Kuda Maloney, M.D/MPhil
Trinidad and Tobago: A feasibility study on the utility of a standard set of Images as a screening tool for Hansen’s disease.
Two heavy barrels block the entrance to the street, communicating the wordless instruction to STAY OUT. But the man leaning against the fence recognizes the social worker, waves two youths over to move the barrels and we drive through. We are in a shanty town built along an old railway line in Southern Trinidad. The community is tight with low tolerance for outsiders, and the living space even tighter.
Despite this, the social worker has established a careful trust allowing the physical and social barriers into the community to be temporarily laid aside, as she visits our contacts. I marvel at her ability to impart vague detail, giving people the impression that they know what’s going on, enough so to allow us access, without imparting any information at all. “ We are from the skin clinic” we smile.
We finally identify the house and climb the tenuous steps. She is lying spread across a mattress on the floor, the attraction of numerous flies. A nappied toddler crawls over her, patting her hopefully for attention. My heart stops for a second, fearing that she is dead, but returns to its usual cadence as I see her thin ribs rise and fall. She sleeps while we talk to her husband. We’ll have to wake her we explain, to look at her skin, as they were both listed as contacts for Hansen’s Disease. We explain what it is. “ Haw, the one from the Bible?” He asks in awe and we affirm. Eventually we wake her and chat to her. She is spent beyond her 30 years. I’m glad that neither of them have skin lesions or sensory symptoms, glad to not have to add to their list of problems. The next family we screen, deep in a rural village, is a riot. The mother is indeed that biblical picture of the leper, with nose collapsed, drooping eyes, contractured joints, multiple amputations. She has managed to draw people to her, her house is bubbling with the activity and laughter of her children and her neighbors. Only her household contacts, her family, are on the list of people to be screened. It is sobering though when we find classic lesions for Hansen’s Disease in one of her friends who fortuitously dropped by that day. We suspect Hansen’s in one of her sons too, and refer them both for evaluation at the Hansen’s Disease Clinic. Our suspicions are later confirmed. We are again met with warmth at the next home we visit as well as a mixture of fascination and pride that a doctor would visit them at home. We also find a new case of Hansen’s Disease there. The numbers are telling...there is still work to be done.