PHA-Exchange> Mass communication and behavioral change (2)

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From: <sunil.deepak at aifo.it>

Dear Sunil,

Thank you so much for sending me the interesting article by Prof. Banerjee.
My recent experience in Madagascar is an additional proof to confirm the
criticism against the WHO's social marketing strategy.

I went to Madagascar from 11th to 19th of April with Dr Yuasa, who wished to
visit there for facts-finding. Besides discussing with the national
authorities, WHO representative and their consultant for leprosy elimination
in Madagascar, we spent five days to visit five so-called hyperendemic
districts (with prevalence rate more than 10 per 10,000 population, some of
them reach 30 per 10,000), including several CSBs (centres des santé de
base, the most peripheral health centers) in each district.

In Madagascar, WHO only focus on: i) updating the register; ii) IEC, or
social marketing; and iii) forcing the national leprosy programme to
implement the "accompanied MDT" policy, but completely ignor the serious
problem of quality control in diagnosis and treatment of leprosy. They have
removed more than 60% of patients from the register through the campaign of
"updating the register", and they claimed that they have examined every
single patient before removing them from the register. However, the truth is
otherwise: in one of the district, while 31% of patients have been examined,
at the end 65% of the total patients (obviously many of them were not
examined) were removed from the register!  Before our site visit, their
consultant insisted that the over-diagnosis rate at the national level is no
more than 5%; but after examine some newly detected patients in the field,
our impression is that it would be lucky if the over-diagnosis rate is not
over 50%! Regarding the social marketing or IEC, we told them that
sensitization of the general population cannot replace the medical exercise
of the health workers in diagnosis and treatment, particularly great
majority of health workers have not been trained or only received very brief
training but lack of necessary skills for diagnosis and treatment. In brief,
the only objective for WHO is to bring down the prevalence rate at any
price!

Probably you heard about the news that since January 2002 until
October-November 2002 when we visited the field, case-finding activity was
forced to stop at the east coast districts (the most endemic area in the
country) by the provincial authorities, obviously the epidemiological data
of the year 2002 is not reliable. During our recent visit, there was a
serious dispute between us and WHO about the reliability of the 2002 data.
WHO consultant insisted that it was a minor issue and is "over", also
insisted that the serious event should not be mentioned in any documents.
Naturally, the strange behavior of WHO lead me wondering what was the role
playing by WHO in stopping case-findings in Madagascar?

Best regards.

Dr. Baohong Ji
Paris, France