MANDAUE, PHILIPPINES -- Lepers, outcasts for thousands of years because of their disfiguring disease, can now be cured by drugs but the mental anguish of former sufferers is less easy to heal.
After years of social rejection, former farmer Teofilo Manchavez cannot face leaving the security of a leper colony in the central Philippines even though he is now free of disease.
"I tried going out there, but I couldn't take it," said Manchavez, who has lived at the Eversley Leprosarium on Cebu Island for 18 years. It is the only life he now knows.
Looking down at his truncated fingers, ravaged from years of leprosy before he was treated, he recalled how people used to react before he moved into the leper center.
"They saw my hands and insulted me and yelled 'leper,' " he said.
As he spoke, sitting on a bench with his hands clasped in front of him, patients in white robes peered out from the men's infirmary. Inside, about 30 lepers were lying listlessly, some covered from head to foot with cracked and oozing lesions. Others were missing fingertips and toes or had noses partly eaten away, a result of the disease's attack on the nasal mucous membranes.
The World Health Organization says drugs now in use arrest the contagious bacterial disease, which attacks the nerves and skin. Medication makes sufferers noninfectious during treatment and in time kills the bacteria altogether.
WHO has called for the closing of leper colonies, where victims have traditionally lived together in isolation from the outside world. Lepers should return to the community, where they can lead normal lives, the organization says.
But doctors say one of the biggest problems is convincing lepers to leave their colonies once they have been cured or are no longer a health hazard.
"One in four patients here no longer has the disease. But they refuse to be discharged," director Conrado Pineda said in an interview.
Attitudes are slow to change among both the afflicted and the healthy toward a disease marked by stigma and fear since the beginning of history. Lepers are mentioned repeatedly in the Bible as hopeless pariahs curable only by miracles. In the New Testament, Jesus is said to have cured a leper who came to him and begged to be made "clean."
People with the disease were traditionally driven to caves, islands and other remote spots where they could not pass it on.
There are now 5.34 million known cases worldwide, mostly in Africa and Asia, WHO says.
The Philippines, with an estimated 38,000 lepers, is completing a two-year pilot study on phasing out leper colonies and reintegrating their inmates into the community.
Pineda says the number of patients at Eversley has dropped from 1,200 to 400 in the last 30 years as more lepers are treated at home. The center discourages new patients unless they are seriously disabled by the disease.
Doctors say the disease is being detected earlier and treated these days. Hideous deformities, once the tell-tale symptoms of leprosy, are prevented.
Unlike Manchavez, some patients say the treatment has given them a new life. Aurelio Abastillas, 37, who has had leprosy since he was 10, says drugs cleared up lesions covering his body. Scars remain and he has lost his fingertips, but he says that for the first time he can venture out into the world without being scorned.
"There was a time when I just waited to die. Now I go out and do what I want," he said at his home, a simple wooden house on stilts in nearby San Isidro. "People don't avoid me the way they used to."
Before a 1964 law banned involuntary confinement of lepers, sufferers on Cebu used to jump into boats and stay out at sea when health workers came to their villages, to avoid being caught.
Now, with the new treatment and an education drive, people are starting to look at the disease in a different light, said Andres Galvez, WHO director of chronic diseases.
"People who once hid are coming forward and asking for help," he said. "But the stigma is still there and will take a while to go away."