Leprosy
mailing list – September 14th, 2005
Ccn: all.
From: A Bryceson, London, UK.
Dear Salvatore,
As leprosy control (i.e. case
management) becomes increasingly integrated into basic health care
systems, there are two directions in which leprosy work can develop.
The first is in community work in the
villages or towns aimed at increasing awareness etc. of leprosy and of
other important local diseases, so that stigma is reduced, diagnosis
speeded up and disability detected early - and poverty is reduced and hygiene
improved.
The second is in the provision of
referral services which would include prevention of disability and
management of disability.
In the parts of Brazil and India that I
visit these services are usually provided by physiotherapists or
occupational therapists, often with NGO support, and their training
and skills are excellent. They can amongst other things, make very
reasonable shoes for anaesthetic feet and for those needing simple
orthoses. But the shoe for the more complicated foot is usually beyond
their skills.
To survive present times and to
provide even these limited services, the POD teams need to address
a wider range of patients than just leprosy patients; and if they are
to make more complex footwear they may need to integrate to a greater
extent with the general health services so that for example diabetic
patients can be well served too.
I suspect that an increasingly broad
approach will be necessary if we are to practice the principles
espoused so eloquently by Linda Lehman and Wim Theuvenet (LML Aug
17th, and LML Sep. 3rd,
2005), and sustain the great practical contributions
of Hugh Cross.
Anthony Bryceson
