Baton Rouge: US Hansen’s patients, Southern Hospitality, Mar 2019

I visited the US National Hansen’s Disease service, United States of America in March 2019. I enjoyed seeing patients there and interacting with the physicians and researchers. I enjoyed Cajun food and Southern hospitality. Barbara Stryjewska and John Prestigiacomo are the United States Hansen’s Disease physicians in the national centre in Baton Rouge and we discussed their patients. Many came from Costa Rica, Micronesia. Marshall Islands, and Mexico. They genotype the leprosy mycobacterial strains infecting the patients. One patient from Mexico had both M. leprae and M. lepromatosis infection and was experiencing typical leprosy. I lectured on my work describing my voyage into leprosy with my research and clinical work. I aimed to improve patient outcomes. My map showing the UK patients coming from 34 different countries was admired. I talked about using single monthly doses of Rifampicin, Oxfloxacin and Minocycline as treatment. Barbara took me to Houmas house, an old plantation house, with southern elegance and fine gardens. The evening light was beautiful on the azaleas. We walked around the grounds. Then had interesting cocktails with gin, lime juice and Prosecco in the elegant bar. We shared crab claws and shrimps and I had shrimps on aubergine. Barbara left Poland in 1988, came to the US and retrained. She is a thoughtful clinician and worries about the patients and the adverse effects they experience from the steroid drugs needed to treat leprosy reactions The next day we talked and saw videos of American patients who had acquired their leprosy in the USA. This is due to infections carried by armadillos. One seventy three yr old man was diagnosed late after presenting with a Borderline Lepromatous reaction with oedema and pain and it took him months to be diagnosed, not surprisingly no-one suspected leprosy. He was diagnosed when a skin biopsy was done to investigate his unusual skin rash. A woman from Oregon developed leprosy after a visit to Louisiana 20 yrs ago, maybe having encountered armadillos in Louisiana. Probably many people are infected with M leprae after encountering armadillos but only a few develop disease. The videos of patients are great teaching tools. We lunched in a local cafe, deep fried oysters as a starter then catfish with rice and were given with a discount for us being in US forces through working for the USNHD. The big cities of Los Angeles, Chicago, New York and Miami have the highest numbers of leprosy patients with many patients with reactions, like the patients in my clinic in London. I hope they will start using the Enlist Severity Score in the USA, we developed this as a tool for monitoring disease severity. The social worker was interested in the New Face for leprosy and some patients there might participate. I shared the Lancet New Face article with some of the patients here, Pedro and Dante who were interested in the project. In the afternoon we drove downtown and scrambled up onto the levee next to a full Mississippi. We had supper of sushi on an open air terrace with a beautiful view of the river. Tugboats were plying up and down the river. We were close to a huge bridge with boats moored, a destroyer and a river boat. The sun set and the river went many shades of blue. It was a beautiful moment. Working for the US government gives them safety but many restrictions. They attend few conferences, and these have to be approved. The next morning, I meet with Linda Adam’s group of scientists at the Louisiana State University. They are working on armadillo models of neuropathy, doing drug testing for leprosy in the nude mouse model, and doing M .leprae strain typing, there are armadillo associated strains which are passed between humans as well. M lepromatosis, causes many cases and all types of leprosy in Brazil. I saw the armadillos, pairs of brothers living in cages. They beat their feet against the cages, a sad sound. I enjoyed these days in Baton Rouge, seeing patients in the USA, and the armadillos are transmission of leprosy here. I enjoyed talking to the small group of leprosy scientists here and appreciated the evening beauty of the Mississippi. Sadly John died of Covid in September 2020. He is one of the few people I know to have died. He was very devoted to his Hansen’s patients. He also had diabetes.