A Surgeon's View
Better than reconstructive surgery is to prevent disability in the first place
|Dr. Tim Lewis of Anandaban Hospital addresses a seminar in Kathmandu last November.
Not enough people affected by leprosy who would benefit from surgery are receiving it, said Dr. Tim Lewis, the Medical Superintendent of Anandaban Hospital in Nepal.
Speaking at a WHO seminar in Kathmandu last November, Dr. Lewis said that increased awareness of both the benefits and availability of surgery was necessary so as to increase the number of referrals. “When we do disability camps, the majority of patients we come across who are surgically correctible are not aware that surgery is an option,” he said.
Run by The Leprosy Mission International, Anandaban Hospital is the only medical facility in Nepal offering leprosy surgery on a regular basis. Of the 200-250 procedures performed at the hospital each year, about half are leprosy related.
Surgery in leprosy has three aims, Dr. Lewis said: to prevent disability, to improve function and to reduce stigma. “I sometimes get young female patients with minor clawing of the hand that doesn't impair function. They tell me they don't want people to know they have had leprosy, but they also want a straight hand for cosmetic purposes. This can help eliminate stigma and integrate them fully into society.”
The people who profit from surgery are those who are motivated to look after themselves, said Dr. Lewis. This is important because reconstructive surgery involves “vigorous pre- and post-operative physiotherapy, and unless the patient is going to cooperate with this regime, he is unlikely to gain much benefit.”
Patients also need a reasonable expectation about the outcome, he said. An operation will improve but not necessarily completely correct a condition, and will not address the underlying problem of nerve damage. Consequently, it will do nothing to restore sensation. “They will need lifelong self care and regular care of the foot or hand,” he said.
Surgery is not for everyone. Those unlikely to benefit are elderly patients with long-standing deformity, patients who have adapted well to deformity and those whose deformity is complicated, he said.
NOT JUST SURGERY
Disability management is far more than surgery, stressed Dr. Lewis. “Probably the most important department in our hospital for the prevention of disability is our footwear department and yet it tends to get a lot less recognition than our surgeons and physiotherapists.”
He said it was regrettable that he was still operating on patients in their twenties and even in their teens. “If you go into their history, you will find that they have taken a course of MDT and have developed disability during their treatment. This has not been recognized and now three or four years down the line they have come looking for surgery,” he said. “We have missed the boat and prevention is far better than what I am talking about today.”
ADVERTORIAL CONDEMNS YMCA
Following last year's refusal by the Delhi branch of the YMCA to allow delegates to a national forum of persons affected by leprosy to stay there (see Issue #23), the International Leprosy Union took out an advertorial in the Indian Express newspaper on January 18 criticizing the decision.
Titled “An Appeal to the Conscience of Society” and signed by ILU Chairman Dr. S.D. Gokhale, the advertorial described as “outrageous” the letter sent to conference organizers canceling the group booking and called it “an affront to not just the leprosyaffected people but to also the governments, the organizations and individuals working for the cause of leprosy.”
“This just shows how difficult it is to change the hard attitudes and mindsets of the community,” added the appeal, which also ran in a local-language Maharashtra state newspaper.
ILU, a non-governmental organization based in Pune, India, promotes the social, physical, financial and emotional rehabilitation of people affected by leprosy. “Let us work together to give them not just economic security, but empower them with their basic human rights which all of us, as human beings, are entitled to,” the appeal concluded.
After the advertorial appeared, Dr. Gokhale received a letter from Dr. S.C. Gupta, Joint Director, Health Services (Leprosy), Government of Maharashtra, which said that the state government was working to eliminate leprosy and raise awareness of health issues, and praised the advertorial's “highly constructive” contribution.