Leprosy Mailing List – September 24th, 2007
Ref.:
Training in reconstructive surgery in leprosy
From: Theuvenet W. J.,
Apeldoorn, The Netherlands
Dear Salvatore,
Thank you for your kind reply!
Herewith are a few words about training in reconstructive
surgery in leprosy. I
personally have been involved in this field in a number of countries
in Asia, Africa and South America in the past 15 years.
The training course is divided in a 4 levels of which the first
level focuses on the prevention of impairment and disabilities, as
well on ulcer care.
There often is a great variation in the background of the
trainees, this from motivated leprosy patients, inexperienced basic
health workers up to senior medical specialists. Apart from this, the
institutes vary from small rural hospitals with hardly any facilities
to well equipped NGO funded referral hospitals. Because of this variation and
the fact that details of the participants/institute often only become
clear at the time of arrival, I try to be very flexible and to adapt
the training to the local situation.
The training is theoretical (PowerPoint + discussions) and
practical including examination, discussion of footwear and
surgery.
1. Learning of the normal functional
anatomy;
2. Learning of the disturbances in
the functional anatomy in leprosy;
3. Examination of normal and affected
gait, of the ankle and the foot (all modalities of nerve function
impairment);
4. Where can foot and ankle
problems be expected and what are their earliest symptoms;
5. How to analyse the cause of
ulceration;
6. How to treat ulcers a.
conservative b. different types of footwear c. types of surgical
interventions;
7. How to prevent the recurrence of
ulcers;
8. How to communicate this with the
patient;
9. How to involve the patient in self
care;
10. How to use the patient as a
teacher.
Some of my basic priciples:
a. When dealing with patients; as a baseline respectful
listening to them is more effective than talking.
b. When properly explained, even illiterate patients can grasp
the context of the functional anatomy quite well.
c. Motivated patients are often the best teachers in POID.
d. Let healthy health workers experience the painful
stress of an abnormal gait by mimicking this and they will never
scold a patient again too easily.
e. Only focus on motivated trainees and circumferent boasting
senior professionals who never dirty their hands.
f. Even the simple of mind can heal an ulcer;
the real intellectual challenge lies in the prevention of the
recurrence of it.
g. Try to avoid therapeutic dogma's: there are multiple good
roads to Rome.
Warm
regards,
Wim
Willem J. Theuvenet, M.D., Ph.D.
Consultant Plastic, Reconstructive and Hand Surgery,
Regional Hospitals of Apeldoorn, Deventer and Zutphen, The
Netherlands.
Consultant for The Leprosy Mission International
Consultant for The Netherlands Leprosy Relief
E-mail: wjtheuvenet"wxs.nl
