A peaceful setting for a once-terrifying disease

FOR MOST of us leprosy is up there with plagues of locusts and the Black Death. They all evoke man’s brutal – and all too often brief – existence back in biblical and medieval times. All three belong firmly in the past.

Yet, there are three elderly ladies living a peaceful existence in a home in Larnaca who will tell you otherwise.

The Ayios Charalambos Home provides medical and other care to Hansenics (leprosy sufferers). It is on the outskirts of the town, situated deep among a forested area. Get there and the gates and fences, while not forbidding, give the impression you are about to trespass on private property. Near the entrance, there is a regular-sized house with a ‘director’s house’ sign on the bolted gate. There, in the garden, is a stretch of grass and two goal posts for playing football, and a basketball hoop above a patch of cement. The house, now empty, was once the home of the home’s director, back in the days when the size of the Hansenic community justified a permanent presence.  

Explore within the gates and the home really does look and feel like a separate community. There are separate houses, one for the nurses, one for the infirmary, and finally a series of little bungalows where the elderly Hansenics live. Flowers and icons of saints decorate the outside of those few homes which are still inhabited. In stark contrast, the uninhabited ones are bolted, and some are defaced with graffiti. Nearby is the small church of Ayios Charalambos which gives the home its name. The home is peaceful, calm and nearly deserted.  

The home is set in 46 acres of land. The accommodation is arranged in blocks of six and sizes vary, as some of the accommodation was built to house whole families. Fifty of those housing units now stand empty.

Andreas has been a nurse at the home for more then 30 years. “There are three elderly ladies currently residing at the home. All three of them are cured of the disease and they are free to leave the home but due to their age they prefer to stay. They go out to the local fruit market and do their shopping and have relatives and members of the church visiting them,” he told the Sunday Mail.

Dr Georgios Mikellides, the dermatologist at Larnaca Hospital and doctor of the patients at Ayios Charalambos home, has been working for the home since 1983 and  visits the patients at the home once a week.

“In Cyprus there are 34 Hansenics, the majority being over the age of 80. The last incident was diagnosed in 2007,” he said.

According to the Health Ministry, 18 men and 16 women between the ages of 51 and 100 have the disease. The patients have recovered completely from Mycobacterium leprae (leprosy), and their illness is no longer contagious. Most Hansenics now live in their own homes. The three women living at Ayios Charalambous are the exception. 

“There was great prejudice when I first came to work here 20 years ago. Now things have changed. On Sunday the people that come to visit the church have breakfast offered by us, together with the patients in the room for entertainment we have,” said Mikellides.

The patients are given €14.56 a day to spend on food and they get to choose what meal they would like, and the caretakers prepare it for them. They are given €170 a year for clothing and money for gas. At the home they are offered accommodation with day and night service, cleaning and nursing care from 7am-7.30pm daily.

“They have their own priest. They have their own land they cultivate, which is a form of work therapy, and they are taken on occasional excursions and pilgrimages,” said Dr. Irene Hadjicharalambous, who has been director or chief medical officer of the Ayios Charalambos Home since 1988.  

If caught and treated early, Hansen’s disease will leave few of the physical disfigurements so often associated with the disease. In Cyprus, those most affected will have failed to seek treatment at an early stage, probably because they lived in relatively isolated communities such as in the mountains, some distance away from specialists.

“According to Cypriot legislation, you have to report it to the Health Ministry. Hansenics are isolated and undergo special treatment if it is believed that they could transmit it. When they are classified as not a threat to public health they are released and discharged as external patients and have to have a compulsory check-up regularly. There are also certain professions that they are not allowed to do,” Mikellides said.

The community may only be home to three people, but for the time being there are no plans to disturb the women’s lives by closing the home.

“The home is also used by outpatients who come here for their treatment and tests and to pick up their food allowance,” said Dr Hadjicharalambous.

The fact that the home is so empty is testament to how attitudes and treatment have changed in recent years.

“Hansenics do not feel the need to be living at the home because it is no longer a disease that isolates,” said Hadjicharalambous.

Despite cure, stigma remains entrenched

Throughout history, leprosy has been feared and misunderstood. For a long time, leprosy sufferers had to wear special clothing, ring bells to warn others that they were close, and even walk on a particular side of the road, depending on the direction of the wind.

Even in modern times, treatment has often occurred in separate hospitals and live-in colonies called leprosariums because of the stigma of the disease. Before and even after the discovery of its biological cause, leprosy patients were stigmatised and shunned.

Leprosy is a chronic infectious disease caused by Mycobacterium leprae, a rod-shaped bacillus. The disease mainly affects the skin, the peripheral nerves, mucosa of the upper respiratory tract and also the eyes.

Scientifically, leprosy is known as Hansen’s disease, after Armauer Hansen who in 1873 discovered the bacillus Mycobacterium leprae, which causes the disease.

Hansen’s disease is still a major health problem in many parts of Africa, Asia, and Latin America. 

Although mostly viewed as a disease of the skin, Hansen’s is better classified as a disease of the nervous system because the leprosy bacterium attacks the nerves. Hansen’s disease is spread by multiple skin contacts, as well as by droplets from the upper respiratory tracts, such as nasal secretions that are transmitted from person to person.

Its symptoms start in the skin and peripheral nervous system (outside the brain and spinal cord), then spread to other parts, such as the hands, feet, face, and earlobes. Patients with Hansen’s disease experience disfigurement of the skin and bones, twisting of the limbs, and curling of the fingers to form the characteristic claw hand. Facial changes include thickening of the outer ear and collapsing of the nose.

The largest numbers of deformities develop from loss of pain sensation due to extensive nerve damage. 

“I have had several Hansenics coming in for treatment for burns in their hands because they have no perception of hot or cold so most of them burn themselves by holding hot objects that they can’t feel are hot,” said Mikellides.

Relief from Hansen’s disease came when Dapsone was made available after the Second World War. But, it could only slow down the progression of the disease.

The introduction of multi drugs therapy with a combined administration of Clofaximine, Rifampicin and Daspone in the early 1980s marked a historical change –Hansen’s was now curable.

It is estimated that there are about 12 million leprosy affected persons in the world, who are cured, but continue to need support for physical and psychological disabilities and for social handicap due to stigma.

According to official reports received from 109 countries and territories, the global registered prevalence of Hansen’s disease at the beginning of 2007 stood at 224,717 cases, while the number of new cases detected during 2006 was 259,017 (excluding the small number of cases in Europe).

The number of new cases detected globally has fallen by more than 40,019 cases (a 13.4 per cent decrease) during 2006 compared with 2005. During the past five years, the global number of new cases detected has continued to decrease dramatically, at an average rate of nearly 20 per cent per year.

Hansenics in Cyprus: A long history of isolation

The first leprosy home was built around 1808 after the Ottoman pasha visited the dragoman Hadjigeorgakis Kornessios, the liaison officer between the Ottoman rulers and the Cypriot community. The pasha was apparently appalled by the presence of Hansenics by the Famagusta Gate in Nicosia and ordered them to be killed, but Kornessios interfered and proposed a more humane alternative. He established a colony on 500 acres of his own land. The first leprosy village once stood where the University of Cyprus stands today, in the Ayia Paraskevi area opposite the Hilton Hotel.

“The unofficial one was the one in 1808-9, and then the official leper village/farm, as it was referred to in those days, was in 1891 under British rule when the first legislation concerning the mandatory isolation of lepers was passed,” said Dr Irene Hadjicharalambous, chief medical officer of the Ayios Charalambos Home.

Hansenics had cosy Swiss-style chalets built for them, a church and mosque and a well-stocked public library. They lived comfortably, but there were terrible limitations. They had to circumscribe their movements to those 500 acres, and the bachelors were not allowed to marry.

“In 1955 patients were taken to Ayios Charalambos in Larnaca which was built specifically for them. The Ayios Charalambos Church was moved to Larnaca brick by brick and the patients themselves helped in its construction within the gates of the Home”, said Dr Hadjicharalambous.