We introduced history of leprosy in Myanmar based on the book of Myanmar Academy of Medical Science published entitled "CONQUEST OF SCOURGES IN MYANMAR (Complied and Edited by Ko Ko, Kyaw and U Thaung) at 2002. "Leprosy Elimination Programme in Myanmar (Kyaw Lwin and Kyaw Nyunt Stein)" was appeared at chapter III in it. After dapsone treatment appeared, leprosy control program has started. Health system and service were developed and leprosy control program was also included in them. The integration of the elimination activities into basic health workers, such as midwives and health volunteers, has enabled the participation of a wide range of people in the community. After 1990s, multidrug therapy (MDT) was covered whole area of Myanmar, and task force for leprosy elimination was formed at Sate/Division, District and Township level. Finally Myanmar achieved the elimination of leprosy in January in 2003.

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Hepatitis C virus, which is non-cytopathic, establishes persistent infection in majority of patients after acute infection, causing various degrees of clinical liver disease. To escape and survive, hepatitis C virus may take ingenious strategies. Hepatitis C virus gene products interact host proteins to evade host immune responses in addition to the appearance of quasispecies. Against hepatitis C virus infection, host may avoid extensive tissue damage by inducing the activity of regulatory T cells. Insights into this mechanism of immune regulation may help to future development of novel therapies against hepatitis C virus.

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Japan International Cooperation Agency (JICA) implemented a 5-year long bilateral technical cooperation project, “Leprosy Control and Basic Health Services Project” in Myanmar. The project was implemented by National Leprosy Control Program, Department of Health with close technical collaboration of JICA experts mainly from International Medical Center of Japan (IMCJ) and National Sanatoriums of leprosy in Japan. It accelerated to achieve the elimination of leprosy at national level, which was declared in January 2003, and at sub-national level onward. It also developed the appropriate technologies for prevention of disability and prevention of worsening of disability (POD/POWD), which were introduced in 9 townships as a pilot service program. The Government stratified the POD/POWD services as a national program since 2005 by taking up the former pilot area to start with. The project also strengthened the function of referral system of leprosy control (Diagnosis and treatment), POD/POWD and physical rehabilitation. Beside leprosy, the project conducted a series of refresher trainings for primary health care givers, Basic Health Service Staff (BHS), of project areas (48 townships) to improve the services on tuberculosis, Malaria, Leprosy, Trachoma and HIV/AIDS for 3 years (2001-2003), which was evaluated in 2004. It contributed to improve the services at township level hospitals in procurement of audio-visual equipments and in conducting microscope training on leprosy, Malaria and tuberculosis at project areas.

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In the developing countries where leprosy is prevalent, diagnosis of leprosy is made from clinical signs and symptoms. However, when difficult and doubtful cases increase after the advance of leprosy control programs, definitive diagnosis of leprosy by histopathology become necessary. This report describes our experience of technical support to re-establish histopathology service and introduction of immunohistochemistry in the leprosy referral center of Myanmar, and we discuss the ideal way of international technical support. This activity was performed as a part of leprosy control and basic health services project of Japan International Cooperation Agency (JICA) since 2000 to 2005.

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“Leprosy control and Basic health service Project” was terminated at March 2005 within the scope of the period. I was assigned to develop the Plantar protect footwear for neuropathic feet, which called “Myanmar Sandals” in common. These sandals are not made by new technologies but made by basic knowledge. I would like to report about this activity as which is a part of distinguished strategy of ODA (Official Development Assistance) for developing country, but not as the technical report of these sandals.
There is only one National Leprosy Hospital in Myanmar. At the time this project started, there were only two footwear technicians for the people who had disabilities by after effect of Hansen's disease in this country. And, it would appear that the number of the people is over 50, 000. Furthermore, the budget of national hospital is not enough to refill necessary consumable supplies and materials. Although, I should instruct new technique which like making in Japan in ordinary circumstances, I could not think that such technical transfer by using costly imported materials woud bring beneficial effect and be continued. We were bound to be anxious about such situations when we made the plan. As a result of examining a plan based on these situations, we reached the conclusion that development of the simplified ready-made footwear was pressing need.

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I participated in “Leprosy Control and Basic Health Service Project in Myanmar” by JICA from 2002 to 2004. I went to Myanmar three times as a short-term expert of physiotherapy. I carried out evaluation training for physio staffs in national Yenanthar leprosy hospital. They learned how to evaluate activity of daily living. And they were able to make modified spoons and the canes. Later, they looked for the contents to evaluate by themselves. And they evaluated and decided by themselves what they should do. They felt the necessity for toilet chairs, modified beds and etc. They formed the plan and manufactured them. They were able to perform by themselves. It is thought that evaluation was fixed to staffs. This knowledge will surely be helpful to patients. I expect that this knowledge will be put to evaluations and exercises of many diseases. The physio staffs of this hospital will surely perform. Cooperation of the shoemaker and nursing staffs is very secure. I hope that it may become the model of saying [working in cooperation with other occupational descriptions] from now on.

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A survey of present conditions of the residents regarding aging, aftereffects and subsequent complication was conducted and its data were analyzed in the National Leprosarium Osima Seisho-en; located on an isolated island of the Seto Inland Sea. The results showed that they have become older with a various type of disease and most of them suffered from aftereffects caused leprosy, although after therapy.
This survey also suggests that future problems in the management of our leprosarium will no doubt be to cope with the aging and to reducing our scale.

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In recent years, the total patient population of Hansen's disease has been rapid declining throughout Japan by as many as 200 ?? 250 each year This decline is due to the aging of existing patients, and scarcity of new cases. Less patients are a welcome phenomenon. However, existing treatment facilities are now confronted with problems. The most serious problem is shortage of treating physicians. The causes of the shortage are (1) the aging of the existing patient population that creates mounting need for medical-surgical care and (2) the nation-wide shortage of physician in national sanatoria all over Japan.
Let me present a sketch of the current situation at Amamiwakouen Hospital as an illustration. Amamiwakouen is a government-run sanatorium. It is responsible to take care of inpatient as well as out patients. Currently, there are 70 long term inpatients, who are handicapped by Hansen's disease sequela of various degrees. 11 minimally former inpatients are followed at the outpatient clinic. The clinic is also open to all community citizens. The number of annual clinic visitors averages 6, 500 ?? 7, 000. They come with wide range of problems requiring a dermatologist. While the total number of full-time staff is 100, only two are licensed physicians at present. This is indeed a disastrous situation. Therefore a number of contract physicians are recruited from nearby medical institutes to meat the demand.

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