Often they go to the river or bathing places and look for early patches of leprosy as people are bathing. Fifty percent of the training is on social issues, the status and problems of women and marginalized groups. Over a period of time their self confidence and self esteem is built up. They share their knowledge with the village people and work closely with both the community organisations namely the Farmers' Clubs and Mahila Mandals. Through constant dialogue and other methods of communication, attitudes of the communities change - there is breakdown of caste barriers and more interaction between groups. Women are empowered, have access to credit facilities and there is improvement in their self image. Children and especially girls are sent to school. Marginalized groups gradually get into the mainstream of society and are able to avail themselves of the development programs that are provided by government and other agencies.
Members of these community organizations, VHWs participated in the house to house health surveys that are conducted by the CRHP health team. These health surveys include examination for leprosy in addition to other health problems such as nutrition of children, immunization status, tuberculosis and other common diseases. Such involvement help the communities to assess different health problems including leprosy and formulate action plans.
Through repeated cyclical inputs and sharing knowledge about leprosy, by VHWs, and the CRHP mobile team, people's understanding about leprosy increases. Additional positive strokes are also provided by health team members. At the beginning of the project the PALs were often driven out of the house of the family and kept in makeshift huts on the outskirts of the village. Someone from the family supplied them food and water for the day.
Members of the community organizations accompanied the CRHP mobile health team to the huts outside the village. The health team demonstrated how to clean and dress the ulcers, the reasons for the complication, and what needs to be done. The members also socialized with the leprosy patients to the extent of having tea or sharing a meal. Such actions made the PAL's family to realize that the disease was not as dangerous as they thought.
The health team use participatory rapid appraisal methods, which include social mapping and focus group discussions, and to analyze the socio-economic problems that marginalized people including PALs face. Such interactions with village people dispel fears. The community organisations support families in taking back their relatives into their homes.
Involving the community in surveys results in the community organisations taking interest in the control of leprosy and they are often challenged not only to work towards the elimination of leprosy from their village, but also to ensure that all PALs are also included in rehabilitation programs.
VHWs and community organisation members are involved in making skits, dramas, songs and go around villages to change people's perception and attitude towards leprosy.
Health team members sharing knowledge freely with village people and involving them in all activities encourages the community organisations to be empowered enough to take up the challenge of improving the health of the village women and children and marginalized groups including PALs. The rehabilitation programs for PALs is not carried out in isolation.
