in India, and also the latest lines of treatment.
In 1978 the Katharina Kasper Leprosy Control Scheme came into existence in Bangalore and it began to take tip work both along SET lines, SET pattern, and also take up Health Education work.
I was the Chairman of the Epidemiology Section of the Conference called by authority of National Institute of Mental Health and Neurosciences at Bangalore, 1980 and I persuaded the sub-committees to accept the proposal of the Prime Minister to say that we can perhaps eradicate leprosy in about 20 years time. This was not a scientific approach but it was more or less in tune with the political will. And we wanted to exploit the political will and take advantage of the willingness of the Chief Executive to give a tremendous push or boost to the whole leprosy programme in the country. The general body of this Conference ultimately accepted this proposal and we sent back the information to the P.M.’s office that this body had accepted the Prime Ministers’s suggestion of eradicating leprosy in a time frame in a period of 20 years.
In the meanwhile some other developments have taken place in the country. Perhaps very few people remember now in 1989 that a Committee had been constituted for the Leprosy Advisory Committee under he Chairmanship of Dr. Sushila Nayar to go into all aspects of the leprosy problem and make suitable recommendations so that is we could really control leprosy rapidly. This sub-committee, under the Chairmanship of Dr. Sushila Nayar, met 4 times in 1978 and its final report was given on July 14, 1978. One of the main recommendations made in the final report was that multiple drugs should be used on a direct study basis. The sub-committee recommended that pilot field trials should he conducted initially to know the effect of the new drugs on leprosy patients as well as on the community and to formulate the methodology of treatment with these new drugs. The trial should he started in 8 districts with different regimens.
The districts selected were Chingleput, North Arcot, Wardha, Amravati, Purulia, Dharwar, Srikakulam or Nizamabad and Agra. The first regimen suggested Rifampicin to be given an the first day in a dosage of 1200mg; on the second day 900mg; on the third day 600mg; on the 4 th to the 21 st day, Rifampicin 600mg + DDS 100mg; from the 22nd day to the end of the first year, DDS 100mg, or 75mg + thiacetazone 150mg + INH 300mg; after one year, DDS alone 100mg. This does not mean that the Committee has not taken into consideration the use of Lamprene. In one of the other drug regimens it had been mentioned.
The Ministry of Health accepted these recommendations of the Sushila Nayar Committee and decided to take up Wardha as the first district for the multi-drug regimen. So preparations were started right in 1978 itself to have the pilot studies going on from 1980 or 1981 onwards. I was contacted in July 1981 and was asked by the Government of India and WHO to organise the work in Wardha District and start the pilot study.
I went to Wardha District, studied the whole aspect, and found it fit to start the Project. So the first MDT regimen Project started in Wardha District on October 2, 1981. Initially we took up only multibacillary cases and out of 2107 MB cases, 1667 positive cases were given daily 600mg Rifampicin and 100mg DDS. This was for a period of 21 days. And later on they were given Rifampicin 600mg once a month, DDS 100mg daily and one INH-Thiacetazone combination tablet. To the best of my knowledge this was the first time that Rifampicin was being given continuously for 21 days under field conditions. Till then all the studies that had been conducted had been to give Rifampicin only when the patient was under institutional care. This was a very big responsibility on my shoulders and I must say that I was fortified because of the excellent team I that I had working for me. The state Leprosy Officer, Dr. Yellapurkar, was a pillar of strength, and I used to make it certain that the team spirit was never given up. We had eight medical officers who used to go to the field and watch the patients daily, carefully, closely so that any untoward reaction was immediately reported to me. We had also three Base Hospitals, one in GMLF, another in Dattapur, the third in Sevagram Medical College. Therefore I could easily organise the work and just see how things were proceeding after the period of 21 days was over. In all the three zones forming the District of Wardha, at the end of four months it was a great relief to know that practically nobody suffered from any side effects because of the continuous daily administration [of] Rifampicin under field conditions. It is imperative to realise that this usage of Rifampicin under field conditions was of great significance. Till that time everybody had been worried about using Rifampicin under field conditions because of the side effects it was manifesting especially when used intermittently in tuberculosis patients. Even I had been warned by eminent colleagues to be careful because of the side effects. Fortunately for us and fortunately for the patients nothing untoward happened.
Everyone knows now that the National Leprosy Eradication Programme contains continuous administration of Rifampicin for 2 weeks in addition to other drugs. In 1982 came the recommendations of WHO with various regimens. From 1981 onwards until now I have continued to work as WHO Consultant to the Government of India in assisting in the implementation of the National Leprosy Eradication Programme especially in the administration of MDT in Districts which are endemic or hyperendemic. The results in the various districts where I have supervised the work and in all the districts where the work has been going on have been very satisfactory,
Now I shall endeavour to answer some questions that crop up usually.
Your principal contribution to enhance the knowledge on the subject and your experiences.
I can say the following….(1) I found that any ulcer in a leprosy patient can be healed fully with the appropriate treatment.
(2) I began to stress more and more on the protection of the eyes and nose to prevent disability and deformity.
These aspects were not being stressed so much in 1962-63 when I entered the field of leprosy.
(3) I stressed the need to use correct terminology to overcome stigma. I was absolutely convinced that it is very important so be precise in our wordings.
(4) We demonstrated in the referral Hospital of GMLF Wardha, that a short stay in the Hospital was sufficient for most cases of leprosy.
(5) During this Period of time I encouraged Professors of Medical Colleges to intensify teaching about leprosy. This was the period when I was Director of the Foundation. I also encouraged them to take up research work. Similarly I was encouraging a number of other scientists to continue their work in the held of leprosy or to take up new fields of study in leprosy.
(6) I pointed out some aspects in clinical leprosy which were perhaps not so very well known in those years. (1) One can be said to be the appearance of new patches within 24 hours in a patient who is on regular treatment. These patches are often evanescent and they don’t require additional treatment except the routine treatment. (2) Nerve abscess was very common in India also; many people believed that nerve abscess was not so common. (3) Occasionally, or very rarely, leprosy can commence as a nerve abscess.
(7) Another point of importance that I can say is my contribution along with a number of other friends is that the Fifth Five Year Plan was salvaged because of our efforts and especially because of my efforts as Director of the Foundation. It may be recalled that the Planning Commission had sanctioned a small amount and with the intervention of the Prime Minister it was possible to get a larger amount and the attitude of the Government changed. This effort was worth all the trouble and it is so satisfying especially looking back because this attitudinal change in the Government has helped in the National Leprosy Control Programme, later on came to be known as the Eradication Programme to pick up speed and intensity.
(8) Another point that I hare already stressed is this that perhaps we were the first people to show that Rifampicin could be used under held conditions without any deleterious effects. Nowhere else in the world, as far as my knowledge goes, had it been shown in this way. People had tried Rifampicin under institutional conditions.
Another question that is asked is how do I view my professional life as a leprologist.
I have felt that it has been very satisfying and very dynamic throughout the last 28 years that I have been working in the field of leprosy. In these 28 years there has been a lot of change in the profile in the country, in administrative matters, sociological, therapeutic, and other aspects. These changes have been for the good of the patient community and for the society and these changes hare also assisted in unravelling mysteries in various aspects, not only in the field of leprosy, but in other fields as well, like immunology.
What is my view about leprosy work in the next 25 years?
I am of the firm opinion that if the implementation is more thorough we can positively control leprosy in the next 25 years and perhaps eradicate leprosy in another 25 years.
In conclusion I can say that leprosy work which took up not exactly in a spirit of dedication or in a missionary spirit but as a medical man would take up the work of any other disease. It has added a new dimension to my life. It has satisfied a number of drug that were there in my system. It has satisfied my mind considerably and I feel also satisfied that this period during which I have worked has been a period where tremendous changes have occurred and leprosy has become more a disease, one amongst the other diseases and the patients get cured.
In that way there is a tremendous satisfaction. I have been a contemporary of many of the eminent people who have made this possible.
The tape received on October 9, 1989.