Leprosy mailing list – September 5th,
2006
Ref.:
Reorganization and rehabilitation models
for former leprosy colony-hospitals
From: Nhanca M., Hippke J.,
Hippke W., Cumura, Guiné-Bissau
Dear José Eduardo
In response to your posting in the LML (26th July, 2006)
allow me first to whish you luck for your theses and luck as well for
a future implementation in Brazil.
Guiné-Bissau, where we are working, is a tiny West
African state with few (<100/year) new Leprosy cases, but with
quite a backlog of "old cases" in need of training, care for
eyes/hands/feet, reaction treatment and socio-economic rehabilitation.
In Guiné-Bissau, on the other side, one of the last
Leprosy-Hospitals in West Africa is still alive, a mission run, 50
years old 90 bed hospital in Cumura (near the capital city Bissau),
which is now shared with AIDS+TB patients - not a happy
combination in terms of treatment needs, bio-security and mutual
stigma. Until now, we
failed to convince the hospital owners, the Franciscans from Italy, to
join general Physical Rehabilitation to Leprosy work - preference is
given to AIDS (funding possibilities?) The hospital is well
reputable for it's Leprosy service; patients are coming even from the
surrounding countries.
The combination of few new cases in Leprosy and the existence
of functioning Leprosy hospital has led to a change of the national
Leprosy politic emphasizing the Cumura Leprosy Hospital as a central
institution: All new cases are confirmed and set on treatment during
an initial stay in Cumura, quarterly evaluations and reaction
treatment are done there and all care+service for eyes/hand/feet
like shoes and ulcer treatment. Great
value is given to direct patient training: patients learn in
standardised courses what has happened to them and how to live with
the consequences. As Leprosy treatment is more than blister
packs, and as the main element in Leprosy work is prevention of
disabilities (PoD) and PoWorsening, Guiné-Bissau decided for the
quality care option centralised in Cumura Hospital. To maintain
an adequate knowledge in all peripheral 250 nurses (who in the mean
get to see a new Leprosy patient every two years) is neither possible
nor economic. Similar to this, cardiology or specialised surgery
is centralised - to guarantee the quality. And patients prefer
travelling rather than mid/low-quality attendance.
Cumura Hospital, being a 50 year old institution, still has a
"Leprosy Village" with some 30 people affected by leprosy
living there, partly on hospitals costs. This is the old way of keeping
patients instead of treating them. For those, who are living
in the "Village" for many years, it will be an unchangeable
situation. Some first steps in Socio-Economic Rehabilitation
have recently started. At the long term, the "Village"
could be transformed in a training centre or could serve for general
physical rehabilitation.
So, to return to your questions, in our view it is necessary,
- to opt for quality care (instead of integrated
superficiality);
- to emphasise patient training ("rehabilitation
starts in the patient's brain");
- to have (a) reference unit(s) serving for
training as well;
- to make referral attractive (pay for travel);
- to use the reference unit for Socio-Economic
Rehabilitation as well
and not only for pure medical purposes;
-
to integrate Leprosy care into general Physical
Rehabilitation or
- to join general Physical Rehabilitation with Leprosy care.
Important will be the shift to a holistic care for leprosy (ex)patients
and away from "Case-finding, case-blistering and
case-forgetting".
Kind regards + um abraço,
Martinho Nhanca
Hospital Mal de Hansen, Cumura, Guiné-Bissau
Jane + Wolfgang Hippke
AIFO Guiné-Bissau
