Learning to manage leprosy after 2005: preserving critical knowledge and exploiting new technology

Amidst the many challenges currently facing leprosy services, two key training issues stand out. Firstly, the struggle to maintain an adequate pool of appropriately knowledgeable and skilled health workers in endemic areas, in order to sustain leprosy services in an integrated setting. The second major challenge is to utilize technology in the fields of training, communication and informatics, in a cost-effective manner. During the next few years, we face the loss of knowledge and experience in the management of leprosy. Many experienced clinicians, from clinic level health workers to district supervisors, medical officers and specialists, will no longer be working with leprosy patients, for a variety of reasons. Many are retiring, or they are being re-assigned to other work; others are leaving to advance their careers elsewhere, either within the same country or abroad. Thus it will become more difficult for people with leprosy to access expert and timely care – both for the initial diagnosis and for the management of complications. Furthermore, these experienced clinicians have, until now, been responsible for the training and supervision of junior staff, who see and manage most cases. Thus over time, one may predict that the quality of care for most new leprosy cases will deteriorate. While this may be inevitable in low endemic areas, it may also become a problem in areas where large numbers of new cases are still presenting. A similar problem is occurring in the commercial world as large numbers of senior staff are expected to retire in the next five to ten years. This has led to further thinking about the kind of knowledge that is particularly at risk of being lost and how it can be preserved. The converse of the problem of the loss of senior staff is the need to enable the many new health staff in integrated health units to learn the clinical and counseling skills necessary to suspect and manage leprosy. There are large numbers of such staff and each one will see at most only a few cases of leprosy throughout their career. Nevertheless, appropriate training at each level (both the primary clinics and the referral centers) will be essential if people affected by leprosy are to be given the treatment they need.