Perception and Practices of Leprosy among Bhils of Jhabua (Madhya Pradesh)
The World Health Assembly in 1991 recognizing leprosy as a serious public health problem, resolved to eliminate it by the year 2000. The major challenges were on one hand to identify the “latent cases” of leprosy and secondly to reach out to the patients residing in remote areas. The Danida Assisted National Leprosy Eradication Programme [DANLEP] which was operational in Madhya Pradesh was actively working towards leprosy elimination using Multi Drug Therapy [MDT] through State Health Department.
Special Action Project for Elimination of Leprosy [SAPEL] is an initiative to provide MDT service to patients residing in difficult areas. The present study is one of the efforts of SAPEL to look into the status of leprosy among the Bhil tribe of Jhabua.
Objectives & Methods
The major objectives of the project are to determine the knowledge, perception and health seeking behaviour of tribal community towards leprosy in tribal district of Jhabua. The study also tries to trace out the weaknesses in the existing system and the necessary measures that can make the programme more effective. For achieving these objectives the study mainly focused on collection of information on indigenous knowledge, behaviour of leprosy patients, impact of government efforts and strategies for better coverage and coordination.
Regarding methodology semi-structured questionnaire was prepared for the patients and villagers. The respondents included leprosy patients, community members, leprosy health workers, village leaders including Sarpanch, Tadvis and others. The study was concentrated on Bhil tribe of Jhabua district. The selected blocks were Thandla, Jobat and Sondwa. The sub clans of Bhils included in the study were Bhilalas and Patlias. The respondents included 45 leprosy patients and 36 public representatives from 18 selected villages, 6 villages per selected block. Out of these respondent patients, 26 were selected for detailed investigation using case study method.
A few strong perceptions of the Bhils about the leprosy are:-
Perception about leprosy
- The disease is incurable
- The disease is hereditary
- The disease occurs due to sin committed in previous life
- The leprosy patent should be buried alive to prevent the soul to come back to the same family / village.
- The Modern medicines have no cure for leprosy
- Leprosy patients have no right to get married.
- The Bhils are not convinced of MDT treatment.
Perception and social behaviour
- The villagers generally believe that the disease is infectious with the result they avoied such patients and socially boycott them.
- Some of the patients interviewed felt that if the villagers came to know about the disease their family status will reduce while some of them were scared that they would not be able to get their children married as the villagers may spread the news in the nearby villages.
- There is a strong belief that serious or acute patients should not be burnt after death as the smoke may spread the disease. They prefer such corps to be buried.
Awareness about government programmes
- Villagers are usually not aware of the government programme of free distribution of medicines. Only half of the patients interviewed were aware about MDT. Due to this the health workers took undue advantage and charged for the medicine.
- Villagers never had full faith in government services and continued to believe that the disease was incurable. Mostly the patients were too late to adopt allopathic treatment resulting in physical disabilities.
- During group discussion it was suggested that government may identify a place where all the leprosy patients may be kept for further treatment.
- The print and electronic media must be widely used to spread awareness about the disease, to wipe out the in-built fear about the disease. The method of communication may be in local language.
- Sarpanch, Panch, school teachers must be given a short orientation about leprosy, who in their turn may spread the massage among the villagers.
- Proper orientation of health workers is required so that they become more honest towards performing their duties.
- Every attempt must be made to bring attitudinal change among villagers about the disease.