People once known as lepers still face stigmas that have lingered since biblical times. But a County-USC clinic provides a place for them to show that their illness is . . . : Only Skin Deep

There was a time when Abraham Almorade would have been quarantined by the U.S. government, exiled to a life that excluded all except those who shared his mysterious and feared condition.

Today, he need only visit a clinic for medication and kinship, but his burden is by no means slight.

Almorade, 65, of Los Angeles, has Hansen’s disease--known since biblical times as leprosy--a difficult-to-transmit bacterial ailment that attacks body tissue and is controlled by medication. It has slowly eroded his body since he was diagnosed in the 1950s, covering his skin with sores and leaving his nose deformed as the cartilage collapsed.

Sitting in an examination room recently at Los Angeles County-USC Medical Center, where a clinic has served Hansen’s patients since 1973, Almorade discussed his condition.

Hansen’s disease has robbed his hands of sensation, making it difficult to feel routine cuts, burns and scrapes. Without feeling, such accidents have become major health risks and over the years have reduced Almorade’s fingers to stumps. As a precaution, he no longer performs tasks that might injure him, such as cooking or cutting.

“I have to protect my hands,” said Almorade, a retired soldier from the Philippines. “They were always numb with no sense at all and I didn’t want to hurt them. I don’t cook anymore. I just eat.”

He is one of about 500 Hansen’s disease patients who visit the Los Angeles clinic regularly. Roughly 500 additional patients are served by clinics in San Diego and San Francisco.

“Leprosy is still very common around the world,” said Dr. John Leedon, head of infectious diseases at County-USC.

The World Health Organization estimated that in 1991 there were more than 5.5 million cases worldwide, down from more than 10 million in the 1980s.

A 1992 article in the journal Clinical Dermatology, however, said there were between 10 million and 15 million patients worldwide, most in Africa and India, and about 6,000 in the United States, primarily in Texas and Louisiana.

“The figures differ depending on how you count them,” said Dr. John Trautman of the National Hansen’s Disease Center in Carville, La. “The World Health Organization doesn’t count patients who have completed drug treatment. In the U.S., we (do).”

Scientists believe the disease is transmitted only by prolonged, close contact with someone who is infected, although its precise route into the body is not known. It causes a “significant disability” in about 30% of those infected, said Dr. Thomas Rea, a dermatologist who heads the clinic at County-USC.

Still, most of the clinic’s patients function normally day to day, often wearing long sleeves and explaining away their sores as bug bites and other minor maladies. They are all ages, although most are adults. Some have jobs, spouses and children. And all visit the clinic periodically to work with doctors at controlling their symptoms.

There is little to distinguish the Hansen’s disease clinic from others at County-USC. A chair-lined hallway serves as a waiting room outside a large check-in desk. Patients wait quietly before being escorted to small, plain treatment rooms. Despite the chaos often found at a large public hospital, patients are treated individually.

“It’s complex, because there’s a whole spectrum of problems,” said Dr. Jim Kunkel. “This clinic has been built into something that can take care of all types of people. (The disease) affects different people in different ways, so you have to take people individually.”

The clinic has become an important part of life for patients like Jesus Villa, 52, of Los Angeles.

“It’s like a haven,” he said. “The doctors work with me to find out what is best. It’s good, because I’ll be taking medicine the rest of my life. I am also able to talk about the disease with other patients. I’m not embarrassed.”

Rea said the disease and its treatment have changed quite a bit over the years, but that the image of Hansen’s disease patients has changed little.

“There’s quite a stigma associated with the disease,” he said. “The idea of the patient being outcast, unclean and the lowest of the low, those things are reinforced in the Bible. Despite the efforts of the informed, cultural values seem to change very, very slowly.”

After the Bible, which mentions leprosy more than two dozen times--usually as a punishment or other negative reference--the 1959 epic film “Ben-Hur” may be the most famous cultural reference to the disease. The biblical stigma remains so great that the emotionally loaded terms leper and leprosy are no longer used. In 13th-Century France, more than 2,000 facilities were built to house sufferers rounded up by the government during an epidemic. As late as the 1930s, those with the disease in China were sometimes burned. And in the United States, laws existed in the early 1900s that allowed authorities to arrest patients.

Most were sent to so-called “leper colonies,” the most famous of which was established on the Hawaiian island of Molokai in the 19th Century. Most of the colonies have been closed. The National Hansen’s Disease Center, located for almost a century in Carville, is believed to be the only residential treatment center in the United States.

“The disease carries with it quite an emotional charge,” he said. “It varies a lot from culture to culture. There is a difference between ethnic groups and within ethnic groups.”

Though many of the clinic’s patients emigrated from countries that still discriminate against Hansen’s disease patients, many who visit the clinic say life in the United States is not perfect, either.

Villa, an unemployed immigrant from Mexico, said the disease not only impaired his ability to work--he is arthritic and losing feeling in his legs--but also affected his marriage. He and his wife recently separated.

“It could be the disease,” he said through a translator. “There are other problems, of course, but I couldn’t say (the breakup) wasn’t related to my disease. I felt embarrassed with my family and friends because, in the past, it was a disease that people have feared. I tended to keep to myself and away from the family.”

Villa now lives alone, collecting a small Social Security pension. He must cook and clean for himself, endangering the limbs that lack sensation.

“I sometimes feel like I’m deteriorating,” he said. “I feel like my skin is thin and I’m constantly burning myself. When I pick up something hot, it doesn’t feel hot. When I take a shower, it doesn’t feel hot or cold.

“I wear loose clothing so it doesn’t bother my skin. Now I have to focus on wearing comfortable shoes because it’s important. I cannot drive, so I don’t socialize.”

Formerly a factory worker, Villa said he is embarrassed because he can no longer work. He anticipates having to employ someone to take care of him soon.

While Villa is uncertain about his future, other patients have had an easier time. Many report little or no trouble with the disease beyond the obvious.

“I used to go to the beach and swim,” said Frederico Amador, 43, of Los Angeles. “That’s something I can’t do anymore. I’m embarrassed. I’m not able to wear clothes that reveal my arms, so I’m not as comfortable. Initially, I felt depressed. But as time goes on, it gets better.”