ハンセン病療養所では、昭和30年頃まで生活困窮が顕在していた。後期高齢者となったハンセン病回復者が当時の生活困窮をどのように意味づけるのかを明らかにするために、瀬戸内地区A療養所の回復者に半構造化面接を行い、その語りを質的帰納的に分析した。回復者の語った生活困窮は、1. 自給自足の生活防衛、2. 苦境を乗り切る人間的逞しさ、3. 知恵者の集まり、4. 自主自衛の組織形成、5. 互助相愛、6. 支援を勝ち取る国との闘いに集約された。人生の最終段階を生きる回復者は、自給自足・自主自衛・互助相愛のシステムを備えたコミュニティーを形成することで、孤島での生活困窮を切り抜けたと意味づけており、老年期の発達課題 (統合vs絶望) の達成が順調であることを示唆する。また、A療養所の固有の特徴は、水不足と、遍路巡礼体験者 (放浪癩) の存在である。尚、全対象者の入所時期が太平洋戦争前後の集中したため、A療養所の歴史の全ては網羅せず、且つ、主観に基づく歴史である。

  As the number of new leprosy patients per year has been stagnant for the past half decade, multi-drug therapy (MDT) alone is now regarded to be insufficient to stop the transmission of Mycobacterium leprae and to eradicate/eliminate leprosy from the world. New strategies are now being searched. Chemoprophylaxis was one promising strategy used during the 1960s and 1970s as a part of leprosy control. However, due to the introduction and successful outcome of MDT since 1981, it was once forgotten. In addition, the drug of choice for the initial chemoprophylaxis, either dapsone or acedaposone, added to its discontinuation as it required long dosing period of two to three years. It was not only impractical for chemoprophylaxis, but also was associated with risk of resistance development.
  Recently, chemoprophylaxis is again drawing attention; this time with rifampicin. Results from one randomized control trial conducted in Bangladesh prompted this reintroduction of chemoprophylaxis into leprosy control, along with a few other studies. On the other hand, concerns remain for wide implementation of chemoprophylaxis. Could we base our scientific background of the intervention solely to these studies with limited follow-up period, while the incubation period of Mycobacterium leprae is said to be as long as several decades? Furthermore, chemoprophylaxis was less effective in close contacts in these studies. What does this result indicate? How about the risk of resistance development? More importantly, how could rights of the patients be protected if they are asked to disclose their disease? This review summarizes the past and present situation of leprosy chemoprophylaxis along with some discussion.