Leprosy research--setting priorities and facilitating collaborations: a personal perspective.

In recent years, as the prevalence of leprosy has declined and the tuberculosis epidemic has gained increasing attention, leprosy research has generally taken a 'back seat' to research in tuberculosis and other emerging and re-emerging infections. This has resulted as much from perceived differences of scientific opportunities in these fields as from differences of the disease burden. At the United States National Institutes of Health (NIH), research priority setting is typically based on a number of factors. In the case of leprosy research, the technical difficulties associated with this scientific area have clearly lessened enthusiasm for and progress in this field. Today, however, we are confronted by the reality of not having sufficient scientific understanding to explain a stable or increasing number of leprosy cases detected annually in the face of a dramatically decreasing total number of identified cases. We also lack adequate tools for diagnosis and prevention. At the same time, new molecular and cellular approaches and knowledge of the complete sequence of the genome of Mycobacterium leprae render leprosy research significantly more tractable than ever before. The combination of these factors has led a number of groups, including the National Institute of Allergy and Infectious Diseases of the NIH, to review the current state of knowledge in leprosy research and draft recommendations for future leprosy research priorities. It is clear that many of the necessary and exciting research activities can best be addressed through collaborations among investigators, with control programmes, and among countries of high and low endemicity.

Self-talk for the licensed practical/vocational nurse.

There are varied opinions on the commonness of self-talk. Some feel self-talk is engaged in more by persons who feel insecure and question their performance (Cauchon, 1994). Others feel self talk is a process people use continually to describe and interpret the world, accurate or inadequate as the case may be. (Hansen, Rhode, and Wolf-Wilets, 1991; Braiker, 1989). Regardless of how much self-talk the Licensed Practical/Vocational Nurse is aware of in interactions with clients, staff, and intraphysically, it is important to assess thoughts for their logic or illogic. Illogical thoughts should be replaced by positive words of encouragement which will in turn raise the client's, staff members or Licensed Practical Nurse's feeling of self concept and level of self-confidence. Making self-talk positive is always good professional practice.

A questäo da interdisciplinaridade no dia-a-dia da enfermeira que atua em centros de atençäo diária de saúde mental / The question of interdisciplinarity in the quotidian of the nurse who workers at mental health daily attention centre

O objeto deste estudo é a percepçäo da enfermeira que atua em Centros de Atençäo Diária em Saúde Mental no que diz respeito ao trabalho interdisciplinar. Esta pesquisa surgiu a partir da necessidade de entender o trabalho da enfermeira que atua nesses novos espaços de atendimento junto a uma equipe interdisciplinar, haja visto que a graduaçäo näo forma as enfermeiras para este tipo de trabalho. O trabalho interdisciplinar tem sido visto como condiçäo sine qua non para otimizar o atendimento de pessoas com sofrimento psíquico grave, como indica II Conferência Nacional de Saúde Mental, A Conferência de Caracas e a Portaria 224 do Ministério da Saúde. Foi utilizado o estudo qualitativo para valorizar a experiência de cada enfermeira, bem como seu percurso profissional e pessoal dentro da saúde mental.

Relationship problems between doctors and paramedical professionals working in leprosy with reference to a possible solution.

An empirical investigation was conducted on the in-group dynamics of health personnel working in leprosy. The sample populations were taken from the National Leprosy Eradication Programme (NLEP) employees of two state governments in India. They consisted of 21 doctors and 335 paramedicals, the former constituting a formal group and the latter a semiformal group. Two separate scales were developed for each of these groups to elicit information on five potential areas of intergroup relationships. The results indicated that there was very poor acceptance of the out-group and its roles, i.e. poor acceptance of the paramedicals by the doctors and vice versa. Three reasons were elicited from this study. First, doctors held their professional standing to be on a higher level than the paramedicals, leading to excessive social distancing between doctors and paramedicals. Second, multiprofessional involvement in NLEP work has increased the trend of professional overlapping, leading to a significant apprehension of the encroachment of skills. Third, there was a mutual lack of trust of each others professional skills. Despite these problems the otherwise more severe human relationship problems, such as domineering behaviour and prejudiced perception against the out-group were found to be significantly less in this study. In order to improve working relationships between these groups a method that has been used at Karigiri is recommended. The method has two parts. The first is aimed at intrapersonal understanding and the second at the development of interpersonal skills. Role play that mimics their original work situation and an analysis of case histories were the methods of teaching that were found to be more advantageous in internalizing these skills.

Traditional healers and community health.

A review of projects in various countries suggests that traditional healers, if properly trained, can contribute significantly to the work of primary care teams. Recommendations are offered with a view to making the best possible use of this valuable resource.

PIP: Positive outcomes, constraints, and future involvement of traditional healers in community health projects is reviewed. 17 projects of which 2 were nongovernmental were included in the analysis of traditional practitioners trained in implementing 1 or more primary care (PHC) activities. Traditional medical persons were, for instance, herbalists, diviners, spiritual or faith healers, traditional midwives, and birth attendants, who worked well with other staff and were willing to contribute to PHC. Skills were taught in promotion of 1) health education and prevention relevant to local problems; 2) improving nutrition and food supplies (breast feeding, weaning foods balanced diets, kitchen gardens); 3) safe drinking water supplies and sanitation; 4) maternal and child health care and family planning (pregnancy monitoring, risk referral, contraceptive distribution); 5) prevention and control of local endemic diseases (diarrhea and oral rehydration therapy--ORS, tuberculosis, leprosy, malaria, malnutrition) and referral for treatment; 6) immunization and referral of children 5 to clinics for vaccination; and provision of 7) treatment of common diseases and injuries (1st aid and accident prevention); and 8) essential drugs and maintenance of a basic dispensary. Examples are given for Ghana, Swaziland, Nepal, and brazil and show the high level of interest of healers. There was increased use of ORS and decreased use of purges, use of handwashing in basins, construction and use of latrines, increased referrals, and increased use of midwives for birthing. 7 projects showed improvements in attitudes, knowledge, and behavior of healers; in the health status of population; and in attitudes and behavior of health staff. Constraints were the lack of government recognition of the value of traditional healers, of government commitment, and of dialogue between healers and government staff. Clearly defined roles and tasks are important for deterring problems. Harmful practices of healers can interfere with proper medical care. Recommendations were to stimulate government action to incorporate traditional healers into health services, to define carefully the role of healers, to engage in evaluation research with other sectors, to tailor training programs to the needs of local traditional healers, and to develop effective strategies to integrate healers. Traditional healers are a valuable resource in PHC.