Histology in Nepal: Treating Leprosy

By: Debbie Wood

In 2017 I was asked by a dermatopathologist to join him on a trip to Nepal. Our task was to assess the Lalgadh Leprosy Hospital & Health Service Center and its patients, to determine if we could help them with a dermatopathology service. If you are asking yourself the same question I asked myself, the answer is yes, leprosy still exists. LLHSC, located 6 hours south of the capital, Kathmandu, in the lowland (terai) region of Nepal, is one of the busiest leprosy hospitals in the world. Annually they diagnose over 1,200 new leprosy patients each year, have 12,800 total leprosy consultations (new and returning), and over 100,000 outpatient visits of all types.

Leprosy is a terrible disease, causing nerve damage and muscle weakness that can lead to deformities, disabilities, crippling, blindness and isolation. It usually affects peripheral nerves causing loss of feeling in the hands, feet and eyes, making it difficult to complete daily tasks and hold a job, which in turn leaves those affected in extreme poverty.

In addition to the physical effects, patients also suffer a social stigma. In Nepal, an individual’s role is dependent in every way on the strong bonds that exist within the extended family, and the community, which makes the isolation these victims face, extremely devastating.

The Lalgadh Leprosy Hospital & Health Service Center first opened in 1996, for the purpose of treating leprosy patients. In the last twenty years they have expanded their services to treat not only leprosy, but other dermatological conditions as well, with patients traveling long distances to seek out this level of care. Of the around 100,000 patient visits a year, 80% of them are there for dermatological reasons. While there is currently a laboratory test for leprosy available, diagnostic tests for the other dermatological diseases present in Lalgadh are very limited.

In a review of 2 days of clinic patients at Lalgadh, 28 of 77 patients had a skin disease that would benefit from biopsy. It is therefore our goal to establish an onsite histology lab, which would aid in diagnosing a wide range of infectious, neoplastic and inflammatory skin conditions.

I applied for, and was awarded, the Lee Luna Foreign Travel Scholarship to help cover the cost of establishing this lab. We have spent the past few months gathering the required equipment, which we will soon be shipping to the hospital. We have also been able to bring some of the laboratory staff over to the U.S for dermatopathology and histology training. We will be returning to Nepal ourselves in October to get the equipment and laboratory staff up and running. Listen to my podcast episode to learn more about leprosy in Nepal and what you can do to help! If you are interested in donating, email me at demwood@iupui.edu

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