For seven weeks in the spring of 2009, I photographed life in and around Lalgadh Leprosy Services Centre (LLSC) in the southern Terai region of Nepal. It was these that I was inspired to start a worldwide projectLeprosy Eliminated?.

Leprosy is a curable air-borne bacterial disease that affects the peripheral nervous system and the skin. The loss of sensation can lead to severe disability, including the loss of digits and limbs, blindness and drop-foot.  Equally as devastating for those affected is the stigma that surrounds the disease. Discovery that a person has leprosy can lead to complete social exclusion. In societies like those found in the Terai in Nepal where hunger, pain, and poverty are daily realities, isolation can be an unbearable additional burden.

Once contracted, it has a 7-10 year incubation period until the effects start to reveal themselves, however children as young as 5 have been known to show symptoms. It is not detectable by any means before then. Physical damage to nerves is irreversible, as are many of associated disabilities that stem from the painless infections. Within 24 hours of starting the year long Multi-Drug Therapy the disease is no longer contagious.

Leprosy is not a new disease; it is an ancient one. So old that most of the world, certainly the developed world, has forgotten it exists. Indeed, the World Health Organisation sets the elimination rate at 1 in 10,000 people, and according to official statistics, all countries - except Nepal and Brazil - have this status. The assumption of the public in the West that it is practically non-existent is therefore understandable. Yet leprosy remains a huge problem in countries all over the globe today.

In 2007, the WHO counted 17 countries that had over a thousand new cases of Leprosy. However, these figures are likely to be - in some cases large - underestimates. These countries have been under a great deal of pressure to reach the target of elimination'. Official figures are often tampered with in order to meet criteria; for example, immigrants with the disease may not be registered. In cases like in Nigeria, doctors I have met say that the numbers of cases they have seen simply don't match up to figures that have been recorded.

 Soon Nepal will reach the official elimination figure, joining all the other countries that have supposedly conquered the problem. But even if the figures were correct, there remains in these countries ahumanitarian crisis. "Elimination" does not mean "no leprosy"; rather, it means that it is no longer a "public health problem".

This is the crisis: the definition of "leprosy" is confined to those in whom the disease is active. Once treatment is completed, they are not - officially - leprosy sufferers anymore. This is true from a medical perspective, yet the disabilities and deformities remain. And so the sufferer is still very much a leper', still vulnerable to intense stigma from the societies whose margins they inhabit.

It's a crisis because people affected by leprosy stand at risk of isolation. It's a crisis because the unaffected world now believes there is no longer a problem of leprosy - it has been "eliminated". It's a crisis because people don't perceive any need to put money into a problem they have been lead to believe no longer exists - no need to support places like Lalgadh. Future funding in Nepal is being cut as it nears "elimination" status, just as it has been in other countries around the world.

The financial crisis has not helped either. As donors in the western world' cut back on unnecessary expenditure' it is charities like The Leprosy Mission that are affected. While I was in Nigeria 6 of the 50 or so Leprosy Mission Nigeria workforce had to be let go, and more job cuts will have to be made.

One thing that really stays with me, and is hopefully revealed in the images is the sheer misery carved onto some of the faces. Even for those that have ended up living the end of their life in a welcoming community, the pain and suffering they have endured all those years is so clear that you only have to look at them to know of it. Perhaps it is naive to think that photographs can have a positive effect on the situation, but I always remind myself of what the humanitarian documentary photographer W. Eugene Smith said: "Photo is a small voice, at best, but sometimes - just sometimes - one photograph or a group of them can lure our senses into awareness. Much depends upon the viewer; in some, photographs can summon enough emotion to be a catalyst to thought."

I do not wish this documentary to be just a record for the future. It must be used to change the present situation in these countries. In an effort to raise awareness and funding I hope to have an exhibition going round various churches in Londonby the end of 2009. If you know of a suitable venue or sponsor for the exhibition, then any help to further this campaign is greatly appreciated. 

Making the extent and seriousness of a disease that can cause complete social exclusion known to the western world is the first step in truly fighting it. If you would like to know more about leprosy in Nepal visit www.nlt.org.uk, for Nigeria www.leprosymission-ng.org and for other information www.leprosy.organd www.leprosymission.org.uk.

©Tom Bradley