A three-year-old girl from Badsuwa village in Mayadevi Rural Municipality, Kapilvastu, has red spots on her right arm. Her five-year-old brother also has similar red spots on his cheeks and neck. Their seven-year-old sister also has red spots and freckles on her back, wrists, and arms.

Their family was unaware of their condition for a while, but after several visits to health facilities, they learned that all three children from the same family were suffering from leprosy.

Leprosy, also known as Hansen’s disease, is a chronic infectious condition caused by Mycobacterium leprae. The disease affects the skin, the peripheral nerves, the mucosal surfaces of the upper respiratory tract, and the eyes. Leprosy is known to occur at all ages, ranging from early childhood to old age. The disease is curable, and treatment during the early stages can prevent disability, according to the World Health Organisation (WHO).

Leprosy is transmitted via droplets from the nose and mouth during close and frequent contact with untreated cases.

On January 10, 2010, Nepal government first announced that leprosy had been completely eradicated from the country. Later, after new patients started showing up, the government set a new target to make the country leprosy-free by 2020, but the plan failed again, so they set a new deadline of 2030.

After Dumra Health Post, located in ward 6 of Mayadevi, started getting visits from suspicious patients, a medical team under the leadership of Dr Mukesh Chaudhary, a medical officer at Kapilvastu Hospital, reached the rural municipality to identify the patients.

On Friday, the team under Chaudhary and health workers visited the homes of the suspicious patients and identified two people infected with leprosy in ward 6 of Mayadevi. According to Chaudhary, all five patients from Mayadevi Rural Municipality have been given leprosy medications.

Kapilvastu has now become the district with the highest number of leprosy patients in the country.

According to Mohammad Irfan, an officer at the Kapilvastu District Health Office, in the last fiscal year, 164 new patients with leprosy were found in the district, and 108 new patients were found in the fiscal year 2021-2022.

In the fiscal year 2012-2013, Kapilvastu was declared leprosy-free, and for some five years the situation was under control, but slowly the number started increasing with time, which has put the district on top with the highest number of leprosy patients in the country.

“Due to a lack of awareness and knowledge, patients hide their disease and inadvertently transmit it to others. In most of the cases of the new patients, when they first start developing symptoms, they only visit some local pharmacies, avoiding proper medical examination until their condition worsens,” said Irfan. “The problem is getting out of control in the district as patients continue to hide and ignore their symptoms,” Irfan added.

Narayan Prasad Chaudhary, chief of the district health office, said that while taking surveys of the new patients, it was found that patients also often hide their condition due to the superstition associated with leprosy as a stigma and religious curse.

“The highest number of leprosy-infected people have been found in Bijaynagar Rural Municipality of the district, and most of the patients did not go to the hospital until it became a big problem. If an infected person doesn't go to the hospital for a long time, then they can easily transmit the disease to others, and when the disease becomes complicated, it can lead to body parts decaying,” said Chaudhary.

Organisations, including the WHO, have also stopped supporting leprosy control programmes. Even though the problem is getting worse, the Ministry of Health has scrapped the Leprosy Control Division.

The infection caused by slow-growing bacteria in leprosy gradually affects the skin and causes thick, discoloured patches of skin, usually flat, that may be numb and look faded. Similarly, nodules on the skin and painless ulcers on the soles of feet sometimes lead to people having numb body parts and skin.

According to health workers in the district, symptoms appear within two to five years of disease onset, and after that, the effects are brutal and badly affect the body.

“Due to the open border with India, it has become challenging to control leprosy in Tarai districts. The number of patients is increasing due to the people who migrate from the hilly areas and the patients who return after working in India,” said Madhab Aryal, senior auxiliary health worker at the Parsohiya Health Post located at ward 4 of Yashodhara Rural Municipality.

Recently, a leprosy prevention programme has been launched to prevent people who are in contact with leprosy patients from contracting the disease. Under the programme, the family is also checked for the disease in five houses around each house where new patients are found.

Leprosy can be cured by regular medication for six months to a year.

According to the district health office, in Kapilvastu, 61 percent of patients come under the one-year regular medication list, and some 4.27 percent of the patients are disabled and did not get treatment on time.

If the disease is detected and treated on time, the patient will not be maimed, and the possibility of transmitting it to others also decreases to a minimum.

“The disease is transmitted through droplets from the nose and mouth. One has to be in prolonged, close contact over months with someone with untreated leprosy to catch the disease. The disease is not spread through casual contact with a person who has leprosy, like shaking hands or hugging, sharing meals, or sitting next to each other,” said Dr Mukesh. “In about 80 percent of cases, this disease gets better on its own, while about 20 percent of people with weak immunity need treatment. The patient stops transmitting the disease when they begin treatment,” Dr Mukesh added.