AP – This July 7, 2010 photo shows the feet of Luis Siqueira Aforn, 65, who's toes were chewed by rats while
OE-CUSSE ENCLAVE, East Timor – If there really was a place so remote it could be called the end of the earth, Adelino Quelo's shabby little hut would be prime real estate.
His thatch teepee-shaped home is the last stop in tiny East Timor. It is perched on the side of a rugged emerald mountain with a million-dollar view of neighboring Indonesia, so close you can almost touch it.
As rare visitors holler his name, a slow shuffling comes from the dirt floor inside. A minute passes and Quelo, 68, appears at the small opening carved out near the ground. He scoots on his rear and grunts while laboriously dragging one leg, then one arm on each side, using a torn pair of mismatched flip flops as his only aid.
His fingers, toes and parts of his hands and feet are missing. Only stubby knobs remain, keeping him from standing, gripping or even bathing himself. But Quelo smiles a toothless grin and motions for his guests to come closer, apologizing for having nothing to offer but his story.
He is just one face of leprosy in a country that has declared war on the age-old scourge. East Timor is one of two places worldwide — the other is Brazil — where the disease is still widespread enough to be considered a public health threat.
But for Quelo, the fight comes far too late.
"I, myself, already suffer from this, and it's enough," he says, a dirty sarong hiked up on his right thigh, exposing a large open sore. "I hope no one else will suffer this."
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Oe-cusse Enclave, a lush secluded area cut off from the rest of East Timor by the Savu Sea, is thought to have been a leprosy colony during Portuguese and later Indonesian rule.
Roughly the size of New York City, it was positioned on the front lines during the brutal fight for independence from Indonesia 11 years ago and was nearly destroyed. Monuments now mark the sites of bloody massacres.
Its 60,000 people are survivors, but they are dangerously poor. Living conditions worsen as the roads narrow and grow steeper, exposing naked children with bulging bellies and blond-streaked hair — signs of malnutrition.
Time seems to have stopped here, and the disease believed long gone in many parts of the world continues to nibble away at lives, despite a three-pill cure recommended for the past three decades. But the number of new infections in East Timor, home to about 1 million people, has dwindled to 160 last year. It is nearly within the World Health Organization's target for elimination, or less than one case per 10,000 people.
Now leprosy specialists like Dr. Rosmini Day, who's battled the disease for 20 years across Asia, are scouring this secluded pocket for new cases to determine if East Timor will meet the mark by year's end. Since the campaign began in 1991, the number of new leprosy patients worldwide has plummeted from about 10 million to 250,000. Leprosy is virtually nonexistent in the West, with only about 150 cases reported in the U.S. annually.
Some experts argue the WHO target makes people wrongly believe that an already neglected disease has been wiped out entirely. And some question the authenticity of the count in countries driven to meet world goals.
But Day, a 62-year-old Indonesian grandmother, has come out of retirement to help East Timor with its last fight. She is a master at identifying the disease and believes no one should be overlooked, no matter how remote.
She hikes up a muddy mountain road too treacherous for even a 4X4 and examines a patient in the rain outside his hut. She interrupts a cock fight in another village to pinch and pull at the skin of a second patient's elbow to see how fast it snaps back. She stops at a third man's house and calls him out onto the road from a funeral to have a look beneath his shirt.
Leprosy is difficult to identify in the early stages, but Day says it's important for a new generation of health workers to learn the traits to stop the spread and cure patients before damage is done. It's the only way to truly get rid of the disease.
"I use a sarong to protect my toes, but the rats still come in the nighttime and eat at my toes," says Luis Siqueira Afoan, 65, a patient who walked more than 2 miles (1 kilometer) on dry blackened nubs to see the doctor who can do nothing to help. "When I'm sleeping, I put my fingers under my head, but the rats still come and eat at my fingers."
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