Haven of cured lepers who choose a life in hiding

FOR THE past decade the furthest 75-year-old Hou Jingyao has ventured from his room is the one mile to the village market. For a long time before that, he went nowhere; the gates of the grey-brick walled compound in Wangdu County were locked. Even after the padlocks were thrown away, the outside world seemed an inhospitable place. Looking at his destroyed fingers, his missing toes, his weakened leg and the sores on his skin, he swore: "This damned disease! I don't know how I got it. Since I got leprosy I have had very few moments of happiness."

Mr Hou started his stay at Wangdu's leprosy clinic in 1960. Until the mid-1980s China's policy was to lock lepers in rural hospitals or isolate them in "leprosy villages", releasing them only if several years' treatment cured them. Liu Shuangzhan, director at Wangdu clinic, said: "We had various gates: one for staff, one for patients who were received, another for when the patient died and one gate for when they were cured."

Those who were cured were often so disfigured they chose to remain rather than be ostracised in their villages. From the mid-1980s, when multi-drug therapy (MDT) offered a quick, permanent cure, China abandoned its policy of isolating lepers.

But the likes of Wangdu were much-needed refuges from the difficulties of life outside. Older, disfigured residents such as Mr Hou stayed on. Wangdu is only three hours by a new highway from Peking but for many of the 38 residents the only experience of a fast-modernising China has been via television. Mr Hou arrived in 1960, was released in 1974, but returned in 1980. "I just listen to the radio and watch television," he said. "My relatives visit twice a year."

This month Peking hosted the 15th International Leprosy Conference, attended by 1,000 delegates working to stamp out leprosy worldwide by 2000. The World Health Organisation estimates there are 1 million cases globally, two-thirds in South-East Asia. It is not very contagious but is a stubborn disease; 500,000 cases are diagnosed each year. Unless treated promptly, nerve injury leads to loss of feeling in the hands and feet, rendering them vulnerable to injury and infection. It also attacks the eyes and causes muscle weakness and paralysis.

In the first half of this century, lepers in China were still being buried alive, floated out to sea to die or abandoned on islands. Since 1949 China has had great success combating the disease, albeit at the expense of individual liberty. The rate has fallen from 2.4 per 10,000 in 1958 to 0.033 per 10,000 last year. After 1987 the situation was transformed by MDT drugs, which can cure leprosy in two years. The number of cases under active treatment fell to 4,045 last year and about 2,000 new cases are diagnosed annually.

For some in China, multi-drug therapy came too late. Yin Dakui, vice- minister for health, told the conference that China had 120,000 disabled cured lepers, of whom about 20,000 were "aged and vulnerable". He Daxun, at the China Leprosy Association, said there were 20 to 30 "leprosy villages" and more than 40 hospitals housing cured patients.

Wangdu, which opened in 1954, had 230 patients at its peak in 1962. It is a walled compound, surrounded by cornfields. Inside, buildings are divided into sparsely furnished, one-room dwellings and the gardens are planted with vegetables and grain.

Of the 38 residents, 25 are elderly, cured patients. Liu Huirong, 66, said: "I came here in 1957. It was sad to be isolated, not a pleasant feeling. I was cured in 1966 and went home. But people in my county were very afraid of me. When they saw me they took a roundabout way." She returned in 1978 after the death of her husband and two of their children in an earthquake. "Life is better here," she said. Her neighbour, seeing a rare visitor, turned away, to hide her absent hands and half-missing face.

The younger generation is luckier. Huang Liying, 34, is Wangdu's youngest patient. The disease was caught before any disability occurred, and next year she should be able to return to her village. Many new victims can also be treated as out-patients or at home.

Conditions are basic and most of the 25 cured but disabled old residents are in ragged clothes. Seeing 66-year-old Xu Diangang's room and unwashed bedclothes, it is easy to understand how infections set in. But, knowing life outside would be worse, the patients are grateful.

"If there is a clinic, we can live several extra years. If there is no clinic, maybe we would just die," Mr Xu said.

The aged residents fear the clinic might close as the number of patients falls. This is partly due to a misunderstanding. "We have seen the slogan which says leprosy will be eradicated by 2000. We are afraid ... there will be no more clinics. And we will have no place to go," Mr Hou said, as staff tried to reassure him it will be years before China can close its leprosy clinics.