KARACHI: The agony of Gregor Samsa in Franz Kafka’s The Metamorphosis of being rejected by his loved ones for no fault of his own, but due to a deformity that suddenly emerged out of nowhere, touched the hearts of many. The misery of being an outcast is traumatic in itself and is precisely what many lepers, admitted to the only city government-run leprosy hospital in Manghopir, feel. But their despair has multiplied owing to the dilapidated condition of the hospital building and inefficient management.

Leprosy is a contagious disease. According to the annual report of the Marie Adelaide Leprosy Centre, there are 700 new cases of the disease found annually in Pakistan. “Furthermore, those infected with the bacteria called Mycobacterium leprae, develop signs and symptoms of the disease in 3 to 40 years. It is transmitted from an infected and untreated patient through droplets (mucus), from the nose and mouth,” says a World Health Organisation (WHO) report.

“Once the patients are administered even a single dose of multi-drug therapy (MDT), comprising three medicines -- dapsone, rifampin and clofazimine -- there are no chances for the disease to be transmitted or its reoccurrence,” the report adds.

Located in a far-flung area of the city, the leprosy hospital was built in 1896 by a philanthropist, Dr B.L. Roy. However, after being run by various NGOs it was handed over to the now defunct Karachi Municipal Corporation in 1960. There is no prize for guessing what happened to the facility afterwards.

According to the Medical Superintendent (MS), Dr Mohammad Abbasi, 180 patients are under treatment in this healthcare unit. However, this scribe could see not more than 80 to 100 patients at the time of the visit. Currently there are six doctors working at the hospital, out of which two work in the OPD till 1.30pm. The other doctors visit the hospital occasionally but are basically called when there is an emergency. The same is the case with the nurses and ward boys, (there are only two of each) and although they live on the premises, they too leave at 1.30pm.

The statements of the MS about the state of the hospital are quite quizzical. He says that most of the in-house patients have been cured and are staying there as they have no other place to go. He also claims that the majority of the lepers came when MDT was not introduced (before 1985) by the WHO, as earlier the disease was considered incurable. Nonetheless, when this reporter mentioned that a patient had been living there for not more than six years, he had no answer.

Thirty-six acres of the hospice’s land have been encroached upon and the administration says that they cannot do much about it. The hospital, which appears quite presentable whenever high-ups of the government have to visit it, in reality has a suffocating environment.

Walls in the ward have cracks running through them and paint flakes off due to dampness. When there is an electricity breakdown patients are seen lying on the floor to beat the heat. Bed sheets and pillows are stained and it seems that they haven’t been changed in ages. In addition to this, the patients have to wash their clothes themselves, while they have no access to recreation facilities.

Proper medicines are not visible on the bedside table. Instead, one can see cooking utensils as the patients have to cook their own food, as there are no cooks in the hospital. It is simply horrific to even imagine what will happen if any of the patients injures or burns themselves while cooking.

But the management seems to be in no particular hurry to appoint cooks. The MS maintains two reasons for this. “The old cooks have retired and the city government has to allow (us) to appoint new ones,” he says, adding that the other reason is that “no one wishes to work among lepers.”

The city government has sanctioned 100 employees, but the administration says they only have 80 people working for them. Forty patients are also employed as gardeners, gatekeepers, watchman etc. Though 30 of them draw their salary from the city government, the remainder are paid by some NGOs.

It is worth pondering whether these men and women, who have lost parts of their hands and feet to leprosy, can perform the job, for example, of a watchman satisfactorily? A recent incident quite clearly illustrates the pathetic situation.

A few men from the nearby colony entered the hospital, as there is no significant boundary wall to stop anyone, and proceeded to beat and rob one of the patients. The watchman tried, to the best of his ability, to stop the intruders but couldn’t do much. Dr Abbasi himself admits that he was helpless to prevent the incident.

On one hand the authorities claim they have no money to improve the conditions of the hospital. However, the administration has spent millions on the construction of a molecular laboratory, tuberculosis centre and dental healthcare unit. Then why are funds not being allocated for the uplift of this facility?

It is not difficult to understand why these patients are forced to live there. Abandoned by their families, they have no other place to go. Some of the women even have their children with them in the hospital. Male patients voice their concerns about food. It seems that they want to complain about other things as well, but the presence of the MS prevents them from doing so. However, the female patients are more careful in this respect and say that they do not have any complaints.

Talking to these patients, one senses an air of melancholy about them. Not being accepted by society they are confined to the hospital, while the attitude of their relatives has shattered them. Thirty-eight-year-old Najibur Rehman has been living in the hospital since he was a young boy. His family found out about him being infected with the disease when he was 9. They tried to have him treated by various hakims and doctors, but it was all in vain. His mother, brother and family visit him once in a while.

On the other hand Anwer Hussain says that he hates his family. When asked why, he says that “when I was diagnosed with leprosy, my mother did not come close to me.” He adds that “not even my dad or brothers bothered to come and see me.” He also criticises the hospital administration for not taking care of the patients. All the patients agree when he says that the hospital gives one piece of bread per meal, which is not enough for them.

Hailing from Chitral, Mirsawat, 70, sits on the floor of the hospital. He lost half of his foot and both of his eyes due to this bacterium. He doesn’t know what has happened to his family as he has not been in touch with them for ages. In fact, he has also lost track of the time when he first came here. He used to work as a street vendor in a nearby area and when he was diagnosed with leprosy, he moved to the hospital.

The situation in the female ward is no different. Bibi Khatoon, 70, sitting on the edge of her bed complains about the poor provision of electricity to the hospital. She reveals that she had to come here as most of her family lives in India. “After my husband died some years ago, I was left with no option,” she says. As she has no children of her own, her brother-in-law’s kids, living in Karachi, visit her. She very innocently says that her nieces and nephews do love her, “but they never take me home and therefore, I no longer insist.”

Sara, 30, had to leave her infant girl in Afghanistan seven years ago. She still remembers how her daughter looked like then. She says that the clothes she and the others wear are donated by charities. She thinks it is best for her to stay in the hospital so as to not infect any others with the disease.

It seems extremely unfair for these patients to suffer further due to the incompetence and neglect of the hospital staff. The city government should try to improve the living standard of these people. If they are cured, they should be shifted to a place where they can settle down and rejoin the fabric of society.