With the birth of two wonderful little girls in my extended family this week in Ireland I am reminded of the mother and baby ward in Lalgadh Leprosy Hospital in southern Nepal.
This last week in February there have been 3 births in Lalgadh, two girls and a boy. All going well the mothers will return home with their newborn baby about 5 or 6 hours after birth. The normal birth figures in the hospital are an average of two a month.
This low figure is due to three things:
1. the specialised ward is a new facility within the hospital compound
2. most mothers have their babies at home and continue with normal daily life
3. the hospital is situated in rural Nepal and travelling long distance, at short notice, usually on foot is not ideal during labour.
This trend is slowly changing as a result of the Village Alive Program which includes training of Rural Health Champions (RHC).
The RHC’s are women working on a voluntary basis and have been selected by their respective villages. These women take part in efforts to control diarrhea, vomiting, malnutrition, malaria, and tuberculosis and referral advice when required. Most of them were illiterate, but now function as health volunteers, measuring blood pressure and performing examinations, including examination of pregnant women. They are also able to recognise danger signs and advise to move pregnant women to hospital if necessary.
Dr Anne Dee will be returning to Lalgadh, Nepal in March after a break of twenty years. She has obtained funding under the ESTHER* alliance which is a European organisation which encourages partnership between developed and developing world healthcare facilities.
Under this scheme, the Department of Public Health in Limerick has been funded to set up a partnership with Lalgadh Leprosy Hospital (NLT’s leprosy centre in south-eastern Nepal) . She will travel with the Director of Public Health in Limerick, Dr Mai Mannix, and will spend time in LLSC meeting the workers there, viewing the projects and agreeing the scope of this proposed partnership.
Dr Krishna Lama and Dambar Aley from Lalgadh Hospital will make a return visit to Ireland in May in order to finalise the partnership agreement.
Dr Anne Dee, Specialist in Public Health Medicine, Department of Public Health in Limerick.
When I visited Lalgadh Leprosy Hospital for Easter 2014 I was blessed to meet some beautiful people. I know I have made friends for life as a result of my time spend there. One of the ladies I met was Sarita, she was part of the outreach team who travelled with us to the remote villages. On these trips she preformed many tasks, one of which was introducing us to the villagers, helping to translate and share their stories.
I also spent time with her in the small jewellery making workshop which she manages. She provides training and support for people in a similar situation to her own. Sarita, seen here on the left, is a very warm, confident and outgoing person but this was not always the case.
Stigma – A mark of disgrace associated with a particular circumstance, quality, or person.
“It all began with a small patch on my skin that didn’t feel anything, but now I feel tingling in my toes and feet.”
Leprosy is caused by bacteria, mycobacterium leprae, affecting the nerves in the skin, face, hands and feet.
“As time went by my hands and feet would get injured. I feel no hurt.”
Leprosy can permanently damage the nerves so that they feel no pain, hot or cold, just like an anaesthetic.
“Cuts get infected, and ulcers develop. I feel no discomfort.”
The patient feels no pain, injuries are not rested and may get infected badly.
“My family don’t like the disease, they hide me, and make me live alone. I feel loss.”
Stigma can begin between husband and wife, parents and children.
“My children are discouraged from going to school. I feel shame.”
The wider community can affect the families of leprosy sufferers.
“We cannot go to the well with everyone else, our neighbours shout at us. I feel anger.”
Fear and misunderstanding in the community can lead to separation.
“I’ve lost my job, as my boss does not want me around. I feel hunger.”
Economic loss can cause the family great hardship.
“I went to the hospital at Lalgadh Leprosy Hospital, the doctor tells me I have leprosy. I feel despair.”
The actual diagnosis can be the most painful part, for patient, family and community.
“The nurses take care of my wounds and ulcers and give me medicine. I feel compassion.”
The secondary effect of having damaged nerves is infections, this is what most people see as leprosy, the leprosy bacteria is treated by antibiotics.
“I sleep in a hospital bed and have a full meal. I feel safe.”
Often patients may be malnourished and need to be admitted as in-patients.
“The hospital staff hold my dry hands in theirs and make me laugh. I don’t feel untouchable.”
Stigma begins in the heart, and we overcome it by the way we live, by the example we show.
“I am much better now, so I can go home, I meet other leprosy patients in my area. I feel a new community beginning.”
Leprosy patients form self-help groups (SHG), to look out for each other. Men and women, young and old, Muslims, Christians and Hindus of different castes all sit together and share their struggles, offer advice, laugh and cry, touch and comfort each other, building self-esteem and confidence.
“In the SHG we can start to learn again, to read and write, to understand health issues. I feel I am growing.”
Self-help groups receive support from Lalgadh Hospital with adult and health education.
“The SHG begins a monthly savings scheme. I feel hope.”
Self-help groups receive seed capital from Lalgadh Hospital and encourage leprosy patients to budget and save.
“I start a small business and earn money to support my family. I feel pride.”
The savings scheme can lend money to its members to start an enterprise to break the downward cycle of poverty.
“My children respect me again, and my spouse welcomes me in the home. I feel love.”
The family often adapts and heals remarkably easily.
“My children can return to school. I feel they have a future.”
Public health education, through street drama or discussion provided by LLSC can help bring down barriers in the community.
“The SHG invites Lalgadh Hospital to start a Village Alive Programme in our village. I feel I am becoming a leader.”
The Village Alive Programme is an intensive three year health, education and development programme, that the self-help group initiates with the support of Lalgadh Hospital and agreement of the local community.
“Our village is doing well, the community looks to me to help and guide them. I feel no disgrace.”
Demolishing stigma by Nepal Leprosy Trust.
All the above quotes are drawn from leprosy affected people in Nepal and this story highlights a common journey of recovery for them as enabled by NLT.
Drinking clean water, washing your hands, seeking treatment for infections: such things may be second nature in Ireland. But for many villagers in rural Nepal, a lack of education hinders their knowledge and ability to live healthy and ward off preventable diseases.
Thanks to a 3-year grant from Irish Aid and effect:hope The Leprosy Mission Canada, Nepal Leprosy Trust Ireland is now supporting some of the very poorest in Nepal to live more productive lives in a project called Village Alive Programme or VAP.
NLT has organised groups in two Dalit villages (a group of people traditionally regarded as untouchable) to effect and promote health improvements. After training and support from NLT staff, a volunteer in each village qualifies as a Rural Health Facilitator, who helps the groups to identify major health problems and tackle them through health education: the use of clean water, and improved sanitation.
The project also includes a micro-finance element, which encourages men and women to develop their own small businesses.
Measurements will be taken to gauge the success of the project, and it is hoped that the long term incidence of Leprosy will reduce as a result of improvements in the standard of living.
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