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Project on ‘FIELD APPROACH FOR PREVENTION OF DISABILITIES THROUGH
COMMUNITY VOLUNTEERS IN RURAL AREAS ADJOINING BOMBAY [PHASE – III]’
[Sponsored by The German Dentist’s Association [HDZ], Germany]
Vidnyan Bhavan, 11 VN Purav Marg, Sion-Chunabhatti, Mumbai - 400 022, Maharashtra
Tel: 091-22-25223040; Fax: 011-91-22-25296486
It is a sad fact that for some years to come millions of our fellow citizens will need physical and social rehabilitation in view of the consequences related to nerve damage. It is estimated that a quarter and a third of the estimated 1.5 million leprosy disabled patients in the world today already have some degree of sensory and/or motor loss, or may develop such loss in view of the permanent nerve damage. While the deformities characteristic of neglected management of leprosy constitute the most important physical component of the stigma attached to the disease, an additional number of leprosy sufferers bear the social consequences of historic attitudes of society towards them and their affliction. In addition, WHO's public announcements give a strong impression that by the end of 2005, all leprosy problems will be solved with the elimination of leprosy and nothing more needs to be done. The various issues facing us currently in relation to a realistically perceived final goal, which is defined as "A World without Leprosy” is yet to be tackled with a long way to go. There is a need for sustained efforts to solve these which will contribute to improved human relationship in general in the community. Bombay Leprosy Project (BLP) implemented a field based disability care and prevention of disability (POD) programme for the deformed leprosy patients living in rural areas of Thane and Raigad district with the financial support from “The German Dentist’s Sponsorship [HDZ], Germany”.
This project has helped to identify greatly the extent of the problems such as new leprosy disabled cases living in the community as well as to improve the service compliance of the disabled leprosy patients in rural areas of Maharashtra. A total of 296 disabled leprosy patients were evaluated and provided necessary interventions during this reporting period. The interventions consisted of educating the patient and his family and provision of disability aids. Periodic contacts with the patients were maintained through regular visits. Most of the patients complied with the given advice and used the POD aids provided. Improvement was noted in physical and disability status and recorded in specially designed forms. About 25% patients with hand deformities indicated that they could now reasonably undertake activities of daily life and in 43% of patients, sole
wounds were reported to have healed and they could attend to their occupation. Long-term follow-up is necessary to determine the sustainability of results.
47 patients were monitored for possible nerve function impairment (NFI) through standardized clinical nerve function assessment. All these patients were treated with a standard course of steroid therapy (PREDNIPAC). Of these, 21 patients were found to have NFI and were put on a fixed regimen of prednisolone. Sensibility improvement in patients was also noted, however; motor function improvement was less satisfactory. This activity also indicated that with the field based practical training field staff and provision of disability care can be practiced effectively at community level.
Details of services provided to leprosy disabled patients:
* Number of services provided will not tally with the number of patients as some patients have been given multiple services for their multiple deformities.
A simple information system (SIS) analysis was carried out in September 2003 to assess the improvement following POD activities. It was observed that, while there was an appreciable improvement in the hand deformities, the healing of sole wounds being the only criteria of effectiveness of the dressing technique with the help of dressing kits was found to be very effective. However the follow-up of patients who received services previously are being continued to ensure service compliance. It is also experienced that by involving the primary health care staff gradually through a long-term follow-up it will help to sustain the impact of services achieved during the project period.
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O NASCIMENTO DO CIDADÃO DIFERENTE: PROGNÓSTICO OU JULGAMENTO Universidade de Santo Amaro - INTRODUÇÃO E OBJETIVOS O nascimento de bebês em condições que exigem a intervenção de profissionais da saúde são bastante comuns. No entanto, quando a condição, como no caso das anomalias congênitas, indica o desenvolvimento de deficiência, impedimento ou desvantage