My first days in RLH were spent learning new protocols and procedures. On my first day the senior doctor took me to the operating theatre to carry out what she called 'Septic Surgery'. As a doctor only familiar with strict, aseptic conditions, this term itself was a paradox. I was to learn, however, that 'Septic Surgery' was a common procedure in Leprosy Hospitals.

A patient with an infected foot ulcer lay in the theatre. To my horror, the doctor made an incision without administering anaesthetic. I could hardly believe it - the patient lay quiet! My senior then explained that leprosy patients do not feel pain and so anaesthesia is not required!!

I have now been doing septic surgery for ten months. My prayer is that I will remember to give anaesthesia to non-leprosy patients!

The 'Fortunate' One?

Mr Parsuram, a 38 year old married bank clerk with two children, has had leprosy for fourteen years. Despite this fact, not even his wife knows he has the disease. He hides his plantar ulcers by sleeping in his socks. He changes his dressings in the bathroom daily and hides the materials in a place where his wife will not find them. I asked him why he wouldn't get admitted into the hospital and receive the surgery that could help heal his ulcers. He swiftly pointed out that there was no way that he could be admitted without the knowledge of his wife. How could he show his employer a medical certificate from a leprosy hospital? He had insight into the social consequences of being diagnosed as a leprosy patient. Therefore he was resigned to live with his ulcers. His one aim was to see his children settled in life. He knew that his leprosy could interfere with their marriage and education prospects. Fortunately, Parshuram had no other visible deformity.

We may have quick fix solutions for patients. However, they often know more about the social aspects of their disease. This can be hard to accept.

The 'Unfortunate' One?

Our chaplain took me to a small hut near our hospital. Inside were two people who are now my friends. Apte Guruji (Marathi, for school teacher) was one of the few educated patients. He joined his palms to greet me in the traditional Namaskar style. The stumps of his fingers pointed in all possible directions.

Apte's fair companion had an aristocratic look about her. For a minute I forgot she was a leprosy patient. The chaplain introduced me as the new doctor. She looked up with joy, appreciating me for choosing to work amid leprosy patients. Grateful for the compliment, I sat and listened to her story.

She was diagnosed with leprosy in 1936 at the age of 14. Her father was serving the British Raj as the Sangli District's Chief Medical Officer. He tried to treat her secretly but the news leaked out! Painfully, he decided to take her to a missionary home for lepers. They met Mrs Dr Richardson who took the girl into her arms and said 'From today you are my daughter'.

The mission became her home. She came to know and love Jesus as her personal saviour. She taught the other children in the home about Christ and ran the hospital's Sunday Schools.

Had she not developed leprosy, her life would have been very different. Still, she praises God for all that has happened to her. Her only regret is that she is no longer able to read the Word because of bilateral cataract. Stories like this can help us see God's love even in the midst of suffering.

The Redeemed One...

There he was sitting in front of me, a handsome young man who played drums in my church. Before I had a chance to speak he promptly said 'Tell me, Juni, do I have leprosy?' I made him sit next to me, examined him, and could see he had the disease. Being more nervous than he was, I tried to beat around the bush, but he sternly repeated 'Is it leprosy?' I gathered up courage and said 'yes'. After a moments silence he said 'The Lord is in control. I'll go and tell in the church that I have leprosy.'

The very next Sunday he testified in front of the whole congregation about his leprosy, praising God for the good hospitals and medicines he had given. Having the disease had helped to strengthen his faith. But he was reprimanded by a church elder for having testified, because it could be a hindrance to others to come to church!!

The Chicken Neck Episode

Mr Balaji was killing a chicken. He took the knife in his right hand and held the chicken in his left. Squatting on the ground, he put the wings of the chicken under his feet to ensure that it did not fly away. Then he cut the chicken and let the blood flow from the neck for sometime. But after he released it from his feet, he found that the chicken flew away happily. Then he realised that he had cut his own fingers. He came running to the hospital with his mutilated finger held in the other hand.

The problem of anaesthesia is something that you don't quite understand until you see the havoc that not being able to feel pain can wreak in a person's life.

The Professional

This smart young man's only visible deformity was his bilateral claw, which I thought was ideal for reconstructive surgery. He was already an inpatient on the ward because of his plantar ulcers, so I called him to the office to talk to him. I wanted to create a rapport, so that I could encourage him to have the operation. Some world famous surgeons were due in about two weeks, and I was keen he should benefit from them.

We began by talking about him and his family. He was happy to talk about his wife and her work, but when we touched the subject of his own occupation he became vague. I did not think that this was important, and promptly moved on to talking about the surgery for his hands. I tried to convince him that after the surgery his fingers would be straight and look almost normal.

He was not impressed by my suggestion, so I pushed further by saying that no one would recognise him as a leprosy patient thereafter, and he would be able to lead an almost normal life. Still he didn't want to know. I pestered, coaxed, and tried all manner of persuasion. I reminded him that the surgery was free of charge, so there was no economical reason for refusing. I couldn't understand why anyone would refuse, so I asked if there was a link between his family and the surgery? If not, was there a link between his profession and the surgery? Then it occurred to me to ask him what exactly his job was, but he refused to answer. So again I asked and angrily he gave in saying 'What can I do other than begging?' adding quickly that, 'after your surgery I will lose that also'. We can repair a marred face and clawed fingers, but what can we do for the spirit of the patient, to reconstruct his broken ego and polish his corroded self-image?

My Patients

The anecdotes above are only a few of the umpteen stories from our hospital. Everyday is a new challenge and requires God's fresh anointing not to get frustrated.

Leprosy patients have suffered discrimination in every culture. 'Leper Squint' in Britain and 'Leper Masses' in Continental Europe are stark remainders of the discrimination that existed in medieval Europe when leprosy was endemic there. In India, even now patients are stoned and are forced to live outside the villages. The discrimination combines with the disfigurement to cause loss of self esteem for the sufferers.

As shown in the Chicken Episode anecdote, anaesthesia is the greatest problem in leprosy. 'Thank God for pain', Dr. Paul Brand declares with utmost sincerity. 'I cannot think of a greater gift I could give to my leprosy patients.'[2]

Leprosy was believed to be hereditary till the 19th century. A young Norwegian doctor Gerhart Armaer Hansen (1841-1912) discovered rod shaped bodies in the material he removed from the nodules of leprosy patients. He hypothesised in 1874 that these bodies were the probable cause. About the same time, Father Damien, a Catholic Missionary on the Hawaiian Island of Molokkoi, contracted the disease, despite the fact that he had no family history of it. Both these happenings helped to disprove the hereditary theory of leprosy.[3]

The Leprosy Mission

Wellesley Cosby Bailey, an Irish missionary in North India was moved by the plight of leprosy patients in India. He founded the Mission to Lepers (now known as The Leprosy Mission, (TLM)) in 1873. TLM works in partnership with churches, governments and other agencies in 30 developing countries. It provides treatment programmes, community education, expertise in rehabilitation, counselling and spiritual care.[4]

TLM's purpose is to minister, in the name of Jesus Christ, to the physical, mental and spiritual needs of sufferers from leprosy, to assist in their rehabilitation and to work towards eradication of the disease. The challenge facing TLM is to reach out to the many untreated sufferers with help. 600,000 new cases develop each year and about four million people, world-wide, have, or are at risk of developing deformities.

Richardson Leprosy Hospital

RLH is one of the 30 hospitals owned by TLM in India. It started out as an 'asylum', for leprosy patients. Now it is an 120-bedded hospital catering mostly leprosy patients. Besides being a referral centre for leprosy, it also has a laboratory doing advanced research in mucosal immunity to M Leprae. We are celebrating our Centenary this Year.

Our work is very different from that of other hospitals. Every morning we start with half an hour of worship, with devotions started by the Christian patients singing traditional 'bhajans'. It is a joy to see them play the drums, cymbals and harmonium, even with their deformed fingers.

The work in the hospital consists of in-patient, as well as out-patient treatment of leprosy. Almost one third of the patients have ophthalmic manifestations. Chronic ulcers are treated by doing septic surgery and giving specialised footwear. Due to the involvement of multiple organ systems a doctor in a leprosy hospital has to be a surgeon, physician, ophthalmologist, and dermatologist all at the same time. Health education also plays a very important role in any leprosy work.

Work in a leprosy hospital can be very tiring. Sometimes one single doctor has to manage the whole hospital. But the good part is that there are hardly any emergencies or night calls. It is not a job that many people choose, because it is nothing glamorous. The job satisfaction is, however, tremendous. Being able to do what Our Lord Jesus Christ himself did - that is fantastic. In the initial days I was awe-struck by the deformities I saw. Mangled hands, deformed feet and foul smelling ulcers filled with maggots. It was disheartening to see the amount of human suffering in this disease. I looked at my own hands and said 'Thank you Lord, for my fingers.'

Leprosy patients do not need our sympathy, but our consideration of them as fellow human beings, co-members of the large human family. They expect from us only the dignity they deserve as humans. Dr Hugh Cross, a Consultant Podiatrist described leprosy patients as 'brave little soldiers in the front-line of the battle within a society suffering from leprosy of mind'.