Nepal is one of the ten poorest countries in the world. Over 90% of the nation are farmers, many practising subsistence farming on steep terrain. Rural poverty results in inadequate housing, malnutrition, poor sanitation and little running water. Leprosy thrives in such conditions of poor hygiene, overcrowding and poor nutrition.
The Leprosy Control Project in the Western and Mid-Western regions is a Government programme assisted by The International Nepal Fellowship, which also runs the Green Pastures Leprosy Hospital in Pokhara.
Danger without pain
Leprosy often causes anaesthetic hands and feet and these, if not cared for, are susceptible to injuries, burns and infections. Patients are.encouraged to keep their anaesthetic skin in good condition by daily soaking, oiling and trimming of excess callous. If a wound is present, salt or potassium permanganate is added to the soaking water and then the wound edges trimmed and dressed by the nursing team.
These activities happen each morning on the veranda and hopefully reinforce self care at home once the patient is discharged. Good self care and early reporting of complications can prevent the deformity and disability associated with leprosy. However, once the patients are back farming in their villages, they are often forced back into their old ways of doing things. A Health Educator assesses an individual's understanding and then teaches about self care of hands, eyes and feet.
To cure or to conserve
Leprosy is curable with multiple drug therapy. This renders patients noninfectious and if started early enough prevents the residual deformity and disability. The length of treatment varies, but is of the order of years and continuity is vital for success. Out patients are seen each month for supervision of their treatment. Patients with septic and other complicated ulcers are admitted. Early diagnosis of nerve damage is imperative if function is to be retained. The nerves may be painful and enlarged, but at other times there is a silent neuritis. Therefore nerve function is assessed by Voluntary Muscle Testing and Sensory Testing. (Voluntary muscles are those which move the bones and joints). If early nerve damage is detected it may be possible to reduce its progress by drugs such as steroids. There is a surgical ward for reconstructive and orthopaedic work. Operations that correct deformity and so reduce disability include:-
Research and rehabilitation
The Socio-Economic Services (SES) workshop provides sheltered employment as does a farm. Here patients whose nerves are already irreversibly damaged can learn to work without damaging their limbs. The SES team also visits patients homes or work places to advise and correct misconceptions. There is a Physiotherapy and Occupational Therapy Department. The nerve testing is carried out in the Physiotherapy Department and the results charted. The hospital is undertaking research into the prevention of disability by early detection of nerve damage. Skills and abilities acquired in the Occupational Therapy Department can lead to vocational training provided later by SES. Other departments include the Orthopaedic Appliances Centre which makes protective footwear and artificial limbs. The rough terrain in Nepal means footwear must be replaced every nine months or so.
Impressions
One of the best two months of medical training! The hospital was much more organised than I had expected. The integrity, flexibility and cheerfulness of staff made a big impression on me. I was struck by the necessity of good nursing care.
It was wonderful to visit a country and people I had heard so much about; to have fellowship in the local Nepali church and the INF family and to learn again that "Jesus Christ is the same, yesterday, today and for ever". (Hebrews 13 v.8)
The Leprosy Control Project in the Western and Mid-Western regions is a Government programme assisted by The International Nepal Fellowship, which also runs the Green Pastures Leprosy Hospital in Pokhara.
Danger without pain
Leprosy often causes anaesthetic hands and feet and these, if not cared for, are susceptible to injuries, burns and infections. Patients are.encouraged to keep their anaesthetic skin in good condition by daily soaking, oiling and trimming of excess callous. If a wound is present, salt or potassium permanganate is added to the soaking water and then the wound edges trimmed and dressed by the nursing team.
These activities happen each morning on the veranda and hopefully reinforce self care at home once the patient is discharged. Good self care and early reporting of complications can prevent the deformity and disability associated with leprosy. However, once the patients are back farming in their villages, they are often forced back into their old ways of doing things. A Health Educator assesses an individual's understanding and then teaches about self care of hands, eyes and feet.
To cure or to conserve
Leprosy is curable with multiple drug therapy. This renders patients noninfectious and if started early enough prevents the residual deformity and disability. The length of treatment varies, but is of the order of years and continuity is vital for success. Out patients are seen each month for supervision of their treatment. Patients with septic and other complicated ulcers are admitted. Early diagnosis of nerve damage is imperative if function is to be retained. The nerves may be painful and enlarged, but at other times there is a silent neuritis. Therefore nerve function is assessed by Voluntary Muscle Testing and Sensory Testing. (Voluntary muscles are those which move the bones and joints). If early nerve damage is detected it may be possible to reduce its progress by drugs such as steroids. There is a surgical ward for reconstructive and orthopaedic work. Operations that correct deformity and so reduce disability include:-
- Tendon transfer for foot drop.
- Tendon transfer for clawed hand.
- Operations on the eye lids to protect anaesthetic eyes from damage due to loss of blinking.
Research and rehabilitation
The Socio-Economic Services (SES) workshop provides sheltered employment as does a farm. Here patients whose nerves are already irreversibly damaged can learn to work without damaging their limbs. The SES team also visits patients homes or work places to advise and correct misconceptions. There is a Physiotherapy and Occupational Therapy Department. The nerve testing is carried out in the Physiotherapy Department and the results charted. The hospital is undertaking research into the prevention of disability by early detection of nerve damage. Skills and abilities acquired in the Occupational Therapy Department can lead to vocational training provided later by SES. Other departments include the Orthopaedic Appliances Centre which makes protective footwear and artificial limbs. The rough terrain in Nepal means footwear must be replaced every nine months or so.
Impressions
One of the best two months of medical training! The hospital was much more organised than I had expected. The integrity, flexibility and cheerfulness of staff made a big impression on me. I was struck by the necessity of good nursing care.
It was wonderful to visit a country and people I had heard so much about; to have fellowship in the local Nepali church and the INF family and to learn again that "Jesus Christ is the same, yesterday, today and for ever". (Hebrews 13 v.8)
