THE METHOD FOR repairing a hand clawed by leprosy is a bit like restringing a broken marionette. The skin is parted at the joint of a finger, along the equator of the palm and at the ball of the thumb to reveal the flexor tendons—smooth and pearl-coloured, a bit like the bands of nylon that sometimes joint a puppet. The tendons are split, snipped and spliced into new configurations in the pulley-like rigging of the hand, redistributing the crippling force of a musculature wrecked by nerve damage. The operation is a beautiful, intuitive piece of mechanics. A deft surgeon with a well trained staff can get the job done almost bloodlessly in about half an hour. In the best case, the wrecked hand returns to near-normal function and, often as importantly, a perfectly unremarkable appearance.
Long before 23-year-old Sunita Gorh was wheeled into the operating theatre of the Catholic Hospital in Borgang—a village in Assam’s Sonitpur district—in March this year, it was clear that her outcome would not be best case. Gorh was almost too far gone to even qualify for the procedure. The backs of her hands were perpetually tensed; her fingers folded down tightly at the joints. Without proper care, the “contracture” had stiffened, and it was now difficult for her to straighten her fingers even when she braced the tips against a firm surface. Septic ulceration had years ago crumbled away bone and left her right index finger stumped at the second digit. Her cosmetic prognosis was bad: her hands would never look normal again.
But the medical team in charge of her care hoped that crucial movements could be salvaged. To be given back the ability to point, to draw the fingertips together in a pinch hold, to pull the thumb out of alignment with the rest of the fingers and across the palm, could mean the return of vital capabilities: eating unassisted, counting out currency notes, holding a pen, tapping a message into a mobile phone, sowing or harvesting a crop. It could mean the difference between an active life and one of dependency and destitution.
Claw hands are the commonest kind of visible disability caused by leprosy, but there are others, typically affecting the feet or eyes, sometimes the nose. Collectively, they are called Grade 2 disabilities by people in the leprosy-control field. In 2019, a G2D is a tragedy of healthcare. Each clenched-up claw hand, dragging dropped foot, hanging eyelid or clouded eye blinded by leprosy could have been prevented by timely treatment.
The window to do so is not small—leprosy is a slow bug. It moves slowly through populations, because the vast majority of people are not susceptible to it, and it moves slowly through bodies. Disabilities like Gorh’s can take more than twenty years to develop. The World Health Organisation assumes an average incubation period of five years between exposure and observable symptoms. Moreover, the drugs that reliably kill Mycobacterium leprae, the bacterium that causes the disease, have been available since the early 1980s. In 1995, the WHO began to offer the treatment protocol—a regime of rifampicin, dapsone and clofazimine, called multi-drug therapy, or MDT—for free to all leprosy patients worldwide.