Leprosy Mailing List – March 20th, 2007
Ref.: Ocular leprosy
From:
Warren G., Chatswood, Australia
Dear Salvatore,
Very pertinent remarks (LML March 16th,
2007). I have certainly
treated patient who have complete anesthesia of the cornea. Hypoesthesia is relatively
common especially in the lepromatous and near lepromatous i.e. LL, BL
and occasionally BB groups (though it certainly may not be there at
diagnosis!). But any
change is sensation needs to be taken very seriously and care taught! As Dr Latif states why cannot
technicians be taught to use a wisp of clean cotton wool to check for
sensory perception of the corneas?
This is another very relevant point. W.H.O.
has changed its guidelines as Dr Latif states- Is W.H.O.
shrinking it’s disability ratings? Certainly the patients do not
know that that is happening and I am getting more and more concerned
by the changing attitudes of many government leprosy departments who
are in charge of administration of the leprosy policies in the
developing world, especially where funds for leprosy are mostly
derived from W.H.O. supporting organizations.
In some cases I noted refusal of trying an
alternative treatment program because they say that the W.H.O.
guidelines do not suggest or recommend it!
In other cases they are changing their
techniques because W.H.O. recommendations state do this (instead of
something that would be
more effective though more expensive). The W.H.O. guidelines are
NOT ORDERS. They do not
cover all needed areas of care and leave out may things that some
of us regard as essential.
Please, when will people realize that W.H.O.
recommendations are guidelines and they do NOT provide any alternate
treatment for the patients who are already severely affected and need
far more care and treatment that is provided for in those
“Guidelines”.
Eyes are just one point. In Dr Butlin’s letter (LML
March 13th, 2007) she point out that uveitis is removed
from the disabilities! This requires urgent treatment if
blindness is to be prevented and it needs to be looked for in every
patient with Madarosis! Recently I have a patient in point
referred to me. He was an old LL who had had MDT and was
declared “cured’ quite a number of years ago, and his eye
specialist picked up uveitis and referred him back and sure
enough he was active and I am sure that without that sensible
eye specialist he would have lost all his vision- what a disability!
We list sensory abnormalities as disabilities- but we
need to take even more care of the eyes, for as Dr
Latif states the blind patients with anesthetic hands and feet are
the most miserable of people and it is virtually impossibly to
completely rehabilitate them.
More and more frequently, round the
world, I am finding that programs are becoming less and less
concerned with the prevention of disability and the simple active
means of rehabilitation that the patients can do themselves without
requiring a lot of financial support which many developing countries
feel they cannot afford.
Lets try and be practical in preventing
disabilities where possible!
Grace Warren
