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Leprosy, also known as Hansen's disease, is an infectious disease caused by the Mycobacterium leprae bacterium that can lead to disfiguration of the body or skin. The modern term for the disease is named after the discoverer of the bacterium, Gerhard Armauer Hansen.
Contents
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* 1 Treatment
* 2 Clinical features
* 3 Transmission
* 4 Incidence
* 5 Risk groups
* 6 Term "Leprosy"
* 7 Asylums
* 8 Famous people with leprosy
* 9 See also
* 10 In literature and film
* 11 References
* 12 Further reading
* 13 External links

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Treatment

Historically, leprosy was an incurable and disfiguring disease. It is traditionally believed that lepers were shunned and sequestered in leper colonies. However, this is an oversimplistic explanation not at all supported by historical evidence. A very great number of leprosaria or leper hospitals sprang up in the middle ages, particularly in England, and there were 250 in England around 1230 A.D., the first recorded one being at Harbledown. These institutions were run along monastic lines, and whilst lepers were encouraged to live in these monastic type establishments, this was for the health of their own souls as well a segregation policy. Indeed, in Catholic tradition, those suffering from leprosy were considered to be going through Purgatory on Earth, and for this reason their suffering was considered more holy than the ordinary person's. Saint Radegund was noted for washing the feet of lepers, and Orderic Vitalis writes of a monk, Ralf, who was so overcome by the plight of the leper that he prayed to catch leprosy himself (he eventually did catch it). The leper would carry a clapper and bell to warn of his approach, and this was as much to attract attention for charity as to warn people that a diseased person was near. Most importantly, Jesus was said to have walked with the leper, and so in medieval religious society, it was a noble thing to be able to converse and build relationships with the leper.

Dapsone was used to treat leprosy from 1946, but it was necessary to take dapsone for months if not years, making compliance difficult. Search for more effective medicines led to the discovery of clofazimine and rifampin in the sixties at Novartis. Of the two, rifampin proved to be particularly effective. The first study using rifampin to treat leprosy was published in 1970.[1] A major breakthrough occurred in leprosy treatment in 1982, with the introduction of Multi-Drug-Therapy (MDT) based on studies published by Shantaram Yawalkar and colleagues.[2] The treatment Yawalkar formulated consisted of dapsone and rifampin combination.

For most people, a six month course of tablets for the milder form of leprosy and two years for the more severe form will cure them of the disease. However, for those who suffer a disabling reaction caused by the build-up of dead bacilli in the body, additional steroid treatment is given.

The main challenges in the eradication of Hansen's disease are in reaching populations that have not yet received multidrug therapy services, improving detection of the disease, providing patients with high-quality services and affordable drugs, and fighting social taboos about the disease where patients are considered to be "unclean", or "cursed by God" as outcasts. The last issue is important to address, because in such societies, patients may be forced to hide their condition (and thus not to seek treatment) in order not to be discriminated against, since the lack of awareness about Hansen's disease leads people to falsely believe that the disease is highly contagious and incurable. Since 1995, the World Health Organization (WHO) has provided all endemic countries with free MDT, supplied through Ministries of Health. In December 2005, an agreement was signed between the WHO and the pharmaceutical company Novartis to extend this free provision until at least the end of 2010.
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Clinical features

The disease affects the skin, nerves, and mucous membranes. This chronic infectious disease usually affects the skin and peripheral nerves but has a wide range of possible clinical manifestations. Patients are classified as having paucibacillary (tuberculoid leprosy) or multibacillary Hansen's disease (lepromatous leprosy). Paucibacillary Hansen's disease is milder and characterized by one or more hypopigmented skin macules. Multibacillary Hansen's disease is associated with symmetric skin lesions, nodules, plaques, thickened dermis, and frequent involvement of the nasal mucosa resulting in nasal congestion and epistaxis (nose bleeds). Contrary to popular belief, Hansen's bacillus does not cause rotting of the flesh; however, due to the body's extensive attempts to rid itself of the bacterium, defenses such as inflammation, cytokines, activated macrophages and other mechanisms cause tissue destruction and regeneration leading to excessive growth and eventually mutilation.


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Transmission

The mode of transmission of Hansen's disease remains uncertain. Most investigators believe that the bacterium is spread from person to person through respiratory droplets. What is known is that the transmission rate is very low. In addition, approximately 95% of people who are exposed to it do not develop leprosy.[3]
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Incidence

Aside from humans, other creatures that are known to be susceptible to leprosy are the armadillo, mangabey monkeys, rabbits, and mice (on their footpads).

According to recent figures from the World Health Organization (WHO) new cases detected worldwide have decreased by approximately 107,000 cases or 21% from 2003 to 2004. This decreasing trend has been consistent for the past three years. In addition the "global registered prevalence" of leprosy was 286,063 cases with 407,791 new cases being detected during 2004.

In 1999, the world incidence of Hansen's disease was estimated to be 640,000; and in 2000, 738,284 cases were identified. In 1999, 108 cases occurred in the United States. In 2000, the World Health Organization (WHO) listed 91 countries in which Hansen's disease is endemic, with India, Myanmar, and Nepal having 70% of cases. In 2002, 763,917 new cases were detected worldwide, and in that year the WHO listed Brazil, Madagascar, Mozambique, Tanzania and Nepal as having 90% of Hansen's disease cases.

Worldwide, one to two million people are permanently disabled because of Hansen's disease. However, persons receiving antibiotic treatment or having completed treatment are considered free of active infection. India has the greatest number of leprosy cases, with Brazil second and Myanmar third.

Hansen's disease is one of the infectious diseases tracked passively by the Centers for Disease Control and Prevention. Its prevalence in the United States has remained low and relatively stable. There are decreasing numbers of cases worldwide, though pockets of high prevalence continue in certain areas such as Brazil, South Asia (India, Nepal), some parts of Africa (Tanzania, Madagascar, Mozambique) and the western Pacific.
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Risk groups

Those having close contacts with patients with untreated, active, predominantly multibacillary disease, and persons living in countries with highly endemic disease are at risk of contracting the disease. Recent research suggests that there is genetic variation in susceptibility. The region of DNA responsible for this variability is also involved in Parkinson's disease, giving rise to current speculation that the two disorders may be linked in some way at the biochemical level. In addition, men are two times more likely to contract leprosy than women.
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Term "Leprosy"

Sufferers of Hansen's disease have historically been known as lepers, however this term is falling into disuse as a result of the diminishing number of leprosy patients and the pejorative connotations of the term. In fact, the term that is now most widely accepted among people and agencies working in the field of leprosy is "people affected by leprosy". The terms "leprosy" and "lepers" can also lead to public misunderstanding because the Bible uses these terms in reference to a wide range of skin conditions other than Hansen's disease. The term itself first appeared in the English language in the 1300's coming from Greek and Hebrew. [4]
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Asylums

There are still a few leper colonies around the world, in countries such as India and the Philippines.

Western humanitarian and church organizations regularly send relief supplies, including handmade "leper bandages"; bandages knitted or crocheted out of cotton, for greater breathability and durability than traditional gauze. The bandages can also be washed, sterilized, and reused making them more cost effective as well. Though leper bandages can be machine made, the colony inhabitants tend to appreciate the handmade variety.

In 2001, government-run leper colonies in Japan came under judicial scrutiny, leading to the determination that the Japanese government had mistreated the patients, and the District Court ordered Japan to pay compensation to former patients [1]. In 2002, a formal inquiry into these colonies was set up, and in March of 2005, the policy was strongly denounced. "Japan's policy of absolute quarantine... did not have any scientific grounds." [2] The inquiry denounced not only the government and the doctors which are involved with the policy but also the court which repeatedly ruled in the favour of the government when the policy was challenged, as well as the media which fail to report the plight of the victims. There are about 7000 records of forced abortion and sterlisation. In some instance of late term "abortion", it is reported that babies are suffocated and killed after birth. [3]
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| Neglected diseases

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Kenneth Loach (born June 17, 1936), known as Ken Loach, is an English television and film director, known for his social realist style and socialist themes.



Biography


Born in Nuneaton, England, Loach studied law at St Peter's College, Oxford. He started out as an actor in repertory theatre, but in the early 1960s moved into television direction and was credited in this role on early episodes of Z-Cars in 1962. Loach, though, made his greatest impact in the medium through docu-dramas, notably the socially influential Cathy Come Home (1966). In the late 1960s he started directing films, and made Kes, the story of a troubled boy and his kestrel, based on the novel A Kestrel for a Knave by Barry Hines. It remains perhaps his best known film in Britain.


Carol White as the title character in the 1966 BBC television play Cathy Come Home, one of Loach's most famous works.




The 1970s and 80s were less successful, with his films suffering from poor distribution, lack of interest and political censorship. His film The Save the Children Fund Film (1971) was commissioned by the charity, who disliked it so much they attempted to have the negative destroyed. It has yet to be shown in public. He was also commissioned by Channel 4 to make A Question of Leadership, a documentary on the UK miners' strike. However, the programme was not broadcast by Channel 4, a decision Loach claimed was politically motivated.


However, the 1990s saw Loach return to form, with the production of a series of critically acclaimed and popular films. During this period he was also three times awarded prizes at the Cannes Film Festival.


He directed the Courtroom Drama reconstructions in the Docu-film McLibel, about the longest trial in English history.


In December 2003, he was awarded an honorary doctorate by the University of Birmingham.


In May 2006, he was awarded the BAFTA Fellowship at the BAFTA TV Awards.


In November 2004, he was elected to the national council of the Respect coalition.


On 28 May 2006, Ken won the prestigious Palme d'Or at the Cannes Film Festival for his film The Wind That Shakes the Barley, a controversial view of the Irish War of Independence between the Irish Republican Army and the British, and the subsequent Irish Civil War during the 1920s. The film has been heavily criticised by sections of the British media.


Ken Loach lives with his family in Bath, England where he is a supporter and shareholder in Bath City F.C. He is also on the National Council of the left wing Respect Coalition.




Film style


Loach's film work is characterized by a particular view of realism; he strives in every area of filmmaking to emphasize genuine interplay between actors, to the point where some scenes in his films appear unscripted. Rather than employing method actors, he prefers unknown talent who have had some of the actual life experience of the characters they portray - so much so that many professional actors aspiring to work with Loach will often pretend to be actual construction labourers or other working class types called for in his script.[1]. For Bread and Roses, he chose two leading actors who had experience of union organizing and life as an immigrant. The lead actress in the film, Pilar Padilla, actually had to learn English in order to play the part.


He tries to make sure that actors express as genuinely as possible the feelings of their characters by filming the story in order, and crucially, not giving the actors the script until a few minutes before the filming. Frequently in a scene, only some of the actors will know what is going to happen - the others will often be able to express genuine surprise shock or sadness because they really are hit with the events of the scene.


Two examples: in Kes the boy actor, discovering the dead bird at the end, believed that the director had actually killed the bird he had become quite close to during the filming (in fact he had used a dead bird found elsewhere). In Raining Stones one of the actresses visited at her house by a loan shark had no idea that he was going to force her to take off her wedding ring and give it him as part payment. There are many other examples.


Ken Loach is a strong opponent of censorship within films and he was outraged at the certificate given to Sweet Sixteen (it was given an 18). Loach himself said; I think it was a very silly decision, such a patronising attitude as well. People are rarely hurt by swear words, yet you see scenes of violence depicted in films often with a 12 certificate. Some of these films have violence for the sake of it, try and push the certification boundaries. I think in my films that the violence is necessary to portray realism, it’s important to the narrative. And yes, it does put a smokescreen on society because it uses violence as a source of entertainment rather than its actual meaning




Filmography




Television

Z Cars (series, 1962)

Diary of a Young Man (1964)

3 Clear Sundays (1965)

Up the Junction (1965)

The End of Arthur's Marriage (1965)

Coming Out Party (1965)

Cathy Come Home (1966) (as Kenneth Loach)

In Two Minds (1967)

The Golden Vision (1968)

The Big Flame (1969)

The Rank and the File (1971) - part of the Play for Today series.

After a Lifetime (1971)

A Misfortune (1973)

Days of Hope (mini-series, 1975)

The Price of Coal (1977)

Auditions (1980)

A Question of Leadership (1981)

The Red and the Blue: Impressions of Two Political Conferences - Autumn 1982 (1983)

Questions of Leadership (1983)

The View From the Woodpile (1989)


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Cinema

Poor Cow (1967)

Kes (1969) (as Kenneth Loach)

The Save the Children Fund Film (1971)

Family Life (1971)

Black Jack (1979)

The Gamekeeper (1980)

Looks and Smiles (1981) (as Kenneth Loach)

Which Side Are You On? (1984)

Fatherland (1986)

Hidden Agenda (1990). Cannes Special Jury Prize.

Riff-Raff (1990). Shown with subtitles in the USA, because of British dialects.

Raining Stones (1993). Cannes Special Jury Prize.

Ladybird Ladybird (1994)

Land and Freedom (1995). FIPRESCI International Critics Prize and the Cannes Ecumenical Jury Prize.

A Contemporary Case for Common Ownership (1995)

Carla's Song (1996)

The Flickering Flame (1997)

My Name Is Joe (1998)

Bread and Roses (2000)

The Navigators (2001)

Sweet Sixteen (2002)

Ae Fond Kiss... (2004)

Tickets (2005), along with Ermanno Olmi and Abbas Kiarostami

The Wind That Shakes the Barley (2006) Palme d'Or, Cannes

These Times (2007) (Currently in pre-production)




External links

Ken Loach at the Internet Movie Database

Ken Loach at SensesOfCinema.com

Ken Loach Filmography

Interview with Loach about My Name is Joe

Interview with Loach from 1996 about Land and Freedom

Interview with Loach from 1998

A biography

Biography from BFI's screenonline

Posters and Stills Gallery from the BFI

Interview: Ken Loach about Media, Culture and the Prospects for a New Liberatory Project, Democracy&Nature, Volume 5, 1999.