LEPRA - Health in Action

Introduction
Activities & Achivements
Case Study

Introduction

ARTH (Adilabad Rural and Tribal Health Intervention)

In the year 2008, the project name has changed from ADILEP to ARTH (Adilabad Rural and Tribal Health Intervention) to focus on Tribal health issues as a strategic direction and shifted project office from Nirmal to ITDA, Utnoor on 01 Jan, 2010.
The project started with 6 Designated Microscopic centre (DMC) in the district to cater to the needs of tribal and remote areas of the district.

Areas of operation

Objectives

To provide quality services to people accessing to centers for Leprosy, LF, Blindness and TB.
To assist the District Malaria Control Society in implementation of controlling the activities.
To organize awareness & capacity building activities

Goal

Improve the health status of rural and tribal populations by providing quality health care to Leprosy, LF, TB and Malaria affected persons in Utnoor and Asifabad divisions of Adilabad district (2,46,350 ).

Case Studies

The support restored the Childhood

Kumari Jyotsna sethi, 14 years old, daughter of Banamali sethi belongs from Rajanpali village of Boudh district. She is the only child of her parents and that is why she gets all the affection from her parents. She grows up with much love in the family. She studies in class 8th at Butupalli, High school of Boudh district.

Her father is a small farmer with one acre of agriculture land. The annual income is not sufficient to manage the family economy. However, with the income from his own agriculture land as well as labour work sometimes, her father manages the family and the education of Jyotshna.
Time passes and one day her mother observes that Jotshna is not able to tracing the things and domestic appliances properly and father also observes the same. School teachers complains that Jyotshna is not keeping any interest on study. Her father also observes the same. The school teacher says that she is not able to look at the black board and reading properly. Subsequently, friends and neighbours starts to address her as the blind Girl in the community. Gradually Jyotshna becomes depressed and stops going to play with her friends and avoids the gathering in the community. She also expresses her unwillingness for study. One of the neighbors observes a white spot on the right eye pupils. Her father contacts the local traditional healer for treatment who fails to recover the same through his treatment. The parents make lots of expenses for the treatment of Jyotshna. Then they takes Jyotshna to Boudh District Head Quarter Hospital for treatment. The doctor diagnoses her with immature cataract and asked them for contacting the Mahanadi Netra Chikitsalaya of Birmaharajpur of Sonepur district.
She comes to MNC 5th August 2009 and was admitted for cataract surgery. Her Uncle and Parents are counseled by the Ophthalmic Assistant for the surgery. The cataract surgery is conducted on her right eye on the same day through phaco with the intra ocular lens (IOL) in free of cost. Free spectacles and medicines are provided to her as per the prescription of the Ophthalmologist of the Mahanadi Netra Chikitsalaya of LEPRA Society. After the successful surgery, her parents express their happiness and gratitude to LEPRA Society as well as the person or institution who provides support for this noble work. Jyotshna is now very happy she becomes able to see. Now she has got back her earlier life stile i.e. in relation to continuing her study, playing with friends and joining the community gathering.

The support could provide relief in old age by restoring the vision

Basanti Mahananda, 65/F, she is an old widow lady belongs to very poor family of the Menda village of Tarabha Blcok of Subarnapur District. Long back her husband dies due to heart stroke. She has 3 daughters only without a son who already have married. So, Basanti is living alone and manages her by wage works in different households. She is landless.

However, she gets the oldage pension which is Rs. 200/- (Rupees Two Hundred only) per month. Suddenly, she feels vision problem which increases gradually. She becomes unable to see and work properly. Cooking for herself and earning for herself becomes difficult. As her daughter are in their in-laws’ house, there is no scope of getting support from them. In the course of time, Basanti loses his complete vision. She could know about the community eye screening camp of Mahanadi Netra Chikitsalaya of LEPRA Society at Tarava. She requests her elder son-in-law to guide her to the screening camp. Basanti attends the screening camp and diagnosed with matured cataracts. She is brought to the Mahanadi Netra Chikitsalay by the project outreach bus on 13th August 2009 and was registered for cataract surgery. On 14th August 2009, her right eye is operated through the use of phaco and operating microscope and IOL is implanted. The surgery becomes successful and Basanti gets back her vision in the right eye. After seven days of her surgery, her vision is tested and found with very good vision. She also expresses her happiness as she is able to see the things and do her daily activities independently. She is waiting eagerly for the surgery in her left eye.

Restoration of Childhood

Sumanta Beriha,7/M of C/O Bhagban Beriha, hails from Jatasingh village of Boudh District. He is the youngest son of his parents with three brothers and only one sister. Being the youngest son of his parents Sumanta is being loved by everybody in the family. His elder brother was having eye diseases which led him to incurable blindness. Sumanta was all of sudden lost his vision at the age only 4 years. His father is a farmer and also works as a labourer. The mother is a house wife and sometimes works as labourer. When Sumanta is admitted into the school, the irony that he is found to have very low vision in both of his eyes for which he faces lot of problems in reading and writing. Gradually Sumanta was pushed into more and more darkness. Sumant is not able to carry out independently the daily activities, reading and playing. Gradually he stopped school going, playing with friends. He loses his childhood. The parents have no money for the treatment of their beloved son and because of the same reason and ignorance their elder son becomes blind. They have to only cry and blame their lucks. The parents go to the District Head Quarter Hospital, Sonepur but, the treatment could not be possible as the hospital is not having facilities for children surgery.

In course of time, his uncle who is staying nearby MNC informs his parents to come to MNC for treatment. The parents come with the son on 7th February 2009 and Sumanta is registered bearing the MR No 47526/09. He is detected with congenital cataract in both his eyes. Parents and the uncle are counselled for the surgery. Sumanta is admitted on the same day. His right eye is being operated with Small Incision Cataract Surgery (SICS) with IOL on 8th February 2009. His vision is improved to 6/18 in his right eye.

Now, he is able to play, read and write and he is happier that his vision has again restored. His parents are too happy as the childhood of their beloved son is getting restored and have expressed their gratitude to MNC for great support to their child and family. After few days, his left eye will be operated.

Resources

Infrastructure: The hospital is housed in its own two storied building having a covered area of 5000 sq. ft.. MNC has accommodation for 30 beds, suitable surgical and therapeutic equipment are available for providing eye care. The hospital has a minibus for outreach activities and transportation of patients identified with cataract to the base hospital for surgical intervention.
Physicians/Staff: There are 30 full time/part time workers at the MNC hospital. These include one full time doctor, nurses, paramedical staff and non-clinical personnel. The physicians are well supported by a multitude of staff members such as nurses, refractionists and technicians who actively participate in the health care team
Work Times: The hospital works six days (Mon-Sat). Patients usually come at 9 a.m. and the work day ends at 5 p.m.
Food: Breakfast, lunch and dinner are also provided free of cost to the patients and their attendants. On an average food is provided to 30 numbers of people per day at MNC.

Case Study 1
MR. Gaddam Gangadhar, a 30 years old male, resident of Surjapur village of Khanapur mandal accessed referral centre with rigorous triple nerve paralysis (Radial, Ulnar and Median) with more than one year duration. He was taken treatment in private sector and not satisfied due to prolongation of treatment and expenditure and also developing deformity. The concerned doctor himself has advised his family members to approach the referral centre for better care and treatment. When they approached none of them had any clarity about the treatment. Considering their level of understanding we have given a systematic counseling to patient and his family members about the treatment and its consequences. He was diagnosed with MB leprosy and was started on MDT.
He had more than five skin lesions with both ulnar, right radial, and median nerves thickened with Type-I reaction. His right ADM, DII, and APB VMT: 0 and right ECRL and left ADM VMT: 2. His right eye encircled with raised erythmatous skin lesion. Thus started Prednisolone with 40 mg for subside the reaction and also helps for improvement of the muscles Exercises not advised due to pain in wrist, after reduce the pain provided cock up splint for extension of wrist. Now he is regular contact with referral centre. His family members are very much satisfied with the services of referral centre.

Note: Consent of the patient has been taken to use his photographs for the purpose of information sharing
Case Study 2
Case Study of Difficult to Diagnosis Case in LRC
MR.B. Venkata Ramana, a 40 years old male, working as a government secondary grade teacher and the resident of Nirmal accessed referral centre with bilateral ulnar silent neuritis with more than two months duration. Before that he consulted skin specialist at Nirmal for tinea versicolor lesion on both bellow the shoulders. In this context the skin specialist suspected as new leprosy and advised him to approach the referral centre for better care and treatment. When he approached the LRC, he doesn’t have clarity about the disease and after physical examination and nerve function assessment, he was found to be noticed bilateral ulnar silent neuritis, both ADM VMT: 2 with 2 months duration. Considering his level of understanding we have given counseling to patient and his family members about the treatment and its consequences. He was advised physiotherapy exercises also suggested to take self care measures etc. The case was diagnosed as bacillary negative PN type of leprosy and was put on 40mg of Prednisolone per day to start with as per the body weight of 80kgs and continued with the treatment of Prednisolone with tapering dose schedule. Meanwhile the patient was also referred to the concerned NLEP centre for the concurrent treatment with MDT, Multi Bacillary regimen (MB-Adult) as he was having both ulnar nerves involvement without skin lesions. Now he completed treatment of Prednisolone and his VMT of both ADM is fully recovered from 2 to 5 and now his health condition is good and no new impairments were noticed. His family is very much satisfied with the services provided by the referral centre.
Note: Patient is not willing to take his photographs