4) Prevention and Management of Disability
Dr. M.Virmond
I am sure that I am not going to present you new ideas on Prevention of Disabilities (POD). Mostly. I would like to refresh your minds with some topics that I think are very important concerning POD. I am not bringing solutions. My aim is to pose problems and stimulate a fruitful discussion on these issues taking into consideration that we have many experts in POD in this audience. I will be presenting some topics and making some personal comments on them - ultimately these topics should be an introduction to the discussions that will follow this session and I strongly believe that this discussion will be more important that this simple presentation.
What is POD? What is the objective of POD?
A nice definition of POD is that patients should not develop new disabilities than that presented at registration, if any!
POD is basically to modify the behavior of patients regarding their sensory and motor loss - that is, how can I spend the 24 hours of a day without harming myself. However, POD is one of the most difficult tasks in a leprosy control program mainly for two reasons：
- we should modify the behavior of a human being
- we should make health personnel believe that POD is part of their duty
The first one is difficult in the same way that
- it is difficult to teach a child that he/she should brush their teeth every day after each meal
- it is difficult to convince someone wanting to loose weight to eat just fruits, vegetables and unattractive soups.
- It is difficult to a leprosy patient to accept that he/she should walk with short steps while his fellows can walk freely.
- It is difficult to a leprosy patient to wear awkward shoes while his fellows can wear nice and beautiful shoes.
In the other hand, it is not difficult to convince someone with impaired visual acuity to wear glasses because vision is an immediate and urgent need that precede many other physical needs regarding a normal behavior. Additionally, mild impairment of visual acuity is almost a constant finding in the vast majority of persons and glasses are today quite attractive that is, we have thin lenses, lighter frames and they are becoming cheaper. In other words, to wear glasses means not an abnormal behavior.
Taking into consideration these comments, the conclusion we arrive is that：
We are all the time saying that leprosy patients are normal people but we are all the time asking them to do things that a normal person doesn't do.
The second one (health personnel) , it is difficult because for a long time it has been said that there was no money nor available time left for health personnel to deal with POD.
The priority is to diagnose and treat cases.
No doubts that the real POD is to diagnose early and adequately treat cases with MDT-WHO.
