The leper house sits at the edge of the village – more accurately,
beyond it. It’s a ramshackle structure, visibly outside the rhythms
of ordinary life. The camera makes sure we understand this geography
before we understand anything else: illness is spatialized. Care
happens “elsewhere,” out of bounds for regular village life.
(It’s like the Sondersiechen, the medieval leper home in Bregenz –
away from town, in a field, in a location that distances illness in
thought, space, and structure.)
In this episode of Cadfael (Season 1 ep.
3), we start our story by following one of the lepers as he
approaches. The leper carries a cowbell mounted on a pole, its
ground-thumps clanging in keeping with his stride. He regularly and
perhaps automatically shakes his other hand to sound a wooden
clacker, a percussion instrument not to entertain but to announce his
presence. Sound arrives before the body. Warning precedes encounter.
As he passes by, we see his wrapped arm – a stump? – across a
colleague’s shoulder; his weakened body needs support. And he has
entered the yard of a place where such care happens.
Another leper emerges from the house,
his face fully covered by a cloth mask pierced only for the eyes, his
clothing ragged but carefully concealing all exposed skin. Lepers
should not be seen. When we do see something of the disease itself,
it is his hand: deformed, with nodules, and missing two and a half
fingers. Damage is real, irreversible, unromantic. Lazarus has been
profoundly altered by his illness.
Bran, by contrast, is younger. His body
has responded to the lotions Cadfael supplies. The monks, Cadfael and
Brother Mark, speculate cautiously about whether he might someday
return to the world. “There’s always hope,” Cadfael says; “By
God's grace and man's efforts we may yet send him back whole into the
world.” It’s a small line, but it matters. Miraculous recovery is
plausible; medical care is feasible. We do not have to sit by and do
nothing.
Medicine opens a door. Society decides
whether it stays open. Donors, we soon realize, could make a
difference.
The first potential donor is a man on
horseback, well-armed, well-accompanied. When the request comes –
“coin for a leper, my lord?” – his response is immediate, and
violent. He raises his cudgel and snaps, “Out of my way, vermin.
Take thy contagion out of my sight.” He follows this with his
chosen epithet, “Filthy lepers.” They are not individuals; they
are a polluted class, to his mind unworthy. And yet his three
followers each toss a few coins as they pass. Fear does not erase
obligation entirely, and the open prejudice looks shameful in the
face of the generosity of his juniors. We should judge a man by his
actions; he has failed a basic test of empathy.
The second donor is a lady on horseback,
her aunt riding behind in a carriage. “A little something, my
lady?” She willingly tosses her coins, and a generous assortment at
that. Her aunt immediately objects: “You should not waste your
coins on lepers.” The one thinks charity necessary; the other deems
it imprudent expenditure. Are lepers worthy poor? Medieval opinion
appears divided.
Stigma and care are not opposites here;
they operate simultaneously, in plain view. The lepers are marked and
masked, sonically announced, verbally dehumanized. They are feared as
contagious, morally suspect, and socially dangerous. And yet they are
housed, supplied with medicines, provisioned with care. They are
expected to beg, their abjection an expectation or even a requirement
of their existence. Yet they also receive alms – not every time,
but more often than not in this clip. There is a system here, however
inadequate or dehumanizing it may feel to modern viewers.
And that’s where this episode’s
careful realism matters. Medieval society did not simply abandon
people with terrifying illnesses, though it assuredly did not embrace
them. Instead, it built an uneasy safety net at the margins:
regulated begging, institutional housing, religious oversight, and
just enough compassion to keep people alive without restoring them
fully to community life. It is an existence on the fringe, a place of
managed exclusion. But care also happens – sores are treated, hope
articulated, and coins, however reluctantly given, still change
hands.
On World Leprosy Day, that tension feels
worth sitting with. Not just the cruelty, but also the
infrastructure. Not just the fear, but the effort – partial,
flawed, deeply hierarchical – to respond to suffering rather than
erase it from sight.
This year’s theme is “Leprosy
is curable, the real challenge is stigma.” There’s
a real call-to-action there. Cadfael reminds us that cures matter,
but that the harder work – then as now – lies in dismantling the
habits of exclusion that make illness socially incurable.
Leprosy (now more properly designated Hansen’s Disease) is a
disease of almost overwhelming stigma. It can cause disfigurement and
is associated with poverty, all the more so now that treatment is
readily available. It is a disease that also causes us to attend to
our social response, highlighting the tension between charity and
revulsion, inclusion and fear.
The work that goes
on around the globe on World Leprosy Day seeks to create social
change – to reduce stigma, emphasize treatment and inclusion in
community, and break the inter-generational cycle in which leprosy
leads to isolation leads to reduced education and livelihood
opportunities leads to poverty which leads again to leprosy.
While it’s early yet to see what will be issued for THIS year’s
world leprosy day, I’d like to take up three examples of the
campaign from previous years which provide a glimpse into the
power that music has in these socio-medical campaigns. It is, in
other words, an example of music as public health, and one that I
like to talk about with students in my Music, Pandemics, and History
class.
EXAMPLE 1: A Leprosy Awareness song
“Gandhi’s dream: India should be Leprosy Free”
The
song conveys straightforward yet impactful messages.
One theme is that of
awareness. “It does not spread by touching”; treat early;
it’s eradicable. Also, finish your course of treatment, “medicine
has to be given till the end.”
A second is working toward a
more inclusive society: “We should get a little more, we
should get all the rights, we should get a sense of belonging in the
heart, the society should accept us from the heart, leprosy has to be
eradicated from the body, mind and thought also.” Likewise,
eliminate discrimination and avoid stigma by adopting a
caring attitude -- “Avoid grudges or bad mouthing”; “Keep the
patient happy with a loving face.”
A
final message is the fact that we are all implicated in this
work: “Through a joint effort we can all make India free from
leprosy.”
The music reinforces this
vision in several ways. It adopts traditional Indian idioms and
instrumentation. The musical style is approachable, trending toward
pop. The presence of a lilting, danceable percussive backbeat, for
instance, gives the performance energy. There’s a good deal of
musical and verbal repetition, and sections are marked with dramatic
gestures such as a rising swoop in the strings. There is a chorus
that comes in to add richness to the texture. Put together, these
choices are signaling that theme of collective effort together; just
as this is “our music,” so is its challenge “our problem.”
EXAMPLE 2: Sparsh Awareness Campaign (A governmental educational program)
Theme: United for dignity
This initiative was a government-sponsored campaign to use a festival model to facilitate education and awareness of the disease. The performances include skits, dance, and song, in between giving speeches about the disease. The (edited) example here comes from Vellore district, and condenses the cultural offerings to focus in on the speeches that convey this 2022 message:
“The disease will not spread through treated persons. Hence all cured leprosy persons should not be neglected or disliked. The WHO Theme for SPARSH Leprosy Awareness Campaign 2022 is "UNITED FOR DIGNITY". Therefore, let us strive to uphold the honour and dignity of leprosy cured persons.” (Excerpt of the YouTube description)
At the beginning of the clip, we again get singing, this time by a woman singing in the traditional Indian style, celebrating the local region, Tamil Nadu. The song depicts the importance of local culture and the importance of state initiatives. This is followed by a traditional circle dance to sung accompaniment which visibly expands to include the community gathered in an outdoor venue.
This
initial set-up emphasizing music and dance creates
a bridge between cultural pride and public health awareness
messaging that follows. There is the familiar sound of local musical
practice. The performances, though polished, are not unduly
professional; they seem to stem from within the community. This is
reinforced in the dance, where the circle of women visually segues
into the circle of the listening audience, many of whom bob and sway
to the sounds they are hearing. We have been brought from the joys of
cultural expression into community, “United for Dignity,” which
shares its appreciation for such beauty. The implication is that they
will share as well in the understanding from the day’s educational
program.
There’s a bit of slippage
here: enjoyment of song, and enjoyment of message are portrayed as
somehow equivalent. This is an important public health messaging
strategy that we see on a variety of fronts (see AIDS awareness in
Uganda, for instance). Music, dance, and other cultural expression
draws in the crowd, garnering attention and preparing them for the
harder-hitting messaging about disease safety, treatment, and the
need for change.
Here in the Vellore
video,
that stratey is made
explicit. After
these initial song and dance excerpts, we cut
to a series of speakers each
of whom speaks from a seat in
front of a poster about leprosy awareness. The
poster behind the series
of speakers is busy
delivering text. It mentions symptoms (“loss of feeling”) but
also seeks to normalize the disease; we should “treat it like TB.”
Lastly, it makes the point that clinics will provide evidence-based
care, there is “no experimentation” (!) in delivering treatment
for the disease. As a
backdrop, the poster is a bit overwhelming; the amount of text and
the array of type-faces and colors seem to function more like a flag
backdrop than a conveyance of information. Tired eyes might prefer
instead to focus on the speaker, and maybe that’s part of its
purpose. It is “official” without being “interesting.”
Reading is work; listening is easier.
Indeed, what IS interesting,
in contrast to the poster, are the series testimonials
from individuals who have had the disease. These
testimonials make up the
central portion of this “Leprosy awareness day.” The first [in a
google translation based on a notta.ai transcript], reads:
My
name is Shafuddin. I am speaking from Vellore. My body has been
damaged since 2001, so I went to the hospital. They said it is
leprosy. In the hospital they said it will be cured by treating it. I
took similar medicine for two years. The body recovered to some
extent. Hands and feet are very nerve affected, there is a lot of
pain, so they said that by doing an operation the hands will be
cured. After doing the operation it got cured. I do my work myself. I
can eat. I do all the work myself. There is no problem. Feeling good.
Leprosy is not a bad disease. If you take the right medicine you will
be cured.
This shared personal
experience helps the audience understand the multiple treatment
options. There were the meds, and then afterwards a surgical
intervention. The success of his treatment and his subsequent
independence would be important to anyone who fears that they
themselves might be suffering. Moreover,
his story demonstrates personal resilience and also the societal
support needed to uphold dignity for those affected by leprosy.
Shafuddin’s journey from diagnosis to recovery directly embodies
the campaign’s call to honor the dignity of those affected by
leprosy. Likewise, his ability to regain independence challenges
stigmatizing narratives. His message, as I see it, reinforces the
hope embedded in the festival's music and dance.
Later in the video (1.59)
there is a masked and
costumed dancer and supporting chamber ensemble; the elaborate
costume and intricate steps contrast with the packed-earth dance
circle and the backdrop of cow and crops. A second and then third
character come in to enliven the skit. This cultural
offering too is followed
by impassioned speakers.
Alternation of entertainment
and education keeps the audience engaged. Such alternations also
subtly suggests that there is a “whole-life” experience in
illness treatment. Just as we (here the we of the community audience
and its internet echo) enjoy the singing and dramatic action, we –
the united “we” of community – should enjoy our support for
these companions who have suffered with the disease, and for their
invisible compadres.
The
video ends with a medical overview of symptoms and treatments, and an
emphasis that treatment is free. The government is working to support
eradication, and anyone who has the disease should be treated.
Here,
we see music as an attention-getter,
valuable for its entertainment value, and providing a forum in which
other socially-critical messages can be sent. We
also see music as a community-building
element, identifying the “united we” of the messaging campaign.
The visual placement –
an outdoor festival setting, with birds and other nature sounds –
create an ironically “homey” atmosphere, in which you are hearing
from neighbors and compatriots about what is possible. And
throughout, the upbeat
music goes along with the upbeat message: Leprosy can be cured. That
message is worth celebrating.
In short, I think this
approach – blending
traditional cultural expressions with modern health messaging
– creates
a shared space for education, empathy, and celebration of civic
progress in a
significant public
health initiative. Like
“Gandhi’s Dream,” the message here is simple: just as we
collectively respond to the music, we should collectively respond to
the disease itself. Through its blend of traditional cultural forms
and modern health education, the Sparsh Awareness Campaign
demonstrates the potential of music and other performative arts to
transform public health initiatives into inclusive, community-driven
movements.
EXAMPLE 3 An Award-winning leprosy awareness short (from 2003)
Dungarpur Films' 2003 award-winning short, recipient of the Indian Documentary Producers’ Association (IDPA) Gold for the best public service film for leprosy awareness, delivers a powerful yet simple message:
One intervention can make a difference.
The film follows a woman and her son as they navigate the stigma surrounding leprosy and move toward the hopefulness of seeking treatment. It begins with the village headman’s stark declaration: “There’s no place in the village for leprosy patients.” This sets the stage for conflict, as the family’s diagnosis has sparked fear among the villagers, who seek to exile him and his mother so that the disease stigma doesn’t pass to the broader community.
Yet,
one woman raises her hand and calls to the mother and son. She speaks
out against exclusion, commanding them not to leave the village, but
rather to go straight to the health center. She reinforces this
message by publicly inviting the mother’s touch, hand to head. Her
intervention shifts the focus from judgment to action and the
narrative from vague crowd mutterings to crucial public health
information: “A disease-free body… Leprosy is completely cured
with MDT [Multi-Drug Therapy]. And this MDT is available completely
free at every government health center.”
The film ends with a
resolution—the mother and son are welcomed at the clinic, where
they receive treatment. The final frame features the National Leprosy
Eradication Programme (NLEP) symbol: four connected stick-figure
hands alongside the message, “Join hands: eradicate leprosy.”
This visual reinforces the short’s central theme of connection and
collective responsibility.
At its core, the film frames stigma as a more pervasive and
damaging issue than the disease itself. We initially sit with the
discomfort of an unhappy village; we are grounded in the reality that
the ill one might be ostracized. The disease is contagious, but
attitudes are even more contagious. The woman’s intervention not
only counters this stigma but also demonstrates the courage and
compassion needed to enact change. By touching and interacting with
the family, she visibly defies the rumor and shunning which had
seemed increasingly normative. Her actions embody the film’s call
for inclusion and understanding.
This act of bravery is pivotal. It transforms a moment of
potential exclusion and banishment into one of connection and hope.
The journey to the clinic becomes a metaphor for the broader societal
journey—from ignorance and fear to knowledge and action. The
message is clear: intervention, grounded in education and empathy,
can dismantle stigma and pave the way for healing.
Her intervention is successful; we follow these characters as they
move toward the clinic, receiving crucial public health information.
Leprosy is completely curable. Treatment is free at all government
health centers. There is a solution. We end with an arm around the
shoulder in support – connection, not stigma, will solve the
disease.
The film’s music underscores this narrative journey, amplifying
the emotional stakes and reinforcing the thematic arc. At the start,
the suspenseful score reflects the villagers’ tension and
hostility. There’s a traditional voice, and threatening
intermittent and unpredictable drum. We hear discussion and crowd
noise. This is the acoustical chaos of bad things happening.
Yet, after a woman intervenes, we move toward acceptance and a
resultant shift of musical idiom. A more hopeful lyrical voice
emerges, as well as more instruments playing in a coordinated and
more predictable way. We have a reiterated drone pitch to provide a
harmonic reference point, making the point that stability comes from
seeking treatment. So does optimism, for a series of arched phrases
accompany images of the journey to the clinic – the boat, a bike
and walk into the clinic. The highest of these vocal phrases is
delivered as our patient receives her packet of medicine, not only a
climax, but a happy one. Throughout this section, there is also more
complexity in the drum rhythms, accompanied with the tinkle of high
bells – a brighter timbre, with more interesting patterns. This is
music that we want to listen to. It is music as “accompaniment to
action.”
The music of this 90-second
short, in other words, tells us that inclusion and intervention are
the right choices, the ones that will lead to a positive, major-key
kind of place. We have, in the final frame, the joy of treatment with
the final high arched phrase. Layered over that is the visual cut-in
– the NLEP symbol, and four connected stick-type figures, with the
words of the final message: “join hands: eradicate leprosy.”
Dungarpur Films’ offering blends narrative, music, and
public health messaging together in order to inspire change. By addressing stigma
through a compelling story of intervention – by illustrating the
transformative power of knowledge and empathy – the film leaves
viewers with a clear and actionable message: inclusion and education
can eradicate both the disease and its associated stigma.
The
music, serving as both a narrative driver and an emotional guide,
amplifies the film’s impact. From the acoustical chaos of exclusion
to the lyrical harmony of hope, the soundtrack underscores the
journey from fear to acceptance. Storytelling and music here foster understanding and community-building. The film's call to “join
hands” remains as resonant today as it was in 2003: just as we
collectively respond to music, we must collectively respond to
disease and its societal implications.
TAKE-AWAYS
As we have seen in these
three examples of leprosy intervention, music plays a vital role in
public health. It bridges the gap between complex medical messaging
and community engagement. Its ability to evoke emotion, foster
community, and reflect local cultural values makes it a powerful tool
for reducing stigma, promoting awareness, and encouraging positive
collective action.
Whether through traditional
idioms, modern compositions, or community-driven performances, music
transforms abstract health messages into relatable, memorable
experiences. By integrating music into campaigns, public health
initiatives transcend mere information dissemination; they build
empathy, solidarity, and hope, empowering communities to confront
challenges together. Music, in essence, resonates not just in sound,
but in its capacity to inspire societal change.
I would like to thank Avagail Hulbert, whose seminar contributions
on India’s leprosy eradication programs introduced me to these
and other compelling examples of music in public health. I would also like to thank my colleague and friend Gregory
Barz, whose work on medical ethnomusicology was my first introduction
to the topic. Lastly, I’d like to thank all those many people –
musicians, film-makers, dancers, educators – whose capacity for
empathy and commitment to optimistic service is the active force for
good that makes real change happen in the world.
