1. SOCIO ECONOMIC AND LEGAL ASPECTS OF LEPROSY/PEOPLE AFFECTED BY LEPROSY IN NEPAL R. Shah, G. Pokhrel and I. Tamang Raj Kumar Shah READ Nepal Email: read.leprosy333@ gmail.com G.Pokhrel & I. Tamang Leprosy Mission Nepal Email: training@tlmnepal.org Nepal Mountain Fishtail

2. Nepal

3. Introduction Landlocked country with 147,181 sq.km Altitude ranging 300 ft to 29,028 ft (Mountain Everest) Total population of Nepal 26,494,504 No of Government Hospital91 No of Primary Health Care Centre (DR. Service) 210 No. of Health post & Sub Health Post (Service from Paramedics) 3,785 0.94

4. Introduction Cont.. Leprosy was officially integrated to general health services in 1987 No of Endemic districts in Nepal (more than 1 PR) 17 District No of Major Leprosy Hospital 3 Leprosy is a still Socially stigmatized problem No of Leprosy Cases under MDT 2,430 No of Leprosy affected person cure from MDT More than 170,000 till now Having Disability grade II Approximately 40,000 existing Trend of PR and NCDR

5. Objective Examining the existing misconceptions, legal aspect, disfigurement and stigma is the major causes in deteriorating the socio economic conditions of leprosy affected people in society of Nepal

6. Method and Materials Literature review published in different journals Discussion with Nursing staff and paramedical worker working in Anandaban Hospital with key questions Discussion with admitted leprosy affected people in Anandaban Hospital with key questions Consultation with book VASTU SHASTRA Legal books of Nepal Review the history of KHOKANA Leprosarium Discussion about the religious, cultural and social codes with all groups of people 6

7. Common causes of stigma still in leprosy are.. Physical outward appearances Progressive characteristics over time Communicability and Disabling Religious links Discriminative legal aspects Poverty related and food habit Tradition of Isolation and Segregation 7

8. Cont… Tradition (Unknown) Priority level of leprosy programme in health Frequency of coverage in media Advocacy strategy and peoples involved Corporate/social obligation being a service provider, activist… 8

9. Individual effects (physical problems) Intra-family relations Within family and relatives Within organization Within community Emotional effects Physiological effects Social relationship and support Common Problems in Nepal

10. Economically marginalized (poor) Female and old age people People with disability due to leprosy Difficult to access in health facilities due to geographical conditions People from marginalize and ethnic groups Vulnerable People to Social Difficulties

11. Results: Misguide for conception: (Misconceptions) Believe in traditional causes & methods of treatment Prejudice opinion Social/religious/Traditional Dictum & Codes Construction house site Regular food habit Emerging the Misconceptions

12. Results Con… Legal aspects: Bankruptcy (KANGAL) Marriage and divorce Social Aspects: Exclusion and discrimination in different organization Isolation and segregation Physical aspects: Physical outward appearance Emerging the Misconceptions

13. Key Questions: Fact about leprosy – Cause of leprosy – Transmission methods – Causes of Disability and Deformity – Consequences of deformity Traditional believes and treatment of leprosy Religious concepts about leprosy Concepts about Leprosy Hospital Legal concepts about leprosy and rights Area of questions

14. Discussions: Awareness about leprosy facts Strategy for the advocacy and prejudices Amendment of laws, bylaws and acts Priority in health programme and media Human rights and social obligation Community Based Rehabilitation and socio economic development Leprosy Related Circumstances

15. Mount Everest