Saturday, 29 March 2014

Team Lockwood at a Leprosy Conference in Le Corbusier’s City. (Mar 2014)

Participating in the IAL meeting in Chandigarh linked into leprosy science and politics and nutured my many friendships.

India has the largest national leprologist meeting so an invitation to speak at the Indian Association of Leprologists (IAL) meeting in Chandigarh, (Mar 2014) was irresistible. I brought my London team, Steve Walker, Saba Lambert (currently in Addis) and David Chandler an MSc student who did a project on the household costs of having ENL, a leprosy complication, in West Bengal. We had to leave our Sudanese colleague Omer Haroun in London because he could not get an Indian visa even though he spent 7 months in Mumbai last year doing new work on neuropathic pain. Team Lockwood stayed in the le Corbusier designed Punjab State Guest house, a 1950s building with a compact design, huge lobbies and mature cedar trees in the garden, we took morning walks by the lake. Our Punjabi hosts organized an excellent conference with talks and excellent open-air parties. The meeting was held in the Postgraduate Institute of Medical Education & Research (PGIMER), one of India’s leading medical institutes where the dermatologists remain committed to the work on leprosy initiated by Bhushan Kumar, a previous head of the department.

The programme included talks from leading Indian leprosy workers including Dr. Vishwa Mohan Katoch, overseas visitors and people working for leprosy in India- NGOs, National and state leprosy programmes. The challenging question of the numbers of leprosy patients in India was mentioned in many talks but more discussion was needed about how to assess the problem now. India achieved “elimination of leprosy as a public health problem in 2005” and this was achieved after patient numbers dropped precipitately between 2003 and 2007. I gave a talk based on my BMJ paper in which I, Vanaja Shetty and Gerson Penna showed that setting targets leads to innovative ways of reducing patient numbers. (1) There was agreement that there is now reduced capacity for diagnosis, highlighted by the talks by Dr. Krishnamurthy and Dr. Sundar Rao.

A new tension is developing because in some districts there will be enhanced case finding which means detecting more cases and this is not compatible with elimination at a district level. I was struck by the presentation of the dermatologist Archana Singal from Delhi who presented data on the numbers of children presenting to her hospital clinic, and showed a significant disability rate in these children indicating that they had been diagnosed late. The Delhi state leprosy officer disputed her data and maintained that there were low levels of children with disabilities in Delhi. The state leprosy officer in Odisha showed that there are districts with high rates, and this is compounded by a huge shortage of trained personnel for the leprosy programme posts. There were two key presenters missing, Dr. Barua from the WHO Leprosy Unit failed to attend, also absent was Dr. Kiran Katoch, she has been closely involved with the Indian national Leprosy sample survey. This was done in 2010 but the results have not yet been published, Dr. Vishwa Mohan Katoch (head of the Indian ICMR) assured us that Parliament would have to discuss the results first. We missed their talks and the opportunity to discuss their findings.

An early morning visit to the Nek Chand sculpture garden was a cultural reward. We were the first visitors and we wandered alone through Chand’s amazing grottos, sculptures and admired his work with figures decorated with glass bangles and abstracts made of old light fittings.
The Punjabis are great partiers and every evening there was an open-air party with abundant booze including Indian style mojitos, food and Punjabis disco dancing. I danced freely and found myself on the conference You Tube next day. When I looked at the clips with my friend Annamma she commented that it must be nice to be so free which is a sad reflection on the trappings of marriage and society.

After the conference I visited Bhushan Kumar and his wife Sarla at home. They have a well appointed house with interesting Indian art and effigies of Hindu gods. Both their children are working in the US, I met their California based IT son with easy openness and an American accent. Bhushan and Sarla retired over 10 years ago but continue to practice. Kumar sees about 10 patients a day in small clinic at the side of his house. It is a real contrast to his days as head of department but also a nice way of using ones medical skills in a low key way.

I was last in Chandigarh 20 years ago and on that visit I then went to visit the Manali valley and drove up to the Rohtang pass. This time I appreciated the lack of traffic in Chandigarh and the organization. I was sorry not to be able to stay on and visit the other le Corbusier buildings.
I travelled to and from Delhi on the fast Shatabdi express. Indian Rail has embraced electronic ticketing and many people showed the travelling ticket inspector their tickets on their smart phones.
I stayed with Jasjit Man Singh in Delhi, she treats me like a daughter welcoming me with green tea even at 3am when I arrived from the London flight and being part of her family enriches my visits. Last time I was there (May 2013) her mother aged 107 was dying; Jasjit had spent years looking after her mother at home. Jasjit is now freer, less sleep deprived and more relaxed, and also on her own spiritual journey. She is an established writer and has written a book about her mother’s life. She writes vividly about her mother‘s early life including a spell as a PhD student in London, marriage to an Army doctor and building an unusual Art Deco house in Haus Khaz. There were family tensions at the end of her life between one son wanting aggressive intervention and others for her to die quietly at home. I suspect that such disagreements are common where ever there are advanced medical facilities.

I left my iPad in Delhi, a disaster because I use it so much professionally. Fortunately I activated my network and within three weeks my iPad had returned to London via Budapest thanks to Leprosy Mission meeting there.

Saba commented on how happy I looked in India, I enjoy being there but it was especially nice having my team there. We all participated in the IAL meeting with different contributions and each took our own lessons from the conference. Many of my professional friends are in the IAL and I enjoyed the warmth of these friendships as well as meeting my close friends .I also met up with many friends and Sujai and Suman Jain from Hyderabad. Sujai was showing photos of his newly adopted daughter aged 6 weeks.

This visit encompassed the politics and science of leprosy, the architecture of Chandigarh and the warmth of friendship.

Lockwood DNJ, Shetty V, Person GO. Hazards of setting targets to eliminate disease: lessons from the leprosy elimination campaign BMJ 2014;348:g1136 doi: 10.1136/bmj.g1136 (Published 7 February 2014)

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