The People Battling Militants, COVID, and Leprosy

Cabo Delgado, a province in northern Mozambique, has endured a nightmare year, even within the context of a global pandemic.

Continued attacks by Islamist militants dubbed “ISIS-Mozambique” have displaced nearly 670,000 across Mozambique, with locals describing the horror of burnt villages, kidnapped relatives, bloodied bodies tied to trees, and starvation. Children as young as 11 have been beheaded by the militants, Save the Children said this month.

The horrific violence has resulted in increased levels of poverty, cutting off Cabo Delgado even more from international support. Now advocates say that there has been a knock-on effect of causing a rise in the prevalence of leprosy, a disease that requires significant resources and training to combat.

In 2019, there were 2,220 new cases of leprosy in all of Mozambique with Cabo Delgado particularly affected due to the vast number of homeless people escaping conflict. ALEMO Mozambique, a small organization that supports people in Mozambique affected by leprosy, collected data from partners in Cabo Delgado and found that “new cases of leprosy are rising, having registered 336 new cases in 2020 in the entire province.” The terrorist insurgency in Cabo Delgado exasperated already impoverished villages, increasing chances of catching a disease that is nearly always linked to malnutrition, overcrowding and poor sanitation.

“Leprosy is a disease of poverty and thrives where there are poor living conditions, a lack of sanitation and malnutrition,” Natalie Gibbs, programmes officer for Mozambique at the Leprosy Mission, a Christian NGO dedicated to fighting the disease in Africa and Asia, told VICE World News. “It is mainly found today in Asia, Africa and South America where there is insufficient healthcare, a lack of education around the disease and a deep-rooted stigma preventing people from coming forward for treatment.” 

Zaina Elias was a young mother when she first noticed discoloured patches on her skin. She wasn’t sure what they were, but when the patches became visible to others in Cabo Delgado, they were identified as signs of leprosy. 

The patches on Elias’ skin did not go away and due to myths surrounding leprosy, she was ridiculed and eventually banished into the forest. “Go to the bush. Go to the bush. Go to the bush,” they chanted over and over again, she recalled. Initially, Elias had her young son with her, but her sister took him away, leaving her utterly alone, without food or medicine. She thought, “I am dying. There is no chance to live.” 

Leprosy is a slow-acting disease often associated with Biblical or medieval times – an infection many believe easily spreads and has a high mortality rate, so this often leads to social exclusion. However, over the last few decades, leprosy has been studied and found to be completely treatable, if properly diagnosed. In 1982, the World Health Organisation (WHO) began dispensing a combination of three antibiotics that could eliminate the bacterium responsible for leprosy, in two years. If it’s caught and diagnosed early, a person can make a full recovery. 

Even though the antibiotic is provided at no cost by Novartis and distributed by the WHO, treating leprosy remains a constant battle in parts of the world.

The bacterium that causes leprosy can grow for up to 20 years before signs of the disease start to show – attacking the nerves and causing affected areas to lose the ability to sense touch and pain. The challenge for places like Cabo Delgado in treating this surge in infections is multifaceted: stigma, false beliefs about healing, lack of medical training, and restricted travel present barriers to tackling the disease.

Maria Da Luz Xavier, a local in Cabo Delgado, is one of the lucky ones, comparatively: when discoloured patches appeared on her body she was quickly diagnosed and given the correct antibiotics. But she was still abandoned by her family. “My husband abandoned me when he found out I had leprosy,” Da Luz Xavier said. “He feared I would transmit the disease to him. I was very sad when my husband abandoned me.” Da Luz Xavier was left to fend for herself and her 9-year-old son.

Before Da Luz Xavier was diagnosed, she went to a traditional healer. Traditional healers are usually approached if a person in Cabo Delgado notices patchy skin. “They may give the infected person a bottle of water to pour in their bath to heal the disease,” said Bahadir Celiktemur, Research and Policy Manager for the Leprosy Mission. It may take months for some people to be convinced that the treatment isn’t working, delaying a proper diagnosis and risking worsening debilitation. 

“When I met the health technician,” Da Luz Xavier continued, “he referred me to the hospital and started treatment.” 

Gabriel is a trained health worker, much like the one Da Luz Xavier would have seen, who travels miles on his motorbike to find and cure people with leprosy. “The diagnosis of the patient starts with me and I accompany all the treatment,” Gabriel says. Many healthcare workers have not been trained to recognise leprosy – some only have a “few hours” training, the Leprosy Mission said. “The Leprosy Mission gives us training and instructs us on how to deal with those affected,” Gabriel said. “Because Leprosy patients often reject their diagnosis, we are prepared on how to react to the psychological conditions of the patient both during their treatment and during diagnosis, so that he gets through the treatment and can finish it without problems.”

Gabriel spends long hours each day driving his motorbike, in the hot sun, on the red dirt roads of Cabo Delgado. There is no road infrastructure in the rural parts of Cabo Delgado, making the transportation of antibiotics difficult. When he pulls into a village, he says he is greeted with shouts and cheers of joy, bringing hope to the areas he works in.

A stranger found Elias, the young mother who was forced out of her village, living in the woods. He built a hut to shelter her from the rain and took her to a local health clinic, where she was given treatment, cured of leprosy, and reunited with her son.

The Leprosy Mission trains community leaders, traditional healers, and village chiefs to help recognise the signs of leprosy and alert trained health workers who can provide the antibiotics for free. The UK government has committed to doubling any donations made by the 24th of April to their campaign to end the transition of leprosy in Cabo Delgado. Elias was trained by the Leprosy Mission and now works teaching villages about leprosy and how to recognise signs. “Whatever it takes to locate the sick,” she says. “We will find them, take [them by the] arm, and take them to the hospital. We will do everything to make sure they take the medicine.” 

“To rid Cabo Delgado of leprosy,” Gibbs from the Leprosy Mission says, “there needs to be a cultural revolution surrounding the disease so that people seek early treatment and aren’t afraid of being rejected because of it.”