This text draws upon an extensive collection of life histories to elaborate the perspectives of patients themselves who suffer from leprosy in Mali. It describes the transformation of leper identities with changes in medical and social responses to the disease. By situating seemingly local experiences of patients within the larger context of national and global change, the author aims to deepen our understanding of a range of issues including stigma, marginality, begging and migration. He explains how the dibilitating nature of leprosy interfered with one's ability to marry, farm and participate in other facets of normal life. Leprosy sufferers became outcasts in their villages and often migrated to treatment centres in Bamako and other towns. At these centres, patients constructed self-conscious communities which empowered them socially and politically.