November 8, 2005

Post-war chaos leaves Liberians battling leprosy

By Katharine Houreld

GBARNGA, Liberia (Reuters) - Like many young girls her age,
11-year-old Fatu Kerkular likes to dance, enjoys basketball and
wants to be a nurse when she grows up.

But above the chipped red nail polish on her toes, her legs
are covered in white patches. On her face and neck, beneath
star-shaped plastic earrings, her skin bears the same marks --
the telltale signs of the first stages of leprosy.

Since she was discharged from her local hospital in May,
the symptoms have recurred. Liberia has the drugs needed to
treat Kerkular, but the health ministry is not distributing

Bureaucratic chaos aggravated by the devastation caused by
years of civil war mean patients in this West African country
are being deprived of badly needed drugs donated by the
international community.

Without the drugs, Kerkular's feet and hands will gradually
begin to rot, like the old men and women shuffling around her
in the leprosy-afflicted village where she lives.

Some of the older people have no fingers or toes left. They
contracted the disease during Liberia's 14 years of on-off war
when treatment was unavailable and many lepers fled into the
bush to escape fighting.

A 2003 peace deal paved the way for presidential elections
last month, but many people say that corruption and
mismanagement mean the health system is scarcely better off
than at the height of the war.

"We haven't had leprosy drugs for three months," said Tokpa
Wakpolo, the director of the leprosy and tuberculosis program
at Phebe Hospital near the central Liberian town of Gbarnga,
where Kerkular was treated.

"I have 48 patients who need them and others who have not
come in to register because they know we cannot treat them."


Liberia's conflict killed around 250,000 people, uprooted
hundreds of thousands and left the once prosperous country in
ruins, bereft of basic services. The war ended after former
president and warlord Charles Taylor fled into exile.

Many professionals, such as those working in the health
sector, left during the fighting.

Efforts to rebuild the country's shattered services have
been hindered by rampant corruption among members of a
transitional government made up of former belligerents,
according to diplomats, donors and local residents.

Tamay Binda, who has six children, says she and her younger
sister both went to register at Phebe Hospital but were turned
away because no drugs were available.

"I am disappointed, if I don't get medicine I will be
deformed," Binda said, lowering her eyes.

Beside her, farmer Stephen Bando nods in agreement. The
40-year-old started treatment a year ago, but had to stop when
the medicine ran out.

Now half a toe is gone and the knuckle on his left index
finger is black and ulcerated.

Like Kerkular and Binda, he does not have the money to
travel to the nearby town of Ganta to receive treatment.

The Catholic-run rehabilitation facility there says it has
seen an increase in the number of reported leprosy cases and
only has enough medicine for its own patients.

Yet the drugs are there, insists Arkor Gbanoe, the health
ministry official responsible for their distribution. "They
(Phebe Hospital) made a mistake on the form, and that's why
they have no drugs," he said.

Finding fuel for vehicles was also a problem, he added,
after the German Leprosy and Tuberculosis Relief Association
suspended aid this year following serious concerns about the
ministry's budget plans.

Nobody at the Health Ministry was able to explain why
regional officials continued to travel to the capital to pick
up hundreds of dollars in cash bonuses from international
donors while patients went untreated for months.

Ensuring donated drugs reach patients is an enormous
problem in Liberia, according to Westman Lars, a consultant for
the Global Drug Facility, an international initiative to ensure
tuberculosis drugs reach the needy.

Liberia is currently down to its last supplies of
tuberculosis treatment after donors declined to finance the
program after much of last year's shipment disappeared.

"(Last year's) consignment was sent out to clinics, where
supervisors were unable to account for the drugs," said Lars.

An emergency delivery is expected soon, but hospitals in
many counties say they have already run out. In some cases
privately run institutions have had to contact suppliers in
Germany directly.

In the meantime, parents of young children with
tuberculosis line up every morning outside Phebe Hospital to
find out if the medicine has arrived.

"When I see them and there are no drugs, I feel bad," said
hospital director Wakpolo. "But this is just the tip of the