Radio Wa is talking health

Most people in Uganda, including health professionals, think leprosy is extinct, an ancient disease from biblical times. They are wrong. From 2008 to 2012, 1500 new cases were diagnosed, and two thirds were reported in the country’s comparatively poor north, a region with a very low population density that is traumatised by 20 years of war inflicted by a militia called the Lord’s Resistance Army. It also has the comparatively high prevalence of tuberculosis and HIV/AIDS.

Over 100 years after the mycobacterium leprae was first identified, leprosy is still prevalent in many countries, and the ways of transmission are still not understood. The disease affects skin and nerves. Nerve damage leads to the characteristic loss of sensibility, first affecting the extremities and later causing the loss of fingers and toes. Even facial features can be disfigured as the illness progresses.

Leprosy can be cured with simple antibiotics that do not cost much. The therapy takes six to twelve months. If the loss of limbs is to be prevented, however, the disease must be diagnosed and treated early on.

This is the way to prevent lifelong suffering. Depressingly, however, many patients spend years going from one quack healer to the next incompetent health provider, until the destruction of limbs becomes too obvious to miss the diagnosis. Even many scientifically-trained health workers fail to identify the disease when they see the skin patches. Therefore, information and awareness raising are paramount in the fight against this age-old disease.

The main challenges of leprosy control are:

• a lack of community awareness,
• delays in the diagnosis,
• the hidden and growing presence of leprosy in so called ‘hot spots’,
• the diminishing knowledge and skills of health workers and
• patients dropping out from treatment regimes.

To ensure impact, the Talking Health programme, which was designed to tackle leprosy in eight northern Ugandan districts, involved a local radio station. It was run from March 2014 to December 2015 by the German Leprosy and TB Relief Association (GLRA), a non-governmental organisation. A sub-national German government body, Nordrhein-Westfälische Stiftung zur Förderung der Leprahilfe, provided the funding. Talking Health was designed to educate people in eight districts in northern Uganda. The programme involved a local FM station Radio Wa, the district administrations and Uganda’s National TB and Leprosy Programme (NTLP). It spread general information, but also offered medical services and built capacities at local health facilities.

Spreading the news

About 2 million people live in the region, and almost all can receive Radio Wa, which has been running health programmes for a long time. In the context of Talking Health, it began focusing on leprosy. Affected people shared their stories on the air, and listeners could call in and would get competent advice.

Leprosy became a regular topic in Radio Wa’s health programme which is called Wa Clinic and is aired on Sundays. Presenter and guests discussed the causes and the treatment of leprosy.

A radio soap opera tackled issues such as stigma and ignorance. People affected by leprosy (PALs) publicly discussed their experiences during and after treatment. They spoke about the issues of discrimination and rehabilitation. Studio guests included traditional healers, faith leaders, politicians, leprosy experts and government officials.

The focus on leprosy proved to be very popular, as the great number of call-ins proved. Previously, the radio programme had focused on reproductive health, HIV/AIDS and malaria, and listeners were interested in the additional topic.

Skin camps

The most important contribution Radio Wa made, however, was to inform people about the skin camps that toured from district to district, providing opportunities to get diagnosed and access treatment. More than half of the patients who attended the skin camps had heard about the camps thanks to Radio Wa.

In the village, where the next skin camp would take place, extra announcements were made. In some places, churches and mosques spread the information as well. Radio Wa also motivated several patients to go to the Lira referral hospital, and quite a few of them came in time to prevent disfigurement and disability. The camps also provided a good opportunity to further educate local health staff on leprosy (see box).

The camps started at 10:00 o’clock in the morning. Normally, hundreds of patients would already be waiting in front of the respective health facility. At first there was a lesson in public health for all, which was followed by questions and answers session. The sessions were recorded and excerpts were aired during the radio show the next Sunday. This way, the reality of leprosy was brought into people’s homes.

At the camps, people were examined and treated after the educational part. Patients suspected to have leprosy were referred to specialists for confirmation. They were then given personal advice and had the opportunity to ask questions. Moreover, they were registered and given medicine. The treatment started immediately. Patients learned when and where to pick up the next dose of medicine. They went home knowing they had finally found competent help.

The total number of patients seen in 13 skin camps was 5354, out of whom 43 were diagnosed as leprosy patients. Another 29 were still on follow-up at the start of 2016 to determine the final diagnosis. The rest had a wide variety of skin conditions, mostly fungal and bacterial infections. Appropriate treatment or referral was provided.

Talking Health was coordinated by Doryn Ebong, a nurse who lives in the northern Ugandan town of Lira and has been cooperating with Radio Wa for health-related broadcasts for a long time. Her coordination committee included a journalist, two persons affected by leprosy, an NTLP officer and district officers. Ebong handled the budget and reported to the German donor NGO. Ebong’s approach was consultative, letting the districts take the lead in identifying the health facilities and health workers to be trained. She was thus actually more a facilitator than a director.

The project had several strong points:

• It addressed an important tropical disease that is normally neglected.
• It reached out to rural people in their own language and in a culturally appropriate way.
• It was very cost efficient.
• It relied on – and contributed to further developing the capacities of – local institutions, including of course the health facilities concerned and the radio station itself.
• It’s impact will be sustained thanks to the increased competence of both the local health staff and the radio team.

It is noteworthy, moreover, that the skin camps did not only contribute to raising awareness for the fight against leprosy. The project actually achieved more than that because it promoted skin health in general and increased the reputation of science-based health facilities.

Olaf Hirschmann was the country representative for GLRA (DAHW, Deutsche Lepra und Tuberkulosehilfe e.V.) in Uganda and South Sudan from October 2011 until March 2016.
olaf.hirschmann@gmx.de

Herman Joseph Kawuma is GLRA Medical Advisor for Uganda.
joseph.kawuma@dahw.org