. Xun Nuo stares into space as he ponders a question that has been put to him. The air is difficult to breathe and, at an altitude of 3,000 metres, it's a bitterly cold November day. His audience shuffles to keep warm while awaiting his reply. Xun is just 34, though you would never believe it. The harsh winters and primitive living conditions in the village of Ma Chan, at the eastern end of the Himalaya mountains, have taken their toll. Weather-beaten and leathery-skinned, the village chief looks at least 10 years older, although he is in better condition than many of his less-fortunate comrades. For this is a leper settlement and its inhabitants not only bear the disfigurements of the disease but are outcasts, shunned and feared by society at large. Even assuming you can find a driver prepared to bring you here, Ma Chan (place of the horses) is difficult to get to. The remote outpost is off-road between Qiaotou and Zhongdian, in Yunnan province, western China. Besides the painkillers occasionally provided by the government and charities, Ma Chan has few of the medical aids you'd expect to find in a village of its size, and no doctor. The villagers can't hide their injuries, most of which are the result of a disease that eats away at nerve-endings and skin; others are caused by the harsh living conditions. Eye disease, crippled joints, loss of limbs and distorted and disfigured faces, hands and feet are just some of the more obvious afflictions. Less visible is the damage done to villagers' lungs by wood-burning fires lit in tiny rooms that have no flues, chimneys or other ventilation. In winter, it is so cold, the villagers say, they rarely venture outside. Xun was 17 when his family, who live 90 minutes away, in Zhongdian, sent him to Ma Chan, in keeping with the policy at the time of quarantining leprosy patients in isolated communities. 'I was bitter and felt betrayed when I was first sent here,' Xun says, recalling how friends and family noticed his appearance changing as the disease took hold. 'My eyebrows fell out,' he says, adding that he also suffered from joint pains. It took two to three years of treatment with antibiotics before he was cured, but many more years before he was given an 'exit certificate', declaring him fit to return to the community. Not that Xun would abandon the village that was once his prison. For many years he, as village chief, was the only person allowed to leave Ma Chan. Official policy towards leprosy patients changed in 2000, allowing them to be treated in their hometowns rather than cast out into separate communities. But by then Xun had met his wife, Qili Lamo, 39, who contracted the disease when she was 25, and Ma Chan had become his home. 'I couldn't leave here now,' he says, flanked by village elders. 'I am too emotionally attached to the village. It is one big family.' In Ma Chan on the day we arrive are 17 students from Ma On Shan's Li Po Chun United World College. The Hong Kong students are on a mission to paint village houses as part of the school's 'China week' programme, a scheme designed to provide adventure for the youngsters and help for the less fortunate. The multicultural group is accompanied by principal Stephen Codrington, who visited the village a year ago to help build a toilet block. In addition to offering practical help to the villagers, Codrington hopes the visit will help to erode the social taboos surrounding leprosy. About 60 adults from six ethnic groups live in Ma Chan, down from 200 when it was first built, in 1959. Xun says some residents have died while others, lucky to have escaped serious disfigurement from leprosy, were taken back by their families after the policy change. Although all the remaining villagers have been cleared to leave, poverty and the fear of ostracism keep them here. 'They are not prevented from leaving the village,' says Xun, 'but they will be rejected by other people, even their families.' He adds that even local doctors refuse to tend to their injuries. 'Doctors refuse to see them because they are so scared of leprosy,' he says. Not all the villagers are former leprosy patients. There are nine married couples in the village, with 10 children, eight of whom have been sent to private boarding schools in Kunming and nearby Lufeng in the past year with the support of charity Caritas Macau. Two pre-school children remain in the village and Xun is concerned about their education. Ma Chan once had a school but it closed when the only teacher prepared to visit the village stopped doing so. Now that charities are supporting the hamlet, Xun is determined to make sure the children do not suffer the same stigma as their parents. 'I want to see all our children educated and able to move to the city,' he says. He no longer thinks of Ma Chan as a leper colony. 'I think of it as an ordinary village.' But it is a village cut off from local trade and most of the outside world. Residents have had no choice but to learn to be self-sufficient. Although the local government gives 300 to 400 catties of rice to each person every year and there are occasional donations of tea, eggs and meat, villagers survive by growing root crops in summer and eating dried foods in winter. They eat chicken and pork 10 times a year but their staple diet is turnips, eggs, other vegetables and rice. The last person to join the community was Ding Zhu, 26, who contracted leprosy five years ago. An orphan, he was sent to Ma Chan after being rejected by his own village. Now cured, Ding, who is uneducated and has only basic farming skills, considers Ma Chan home. 'I would leave if I could but I don't have any money and I would be discriminated against,' he says. 'No, this is my home now.' The remote, tough existence is perhaps hardest on the young adults whose parents were leprosy sufferers. Although they've never had the disease, these twenty-somethings have been as isolated from the modern world as their shunned elders. Zhang Liying, 21, looks almost fashionable in her woollen hat and denim jacket. In stark contrast to most of the villagers, the pretty young woman would not look out of place in image-conscious Shanghai. But, uneducated and with a four-year-old son, Qili Nima, to raise, she is trapped in Ma Chan. Zhang had no schooling until she was 17, when she received two years of primary education from a teacher supplied by Caritas. 'If I had the opportunity I would like to leave the village and study to become a doctor,' she says shyly. 'But I don't know how I could do that.' For the visiting school pupils, the first hurdle they faced was finding drivers prepared to make the 90-minute trip up the mountain then drop them near the village. Now, they must scrape years' worth of soot from villagers' walls before they can start painting. But the DIY is only a small part of why the students are here. Their major aim is to break down barriers and prove there's no reason to fear the former lepers. Speaking at the end of a strenuous day, Codrington says: 'Lepers in China really are the most outcast group in society and I think what we're doing in a broader educational sense is to overcome those stereotypes that people have. 'The last time a resident came to the village was about six years ago. No one has ever caught leprosy within the village. They've all been cured and they all have their exit certificates. They could leave if they wanted to. So we asked them the obvious question: 'Why don't you want to leave?' It was partly because of poverty - they've had no way of earning an income and therefore have no marketable skills in the outside world - but the big thing was the prejudice. 'Because of their physical disfigurement, they know they'll be outcast in society - and that even includes their own families. So that's the real thing that traps them here: the ignorance of people. 'I hope that we've been able to do something to overcome that. But obviously there is a long way to go because these people have virtually made themselves prisoners in the village because of the discrimination and stereotypes that people outside have. 'I think that's incredibly sad.' Leprosy, also known as Hansen's disease, is an infectious ailment caused by mycobacterium leprae, which invades human nerves and causes a range of skin problems, including loss of feeling, paralysis of the hands and feet and disfigurement of the joints. It is easily diagnosed and treatable with multidrug antibiotic therapy (MDT). The World Health Organisation has made MDT freely available to all patients worldwide since 1995. At the start of this year, there were 219,826 existing cases, according to data from 115 countries. There were 296,499 new cases last year, down 27 per cent on 2004. The average annual decrease in the past four years has been about 20 per cent. Most countries have eliminated the disease, but it is still prevalent in some areas of Angola, Brazil, Central African Republic, Democratic Republic of Congo, India, Madagascar, Mozambique, Nepal and Tanzania. Improving detection and fighting social taboos is important. In the past, patients were considered to be 'unclean' or 'cursed'. This led them to hide their condition and avoid seeking treatment. Sources: WHO and Wikipedia