Counterpoint - The Wilkie Duran Story

by Verna Mamicpic-Alih

Let me familiarize you on the Rural Health Unit (RHU)-Department of Health policy for enrolling patients in the leprosy and tuberculosis programs.  The Municipal Health Officer (MHO), after a complete physical examination of a patient renders his clinical impression/initial diagnosis of either disease.  The MHO, per policy, must refer the patient to a higher level/unit who has the capability to make a definite diagnosis based on positive laboratory test results with positive x-ray findings (in the case of tuberculosis).  Only when there is a definite diagnosis from the higher health authority can the MHO enroll the patient in the leprosy or tuberculosis programs.  These programs provide the medicines and regular follow-up consultations usually from 1 to 1-1/2 years or until the patient is cured. These services are free to patients enrolled in the program.

In the case of Wilkie Duran Monte, the Lazi MHO referred him to the Siquijor Provincial Hospital in year 2000, with the working/initial diagnosis of leprosy.  Subsequently, Wilkie returned to the Lazi RHU bringing the recommendation from the Siquijor Provincial Hospital that he be enrolled in the government's Leprosy Program, as the laboratory test for acid fast bacilli (AFB) was positive for leprosy.  (Not knowledgeable about this test, I asked the Silliman Medical Center pathologist who told me that the AFB test is an accurate test for the diagnosis of leprosy, more definitive than a skin biopsy).

Forthwith, the Lazi MHO and nurse sat down with Wilkie and his wife Sherlyn to discuss the mechanics of the leprosy program.  Both of them were made aware of the dosage requirements, possible allergic reactions to the medications - what to do, and personal hygiene instructions.  Stressed to both Wilkie and Sherlyn was the need for Wilkie to take a rest from his job with the mining company in Simacolong (since he was in the infective stage yet, it was necessary that Wilkie be "isolated" from others, as well as avoiding complications due to his lowered immunity).   Emphasized also was the need for Wilkie to return to the clinic in case of any allergic reactions so the medications could be changed or the dosage adjusted.

Taking a sick leave would have meant no salary for the period. Wilkie and Sherlyn felt this was financially bad for their family so he continued working.    Wilkie did develop allergy to the leprosy drugs (commonly seen in patients who are given leprosy drugs), manifested as blister-like on his skin and labeled as "skin swellings" in the documentary.

Typical of the superstitious Filipino in general (and a Siquijodnon in particular), Wilkie and Sherlyn, and a few relatives and friends, thought that the "blisters" spread over his body was due to having angered some supernatural forces because of his work in the blasting section of the mining company.  With this conclusion they went to consult a folk healer (mananambal) in Siquijor, disregarding the instructions to return to the clinic in case of any allergic reactions.

Unfortunately for Wilkie, the folk healer/mananambal rubbed the so-called medicinal oil on the affected skin areas.  This medicinal oil is a concoction of coconut oil and herbal plants-leaves and roots.  (One should understand that anyone who visits the mananambal has easy access to this "medicinal oil."  The hand's palm is clapped over the bottle opening [usually a long-necked bottle], then the bottle is turned upside down so that oil coats that part of the palm placed over the bottle opening.  In the process of turning the bottle right side up, whatever dust/dirt was on the palm would now be in the oil.)   It is safe to conclude that the pseudomonas bacteria was already present in the "medicinal oil" and entered Wilkie's body once the oil was rubbed onto his skin.  From then on, his condition worsened.

From Lazi, Wilkie was transferred to the Negros Oriental Provincial Hospital (NOPH) in December 2000.  With no response to the antibiotics given by his doctor at the NOPH, he was transferred to the Silliman Medical Center on 18 January 2001.  Based on interviews by the Silliman Medical Center Resident Physicians and medical social worker, Wilkie and Sherlyn revealed that Wilkie complied with the intake of leprosy drugs for 3 months but stopped when he went to a mananambal.  They also revealed that when his skin condition worsened, they went to the leprosarium in Cebu for further treatment. But because of financial constraints, they returned to Lazi after a few days then came to the NOPH. At the Silliman Medical Center daily debridement of his skin lesions was done. He was given injectable antibiotics to treat his Pseudomonas infection.  He was discharged well on 10 February 2001. His skin lesions healed with about 2-3 remaining small lesions healing well.  Instructions were given on home care for the remaining small lesions, medicines given for the lesions and his leprosy condition, and above all instructions on personal hygiene.  Final diagnosis upon Wilkie's discharge was: 

"Hansen's disease.  Erythema nodosum leprosum with allergic contact dermatitis and superimposed bacterial infection.  Sepsis secondary to above."

Wilkie returned home to Lazi, re-enrolled in the Leprosy Program of the RHU and was given all necessary medications and instructions.  Again, he failed to follow instructions.  The remaining healing lesions worsened and other lesions cropped up.  He was admitted to the Siquijor Provincial Hospital about a month after his discharge from the Silliman Medical Center.  Sherlyn came to me at the Silliman Medical Center Laboratory with a request for the necessary materials for culture and sensitivity tests.  I learned from conversations with Sherlyn that he had not followed personal hygiene instruction after his discharge from the Silliman Medical Center. 

I agree that there is environmental destruction with the mining in Simacolong, Lazi, or for any open-pit type of mining, but from what I have learned about this case, especially the positive AFB test and the final diagnosis at SUMC, Wilkie Duran Monte contracted leprosy. He was not a victim of toxic chemical poisoning.