BANGUI, 17 April 2007 (IRIN) - BANGUI, 17 April 2007 (IRIN) - Henri Kombo, a 60-year-old father of five from the southern M'baiki region of the Central African Republic (CAR) has suffered from leprosy for years and has watched the disease slowly debilitate him.

"Can I still say I am a man?" he said. "Previously, I tried to do something for my family; I cut palm trees to produce palm wine. Today the disease [has affected] me and I cannot do anything anymore."

Forced sometimes to beg, Kombo wished the CAR authorities could provide him with help to overcome his misery. "I have become a burden to my children and family. Nuns send soap, some money and old clothes but these are not enough."

Kombo is just one person in CAR suffering from a disease that has largely been eradicated from many parts of the world. A country of more than four million people, CAR has tried to fight the disease, but it still persists. According to statistics at the health ministry, some 2,242 cases were reported in 1996, although this figure is reported to have fallen since then.

"A census of affected people in 2005 found 329 leprosy patients presenting not only physical handicaps but also suffering from multiple social problems," said Thomas d'Aquin Koyazegbe, coordinator of the National Programme to Fight Leprosy, (PNLL).

"They are forgotten by their families, without any decent accommodation," he added.

According to official statistics, CAR had fewer than one person in 10,000 suffering from leprosy in 2005. However, this has not enabled the country to be deemed leprosy-free.

PNLL officials said the fight against the disease had been complicated by difficulty of access to some remote villages. These include villages in forest zones inhabited by pygmies in Lobaye and Sangha Baéré areas of southern CAR.

To make matters worse, the pygmies tend to move between the CAR, the Democratic Republic of Congo, Cameroon and Gabon; sometimes for periods of six to 12 months. This makes it difficult to deliver medicine to them, creating hidden pockets of the disease.

According to the United Nations World Health Organization, leprosy is a chronic disease caused by a bacillus. Symptoms can take as long as 20 years to appear, although the disease is not highly infectious.

It is transmitted via droplets from the nose and mouth, and mainly affects the skin and nerves. If untreated, there can be progressive and permanent damage to the skin, nerves, limbs and eyes.

The disease remains a major public health problem in six countries in Africa, including CAR. A report by the PNLL presented in March indicated that new cases had appeared, proving that the threat of leprosy remains.

Countering attitudes

The fight against leprosy in CAR began several decades ago, but political upheavals and social attitudes have disrupted it.

According to Koyazegbe, the social stigma that lepers face remains a major challenge. "The people handicapped by leprosy are stigmatised, despised and socially excluded," he explained.

"Leprosy is a punishment from God. Only those who are guilty of relationships with family members or who have been incestuous are hit by this disease," Mologbama Georges, a 45-year-old craftsman said. "Isolating them from the rest of the population is justice - that is what I have been told since I was very young."

PNLL received a boost to its efforts in October 2003 when a taskforce of officials from various ministries and civil society was created to assist it.

"Leprosy is not a punishment from God," said Dénis Sapoua, a doctor who is a member of the taskforce. "We try to explain to different people that leprosy is a disease like others despite what people tend to think. It can be treated if reported on time [and] treatment is free."

To support ongoing sensitisation work, the government has provided health centres with relevant equipment, and encouraged them to hold "leprosy days".

Still, the social problems that patients face remain. According to an association that is helping leprosy patients, Emmaüs Suisse [Ales], medical donations and sensitisation are not enough; there also has to be a social programme for the care of the patients.

The association is implementing such a programme for patients who are not in the healthcare system, in which they will receive medical attention, physical and social support.

"[We need] to reestablish their lost dignity, to try to put an end to their status of beggars, to humanise and reintegrate them into a society that used to be theirs," said Etienne Dolido, the association's technical representative in CAR.

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