Leprosy Mailing List – September 24^th, 2007

 

Ref.:     “I can do it myself!” (Self-care booklet)

From:   Cross H., Greenville, SC, USA

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 "I can do it myself!  Tips for people affected by leprosy who want to prevent disabilities."

 W.H.O. Regional Office for South-East Asia, New Delhi

 

 

Dear Dr Noto,

 

I was pleased to read questions submitted by Joseph Chukwu, from Enugu, Nigeria (LML September 4^th, 2007), regarding operationalizing the self care booklet "I can do it myself".  The points he raised are fundamental and an opportunity to discuss them now is very timely.

 

The "I can do it myself" booklet was written to reflect the advice given in the ILEP Learning Guide 4, "How to Prevent Disability in Leprosy".  That ILEP learning guide was written for health workers, for whom it is recommended as essential learning material for prevention of disabilities (POD).  ILEP Learning Guide 4 was written as a resource for self learning, but I suggest that it will be used to best advantage where it is given as a resource to health workers who have undergone POD training.

 

Adequately trained health workers will be those with sufficient knowledge and skill to transfer the essentials of self-care to those who require it.

 

The basic self-care information contained in the "I can do it myself" booklet is intended as a take-home aide memoire for people who have been guided by health workers.  A good scenario will be where the booklet is given to the leprosy affected individual after the health workers have:

• listened to the concerns of people with leprosy;
• explained how leprosy related impairments affect life;
• demonstrated essential self-care activities;
• discussed self-care in the context of the individual's environment (social and physical);
• encouraged people to ask questions about self-care;
• engaged family members in the commitment to life style adaptation;
• encouraged commitment to simple, attainable self-care related objectives;

As a further service it will also be very beneficial if health workers are able to encourage and assist in the organization of community based self-care cells.

 

Evidence from China and Nepal have shown that encouragement and support are essential for the first 6 months after starting self-care (after that time, results become apparent and self-efficacy becomes the principal motivating dynamic).  Ideally, therefore, a monitoring program should be organized with a particular focus on providing encouragement and support through the initial 6 months (where appropriate and possible, community members should be mobilized to participate).  The record of impairment control is perhaps best reflected when impairment summary forms are maintained by the health worker.

 

What has been outlined above reflects an ideal, but I realize that in many countries this will not be attained as health workers are often poorly prepared and / or  over worked.  An understanding of the reality of health service provision in many countries was also a factor that influenced the way in which the self-care booklet was constructed.  Even if only a basic explanation of how to use the booklet is given and the booklet is simply handed out with MDT, it may help some people to prevent disability. 

 

In many of the leprosy endemic countries there are POD specialists and consultants who will be able to assist in the development of POD, whether it is considered an integral part of leprosy control or not.  I will be happy to assist with introductions should any members require such.

 

Hugh Cross BSc (pod) PhD, American Leprosy Missions, Regional (Asia) POD Consultant