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PHILADELPHIA COMMUNITY
H O S P I T A L S A L U R,
V I Z I A N A G A R A M D I S T, A . P.
This hospital has been renamed as Philadelphia Community Hospital (PCH) in the year 2005
Objective :
1. To reduce Health Problems faced by People affected with
Leprosy and other marginalized people in the communities
around the hospital.
Target Population
Marginalized people from the rural areas of Vizianagaram, Visakhapatnam, Srikakulam,
East Godavari District of Andhra Pradesh and tribal villagers of surrounding area of Hospital
Statutory compliance
1. Leprosy Services:
Leprosy is endemic in the District of Vizianagram. As per NLEP(National
Leprosy Eradication Programme) statistics 2014-15 , the prevalence rate of
leprosy in Vizianagram district was 1.06/10,000 , the highest in Andhra
Pradesh and ANCDR is 20.83/1,00,000 , again the highest in Andhra Pradesh.
If leprosy is not diagnosed and treated at the early stage it further gets worse.
Those patients who have already disability due to leprosy also need medical
care to prevent further disabilities.
We at PCH Salur
In 2002, Government of India integrated Leprosy care with other general health care
system. Philadelphia Leprosy Hospital also started providing non leprosy services to
the communities around Salur. It was rename as Philadelphia community Hospital in
2005.
Following Non Leprosy Services provided at PCH through OPD and IPD
Ophthalmology
Dermatology
General Medicines
Obstetrics and Gynaecology
General Surgery by visiting Surgeon
Dental
6 year statistics of Non Leprosy Services availed by Patients at PCH Salur
There are 2 PHCs in Makkuava and Pachipenta and 1 CHC in Salur Mandal, beside
this most of the health care provider based at Salur town .The surrounding village
community totally depend on these health care provider. And for tertiary care people
go to vizianagram or Visakhapatnam which 50 and 100 K.m. Most of the private
nursing home are expensive and run with the business motive without the caring
element.
The villager having the little knowledge most often duped by the medical practitioner
and sell their money.
Since most of the disease can be manage with little medication it is important to look
at all the different factors that prevent people from accessing treatment. These factors
all have socio-economic implications and are listed below:
1. A basic lack of awareness about common diseases and treatment methods
2. No one to accompany aged person to the hospital (many of these people come
from daily wage earning families)
3. Lack of money for transportation
4. Fear of Hospitalization
Because of their unawareness and poverty they continue to deprive from getting basic
health care facilities.
Community outreach planning & Methodology
A medical team consisting of 1 Doctor, 2 nurses, 1 lab tech, and 1 Eye tech conduct
medical camp in the surrounding villages.
It has the following elements of approach
Physical Outcome:
Improved Function
Cosmetic appearance restored
Psychological Outcome:
Increased self confidence in patients to face the community
Build Self-esteem of the patients to have a desire to be a productive
member of society.
Social Outcome:
Increased work output
Eligibility for Education
Re-Union with family
Marriage
Employment / Employability
Improved Socio-Economic status and Social participation
The Hospital has experienced staff and infrastructure to manage severe
complications on leprosy. Patients having severe complication and bad ulcers
treated here with love and compassion by dedicated staff.
The Hospital does not charge to leprosy patients for service rendered
and provide leprosy and non leprosy services to leprosy patients and non
leprosy patients under one roof. So our hospital is the last resort for the
leprosy affected who were turned down by Govt. and other health care
providers due to fee and stigma.
The patients of different social status (poorest of the poor from adjoining tribal
villages, middle class and rich from the Salur town) mingle those with leprosy
deformed share the amenities, thereby an opportunity to reduce oppression
due to leprosy related stigma.
Many tribal populations live in the hills finds it difficult to access their health
care. Through our outreach activities we reach to this unreached group
and provide basic health care and complicated cases refer to Base Hospital for
further management.
The Hygienic and living condition of villagers improved due to awareness talk
and Health Education.
Leprosy
Among all the complications, deformities are the commonest and restrict activities.
The main cause of deformity in leprosy patients is nerve damage. This occurs because
the leprosy germs grow in the cooler parts of the body, such as skin and nerves which
are close to the skin. The body tries to get rid of the germs and the resulting
inflammation compresses and destroys these delicate fibers with more or less
complete loss of function. So feeling is lost and muscles paralyzed, thus paving the
way for disability/ deformity, anesthesia, ulceration, damage through injury and
eventual fixed in-correctable deformity. The Leprosy affected who develop deformity
have several problems - physical, social, economic, psychological etc
Physical
Deformity in leprosy makes the person vulnerable. Any deformed patient (hands or
feet or both) becomes increasingly dependent on others for his daily activities as well
as his livelihood. A person with deformity cannot do his work properly. Deformities
like clawed fingers or wrist drop do not allow a patient to even hold a glass of water.
Similarly other deformities due to leprosy make life even more difficult. They come to
the hospital when they feel that there is no option other than surgery. Often the delay
is because of a lack of awareness. It takes one to two weeks physiotherapy before
surgery and three to four weeks of post – operative physiotherapy.
Psychosocial
Deformities in leprosy do not just limit mobility; they also cause the patient to be
isolated from society. The common perception of people is that a person with clawed
finger may spread the disease and hence they prefer to keep a distance from them, do
not talk to them and even drive them out of the house. Most general and government
hospitals do not provide comprehensive care for the leprosy affected. They have only
MDT which is not always available, knowledge of deformity care is not widespread,
stigma prevails – and patients are discriminated against. This causes the patient to lose
dignity and also a host of negative emotions, depression and even suicide. Hence they
need not only medical and surgical care but also psychological care.
Economical
The most expensive and probably the worrying factor today is the cost of health care.
The relatively well off find it difficult, the poor impossible. The patients admitted in
Philadelphia Leprosy Hospital Salur for deformity correction are mostly the rural poor.
They are the children of or are themselves farm laborers earning daily wages and the
monthly income is less than Rs 2000/month. They have large families and several
expenses hence medical treatment gets a low priority. They often avoid it and accept the
consequences. This is even truer for the leprosy affected. There are very few (one or two)
Government hospitals that provide Reconstructive Surgery (Deformity correction) for
leprosy in Andhra Pradesh. Private hospitals charge a high fee (> ` 50,000) only for the
surgical procedure and most do not include physiotherapy, food or stay. They would
have to borrow from money lenders and be in debt for a very long time. This often
causes them to decide to die with the deformity at home rather than to spend their hard
earned money.
Social Impact
There still exists a social stigma against leprosy, mainly due to lack of knowledge and the
misconception that it is a curse from God. This is worse when the patient gets deformity
or ulcers. Patients try to hide their deformity from others so that they may escape from
social ostracism. But gradually when the deformity gets worse it cannot be hidden from
others in the home and community; hence many of the patients have been driven out of
their homes and villages just because of their deformity or ulcers. They cannot afford
treatment in private hospitals and are usually not accepted/treated properly in
government hospitals so they continue managing at home with local quacks and come to
Philadelphia Leprosy Hospital Salur when they find no other way. Here they are
welcomed, admitted and cared for unconditionally. They get compassionate, holistic
care – medical, surgical, psychological……..
RE-CONSTRUCTIVE SURGERY
“Reconstruction of a new life”at Philadelphia Leprosy Hospital,
Salur
More than 60 Reconstructive Surgery per year done at PLH Salur and there are
many success story.
Process of Surgery
Patients eligible for surgery are selected and motivated. All patients are
explained the procedure to build and gain their confidence. The muscle that is to
be transferred is isolated and strengthened for about a week or more based on
the condition of the muscle and joints. Regular assessment is made by the
operating surgeon as well as the physiotherapist during rounds, and once fit
they are posted for surgery. After surgery a Plaster is applied for 3 weeks
(hands) and 5 weeks (feet). Patients are encouraged to go home with the plaster
and return for re-admission on its removal date. The physiotherapy management
involves re-education by Exercises, Splinting etc. and lasts for 3-4 weeks. The
first step in re-education is to teach the patient, how to use his old muscle for a
new job, and train them to apply it unconsciously. In the second step, the
Physiotherapist trains patients to use their limbs effectively and safely in their
day-to-day life.
Rehabilitation Plan
Outcome of Surgery
Physical Outcome
Improved Function
Cosmetic appearance restored.
Psychological Outcome
Social Outcome
DETAILED COSTING
Mandal SC ST All
Male Female Total Male Female Total Male Female Total
Salur 46.00 30.00 38.00 30.00 25.00 28.00 33.00 29.00 30.00
Makkuva 52.34 45.37 48.88 59.45 51.94 55.70 63.30 49.18 56.11
Pachipenta 38.32 33.70 35.36 21.60 37.10 31.60 46.60 31.50 39.05
As per the above statistics , the tribal populations in these 3 Mandals are :
Salur Mandal – 43 %
Makkuva Mandal – 33%
Pachipenta Mandal - 56%
Most of the tribal villages located in the foot hills and state border of Andhra Pradesh
and Odisha . Many of them were migrated from odisha . They have their own culture
,language and lived in isolation for centuries. Their main occupation is to grow
vegetables , work in paddy fields , cut wood from the forest and sale as fire wood . They
are very proud people and preserved their culture over the centuries mainly by living in
groups in the forest , now in villages comprising themselves and marrying among their
relatives.
Their main method of transport is by walking and takes days to reach nearby towns to
buy things and back. They go by walk to see their relatives to the neighboring villages.
Occasssionally they use public transport like buses . There are no proper roads
connecting their villages as they are in remote areas. They cook only one meal in the
evening , keep the left over for morning , in the morning they eat the left over and go for
work .
Need and Importance of Eye Care at this tribal villages
There are 2 PHCs in Makkuava and Pachipenta and 1 CHC in Salur Mandal with out
having ophthalmologist and Surgical facility for cataract . Most of the people depend on
vizianagram or visakhapatnam for tertiary eye care which is 50/ 100 k.m from salur .
Since cataract is a curable disease it is important to look at all the different factors that
prevent people from accessing treatment. These factors all have socio-economic
implications and are listed below:
1. A basic lack of awareness about common eye diseases and treatment methods
2. No one to accompany the blind person to the hospital (many of these people
come from daily wage earning families)
3. Lack of money for transportation
4. Fear of surgery
Because of their unawareness and poverty they continue to remain needlessly blind.
The social and financial hardships created by blindness gravely affect individuals and
families in particular and the nation at large.
The Opthalmic Unit was established in 1979 . CBM had been supporting for its
infrastructure and operating cost till 2011 . They stop the support due to non availability
of regular ophthalmologist . The Opthalmic department restarted in 2013 . The hospital
has a ophthalmic department headed by visiting ophthalmologist and supported by
experience Ophthalmic technician . There is a dedicated eye operating theater and
necessary eye equipment to manage secondary eye care including doing cataract
surgery. Following is the statistics of number of cataract surgeries done from 2013 to
2016
In 2018 , we have target to do 800 cataract surgery . Till jan to Sept 573 surgery been
performed.
All the surgery performed at free of cost.
Activities
Since Cataract is the major cause of blindness, our main acitivity is to conduct eye
camps and identify people with cataract in camps / OPD and provide them with
the necessary treatment, that is, surgery.
To detect and treat (operate when required) diseases such as pterygium, chronic
dacryocystitis and other infections.
Development Outcomes
The development outcomes focused on prevention of need less blindness breaking the
cycle of poverty and ill health. As such, there are 2 key development outcomes:
1. Improved health and vision of the target population
2. Improved quality of life.
Sponsorship request for 20 cataract surgery @ Rs.5000 per surgery.
Aim :
To treat, heal and rehabilitate leprosy patients suffering from ulcer complications
offering them a supportive environment that meets the needs of the whole person.
Over time leprosy destroys the peripheral nerves in the body leading to loss of sensation
in the extremities i.e. hands and feet. This results in increased chances of injuries, burns
and ulcers which become deeper and complicated, can become infected as patients
cannot feel pain and therefore do not take care of their wounds. Ulcers cause physical,
economic, social and psychosocial challenges for people affected by leprosy as detailed
below.
Economic & social: Those suffering with ulcers are often unable
to work due to their limited mobility and the stigma they face.
People are often isolated from society due to the unpleasant sight
and smell of ulcers lead by issues with limited mobility. In some
cases those with ulcers are rejected by their family and friends and
have to live as o utcastes.
Psychosocial: The presence of ulcers and their socio economic
impac t can result in reduced self esteem, and strong feelings of
hopel essness and depression.
This project aims specifically to treat and rehabilitate ulcer patients who
cannot get treatment at the local governmen t health f acility. It needs to
see people being restored to health and able to resume their normal daily
activities and engage socially within their communities and families. It is
anticipated that 360 people will benefit from in-patient ulcer treatment in
2018.
P L Hospital is the only r eferral hospital providing ter tiary level care for
leprosy in the three districts of Vizianagram, Srikakulam and
Visakhapatnam of Andhra Pradesh and Koraput district of Odisha State.
3.Follo wing surgery, patients are monitored by the nurses - many times a
day for medication and twice a day for dressing of woun ds.
4.The patient is seen every day by Doctor Whenever sick and need for
intensive medical attention, once the patient is stable and only in need of
Ulcer dressing, he/she will be seen on the ulcer ward rounds by the
Docto r, physiotherapist, nurse and footwear technician.
7.The hospital co unsellor spends time with the patients, as required. The
ward nurses also have a role not just in administering medicines and
seeing to dressings, but in teaching self care and being someon e who is
willing and able to listen to patient’s problems and concerns.
10. Follo w-ups for medical and social aspects are advised af ter 1 month.
11. Patients (especially younger people) who are interested in vocational
training options are offer ed places on appropriate cours es at
Vocational Training Centre Vizianagram
Out Comes :
Physical:
Psychologica l:
As a result of their physical treatment, counseling and access to
educational programmes, the patients’ self confidence and self esteem is
increased, enabling them to face their communities and to become
productive members of society.
Statistics:
ULCERS 2012 2013 2014 2015
No of Readmission (among
2 27 40 13 23
above)
Total no of Amputations
4 12 19 13 4
(Major Below Knee etc)
5 ulcer 35 33 36 36
6 Bed days used for Ulcer Patient 10,697 9,214 10,562 12,467
Orhthosis 875
Splint 475
Crutches 150
I.V Fluid 50
I.V Set 60
Venflow 75
Suture 20
Artiflex 1500
Total 19,935
Support Request for 10 Patients