Prevention-of-impairment-and-disabilities activities in leprosy after integration: role for physical medicine and rehabilitation personnel.

Referral options for specialist care for prevention of impairment and disabilities are imperative in order to make an integrated leprosy control system work. This requires an understanding of the disease, in addition to the special skills for managing specific disabilities. Physical medicine and rehabilitation (PMR) personnel are better equipped to handle leprosy-related disabilities. They are well versed with biomechanical aspects of deformities, and are competent to provide splints, orthoses, etc. to the needy persons, and they can assess sensory motor functions and deformities. If PMR personnel can be trained in deformity correction they can become valuable resource persons for secondary and tertiary care of leprosy-affected persons. PMR persons, therefore, have the opportunity to volunteer themselves for this job to fill the void created by the fading out of leprosy surgeons. They will also have to bear additional responsibility to train general health care workers so as to empower them to look after the needs of those disabled by leprosy, many of whom will continue to be available for a number of years to come.

[Training of the rehabilitation staffs through taking measures against leprosy in Union of Myanmar].

I participated in "Leprosy Control and Basic Health Service Project in Myanmar" by JICA from 2002 to 2004. I went to Myanmar three times as a short-term expert of physiotherapy. I carried out evaluation training for physio staffs in national Yenanthar leprosy hospital. They learned how to evaluate activity of daily living. And they were able to make modified spoons and the canes. Later, they looked for the contents to evaluate by themselves. And they evaluated and decided by themselves what they should do. They felt the necessity for toilet chairs, modified beds and etc. They formed the plan and manufactured them. They were able to perform by themselves. It is thought that evaluation was fixed to staffs. This knowledge will surely be helpful to patients. I expect that this knowledge will be put to evaluations and exercises of many diseases. The physio staffs of this hospital will surely perform. Cooperation of the shoemaker and nursing staffs is very secure. I hope that it may become the model of saying [working in cooperation with other occupational descriptions] from now on.

Surgical correction of deformities and disabilities in leprosy patients.

Despite some positive experiences, surgical rehabilitation, presently, is minimally available in endemic countries and the contingent of patients in need of this modality of treatment is enlarging constantly. With the reduction of prevalence of leprosy and the progressive integration of care of leprosy-affected persons into the general health services, surgical rehabilitation should be made available in these centres. Training health personnel of general health services in leprosy surgery is mandatory and urgent. There is a need for the settlement of a multi-organizational task-force (WHO-ILEP-ILA) to deal with this problem. The aim of this task-force should be the definition of strategies to organize such training and to increase awareness among medical societies and schools regarding this issue. This group should also remember that the referral centres in Africa, Asia, North and South America should act as reservoir of this knowledge and, as such, should be fully supported and enhanced, since they have an important and unique role to play in the training of general health services personnel.

Management of simple plantar ulcers by home based self-care.

Seeking a solution to bring down the prevalence of simple plantar ulcers in the field, Damien Foundation India Trust (DFIT), Chennai, developed a curriculum to teach the field staff of all its projects. The purpose was to make patients self-reliant in the care of their plantar ulcers in their homes. The strategy used was to make patients take care of their ulcers using tools found in their homes and surroundings and become responsible for the care of their limbs. This strategy was implemented in eight projects of DFIT and the programme was followed regularly for one year. Regular monitoring and evaluation showed that under this strategy the prevalence of plantar ulcers was reduced by about 50%.

Problem-based learning for tuberculosis and leprosy supervisors.

A problem-based learning programme for tuberculosis and leprosy supervisors is reported from Nigeria. It proved stimulating, motivating and enjoyable, and encouraged independent learning. The quality of their subsequent field work was average to good and showed sustained motivation.