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Support for Reconstructive Surgery,

Cataract Surgeries and Ulcer Care

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.

Philadelphia Community Hospital


Salur, Vizianagram District-535591
Andhra Pradesh.
E-mail: Surjit.pal@leprosymission.in , Phone: +91-08964-242320
Support for Reconstructive Surgery,
Cataract Surgeries and Ulcer Care
P H I L A D E L P H I A C O M M U N I T Y 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.

Introduction to the Hospital:


Philadelphia Leprosy Hospital, a unit of The Leprosy Mission Trust India was
established in 1906 as a Leprosy Control Unit, developed into a tertiary care Leprosy
hospital, now transformed into a 60-bedded community Hospital.

This hospital has been renamed as Philadelphia Community Hospital (PCH) in the year 2005

aiming to serve the community with different specialties e.g. General


Medicine, Ophthalmology, General Surgery, Obstetrics and Gynecology,
Dentistry, Diabetic Clinic alongside leprosy. It is a tertiary level and referral
hospital for Leprosy for the district as well as surrounding districts of Andhra
Pradesh and Orissa states. Hospital conducts plenty of outreach activities in
the inaccessible tribal areas around Salur. The Hospital is strategically located
at Andhra – Odisha border at Tribal belt where health care providers are very
less.
Vision : People affected by leprosy living with dignity in a transformed
inclusive society that has overcome leprosy

Goal : Improved Health and Inclusive Development of People affected


by Leprosy and other Marginalized People in the Communities
around Visakhapatnam, Vizianagram, Srikakulam,East Godavari
district of Andhra Pradesh and Koraput, Rayagada district of
Odisha

Objective :
1. To reduce Health Problems faced by People affected with
Leprosy and other marginalized people in the communities
around the hospital.

2. To promote inclusive development of people affected by leprosy


through awareness of rights, livelihoods options and advocacy
through relevant partnerships.

3. To increase and sustain expertise for effective programme


delivery

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

 FCRA Registration No. of the Hospital is 010370002


 Hospital is registered as Clinical Establishment – Hospital Registration No.
30/DRA/VZM/09
 Genetic Counselling , Genetic Lab / Genetic Clinic – Registration No.
06/DMHO/DAA/VIZIANAGRAM/2014
 Authorize to generate , segregate and safe disposal of Bio-Medical waste –
Order No. 4/APPCB/BMWA/VZM/2010-944
 Drug License No. AP/02/02/2014-120574
Services Provided by PCH salur:

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

 Diagnose and treat difficult to diagnose case of leprosy


 Manage cases of reaction , neuritis , ulcers , eyes and other medical problems
in Hospital ward
 Conduct Reconstructive Surgery for people with deformities and disabilities
due to leprosy
 Provide education to people affected by leprosy and their families on
prevention of impairment and disability
 Make and provide Artificial Limb and customised protective footwear for
anaesthetic feet
 Provide Physical therapy services for people affected by leprosy
 Provide counselling service to patients

6 year statistics of leprosy patients availed various services at PCH Salur

Services Availed by Leprosy


patients at 2012 2013 2014 2015 2016 2017
PCH Salur
Leprosy patients seen and treated 3771 3598
4925 4956 4375 4156
in OPD
Leprosy patients admitted and 504 546
503 446 531 519
treated in the ward
334 369
No. of Ulcer Admission 304 282 290 348
No. Of Reconstructive Surgery 62 60
46 61 64 60
done
No. Of Artificial Limb made and 33 36
15 23 37 38
supplied to patients
No. of Customised foot wear made 325 530
706 443 425 535
and supplied
Physiotherapy services provide to 1590 1790
1414 1343 804 1341
leprosy patients
No person who comes to PCH denied any aspect of leprosy treatment due to his/her
inability to pay.
2. Non Leprosy Services:

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.

The reason to start non leprosy service was

 Leprosy affected patients with other health problems feel unwelcome in


Government and Private Health Care facilities due to Stigma against the
disease.
 The Hospital area where it located is inhabited by people who are socio-
economically deprived. The tribal population living in the hills find it difficult
to access their health care needs.
 This area is prone to malaria and other communicable diseases. Medical care
in this area is often given by unqualified and unscrupulous medical
practitioner at exaggerated cost and it is often incomplete and inappropriate.
 The funding to support leprosy cost reduced significantly in past years due to
global economy slow down and donor’s other priorities. For income generation
purpose to support leprosy cost , non leprosy services started on payment (
presently 20% of Leprosy cost borne by Non leprosy income)

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

Speciality 2012 2013 2014 2015 2016 2017


Ophthalmology 577 2291 2280 2659 2415 1661
Dermatology 1655 1760 1818 1975 2249 1932
General Medicines 10601 11608 12101 9905 11,805 15310
Obstetrics & Gynaecology 18 236 775 1092 1114 1511
Dental 488 1231 1438
General patients admitted in the 1330 1282
1026 1031 986 1190
wards
TOTAL 13877 16926 17960 17309 20144 23134


 Other Support service
2012 2013 2014 2015 2016 2017
No. Of Lab test done 33027 31100 30602 32371 35428 35795
No. Of X- Ray Done 1108 1159 827 661 682 878
No.of ECG done 263 262 290 328 201 227
3. COMMUNITY OUT REACH PROGRAMME:

Hospital conducts plenty of outreach activities in the inaccessible 3 Mandal of Salur,


Makkuva and Pachipenta Mandal of Vizianagram District. The tribal population in
these 3 Mandal are:

Salur Mandal 43%


Makkuwa 33%
Pachipenta 56%

In 2016 the Hospital’s community outreach department conducted 44 medical camps


in theses villages. 8759 patients benefited through these Camp.

I. Need and Importance of Community Outreach

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

a) Weekly clinics – 4 time a month


b) Home visits by health workers
c) Primary health care and pre-natal and post-natal mother and child care
d) Growth monitoring of children through parent retained cards
e) Treatment to common illness by providing free medicines
f) Referral service to Base Hospital for management of complications and surgeries
Further, strong emphasis is being laid on preventive care. Safe drinking water, proper
disposal of human waste, personal hygiene and oral rehydration are given due
propaganda to prevent communicable diseases.
How this Hospital Impacting lives of People
 The Hospital is the only referral hospital which admits patients and
performs Reconstructive surgery in the surrounding three districts.

Following are the outcome of Reconstructive Surgery:

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.

 The hospital provides quality and affordable medical services to


majority of poor and needy of surrounding tribal villages. The hospital
provides free consultation to those below the poverty line. And bear the
Hospitalization cost of those patients who cannot afford to pay their bill
through Good Samaritan Fund.

 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.

1 . Support Request for Reconstructive Surgeries

The Problem of Deformity in Leprosy


Leprosy a so called cruel disease, while it doesn’t kill directly, it deforms and
stigmatizes, leading to rejection by communities, and consequent impoverishment,
disease and early death. Leprosy causes both disfigurement and disability specifically,
hands, feet and eyes. While disfigurement often leads to social rejection, disability
reduces the possibility of undertaking productive work. Together, they are a life
sentence without surgical intervention. Leprosy is also a neglected disease, ignored or
denied in many countries and communities. This denial increases the negative impact
of the disease as it is often not treated early enough.

Leprosy

o 50% of the world’s leprosy cases are in India.


o Is caused by a bacteria - Mycobacterium leprae
o Is treated with MDT - Multi Drug Therapy for 6 – 12 months
o Starts with a skin patch and if not treated promptly can lead to
deformities
o Is a disease which has several complications like Deformity, Reaction,
Neuritis, ulcer etc.

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

Surgical reconstruction for the correction of deformities due to leprosy is now


well and firmly established. For a leprosy patient, appearance is very important
since his deformity not only separates him from his family, friends and relatives
but it causes a stigma against him in the community. So the main aim of Re-
constructive surgery is restoration to normality. The commonest deformities in
leprosy that can be corrected by surgery are Claw Hand, Ape thumb,
Lagophthalmos, Foot drop, Claw toes, etc. Reconstructive surgery facilities are
available in Philadelphia Leprosy Hospital Salur.

Philadelphia Leprosy Hospital Salur is the only referral Hospital for


Reconstructive Surgery in the neighboring 3 district; Visakhapatnam,
Vizianagram and Srikakulam.

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

A Rehabilitation plan is made for each individual patient who underwent


corrective surgery, and they are followed-up. The plan will take into
consideration, his occupation before admittance for surgery and what he intends
to do after surgery, whether going back to the same occupation or not. Based on
his academic/technical qualification, previous experience, interests, disabilities
and needs of the community they are referred for programmes like CTY, CBR,
VTC, etc.

Outcome of Surgery

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 & Social participation . 
Cost

The cost of One Reconstructive Surg ery is INR 22,000 including


Surgery / Medication / Hospital Stay / Food / Nursing Care /
Physiotherapy Service / Counseling Service.

DETAILED COSTING

Hospital Bed Charges Rs. 6,200

Physiotherapy Rs. 2,000

Surgery Fees Rs. 5,000

Anaesthesia Charges Rs. 1,000

Post-Operative Drugs Rs. 200

Pre-operative drugs Rs. 100

Nursing/Support staff cost Rs. 2,000

Surgical materials Rs. 2,000

Administrative expenses* Rs. 3,500

Total cost of RCS Surgery per patient Rs. 22,000

Support Request for 10 Reconstructive Surgery


10 x Rs.22,000 = Rs.2,20,000
2 . Support Request for Cataract Surgeries

Introduction to the Community :


Salur , Pachipenta and Makkuva are three mandals in vizianagram District of Andhra
Pradesh State . These area are surrounded with green forests and chain of hills on two
sides and by River Vegavathi on the other two sides . Telugu is the local official language
. But the tribals people have their own language.
Following 3 Mandal covered

 Salur Mandal ( 81 Villages )


 Makkuva Mandal ( 48 villages )
 Pachipenta Mandal ( 27 villages )

Mandal wise Population ( As per 2011 census )

Mandal TOTAL POPULATION TOTAL SCs TOTAL STs


Total Male Female Total Male Female Total Male Female
Salur 105389 51107 54282 11232 5394 5838 33610 16106 17504
Makkuva 50506 25225 25281 5496 2740 2756 11264 5599 5665
Pachipenta 48233 23870 24363 3833 1888 1945 23227 11518 11709

Literacy (Rate in percentage)

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 is very little Information


available on the Ocular Health of Tribal Populations of these villages . These
Communities live in Undeserved and remote areas with Limited access to health care of
any sort. Their perceptions and attitude towards Health also determine their behavior
with regards to accessing Modern Health Care.
Blindness due to cataract still remains a big challenge to Both Medical and Social
Welfare field in India.

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

2013 2014 2015 2016


No. of Cataract 314 370 451 559
Surgeries done

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 prescribe glasses for refractive errors.

 To detect and treat (operate when required) diseases such as pterygium, chronic
dacryocystitis and other infections.

 To refer school children in the villages for refractive errors, squint,amblyopia,


nutritional deficiencies etc.

 To undertake health education of the community on proper care.

 To develop and maintain relationship with the community.

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.

Support amount request Rs. 1,00,000

3 . Support Request for Ulcer Care

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.

Focus on Ulcer Care – Overview

Why is ulcer care important?

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.

 Physical: Ulcers that are left un treated can become severely


infected leading to leng thy hospi tal admissions (for up to 2 -4
months). In serious cases limbs that are left untreated may need to
be ablated.

 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.

Service Provided by PCH for Ulcer Care :

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.

Unfor tunately, there is ample evidence that leprosy is not treated


effectively at Government Primary Health Care Clinics (PHCs) and other
private Hospitals. Many Governmen t or private sector hospitals often turn
away people most severely affected by leprosy (particularly those with
infected ulcers and deformities). In any case, treatment at these hospitals
is most often prohibitivel y expensive and so leprosy affected often live out
their lives getting poorer and poorer as their condition worsens.
At P L hospital 50% of patients in the in-patients ward are for ulcer care.
20% of ulcer patients ar e women and less than 5% are children. Ulcer
treatment involves a series of specific processes as follo ws:

1. Admission after an initial medical assessment, dressing, health


education, counselling, rehabilitatio n assessment and the administration
of antibiotics if needed.

2.Within 48 hrs, debridement of wounds was un dertaken in the operation


theatre.

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.

5. For ulcers, the healing process is about 6 weeks on average. H ealing


time depends o n the size and site of the initial wound, associated illnesses
such as diabetes, vascular insufficiency or lepra reactions needing steroids
and the age of the patient.

6.During the patient’s stay in hospital, self-care of ulcers is taught to the


patient. OPD patients are taught self care for their anaesthetic hands and
feet in the Physiotherapy Department, individually and in self-care
groups. This is re-inforc ed frequently during re-visits and pati ents are
made to practice so that they get in to good habits and c are This im portant
aspec t of disability prevention helps to avoid further damage especially to
feet. Each patient is given a pictorographic self care bo oklet to encourage
practice at home.

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.

8. Special Footwear is issued to the patient. This is made from micro-


cellul ar rubber and is designed specifically to address the patient’s foot
condi tion. Foo twear and splints are man ufactured and provided to
patients. (See photograph below). In 2015, P L Hospi tal provided more
than 500 protec tive shoes, special orthotic sandals and customized braces
to protect the lo wer limbs and reduc e the rate of ulcer r ecurrence.

9. As the patient improv es in health, their rehabilitation needs are


assessed by the social worker. For younger patients the feasibility of a
place on a cours e at the Leprosy Mission’s

Vizianagram Vocational T raining Centre is considered. Over 50% of the


ulcer patients are illiterate and P L hospital has recentl y started with help
of a retired staff to come every day to the wards and teach the elderly
patients to read and write.

10 The patient is discharg ed when the wound has healed or is small


enoug h for him/her to manage at home.

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 :

Successful treatment leads to the following life changing outcomes:

Physical:

Through treatment ulcers are healed an d the patient’s cosmetic


appearance is restored o r improved and the recurrence of wo unds is
prevented. In 2015 only 6.6% of ulcer care patients were readmitted,
thereby indicating that those treated are applying the skills learnt
regar ding self c are, consequently avoiding further ulcers in the future.

Economic & social:

P L Hospital Salur provides affordable, subsidized and so metimes


completely free, care for those unable to pay for treatment thereby making
treatment accessible and enabling patients to be able to reco mmence
working. The majority of the patients are farmers and they are encouraged
to go back to their occupation, taking pr eventive c are to avoid the
recurrence of wounds. Vocational training is an option for younger
patients. Howev er the majority of ulcer patients are older with an average
age of above 60 years. Once treated, patients are eligible for education,
are re-united with their families, have increased marriage and
employment pr ospects, and improved socio-economic status an d social
participation. The aim of the in-patient education programme is to
improve their social standing in the communi ty when they return.

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

1 No of Ulcers admissions 304 282 290 348

No of Readmission (among
2 27 40 13 23
above)

Total no of septic Surgeries


3 161 163 225 169
done

Total no of Amputations
4 12 19 13 4
(Major Below Knee etc)

Average duration of stay for

5 ulcer 35 33 36 36

Patients (in days)

6 Bed days used for Ulcer Patient 10,697 9,214 10,562 12,467

FOOTWEAR 2012 2013 2014 2015

1 No of MCR Footwear Supplied 626 443 425 523

No of Repairs made / Spare


2 27 40 13 23
Parts (FDS etc)

3 No of Orthotics Supplied 161 163 225 169

4 No of Artificial Limbs made 31 27 26 30


5 No of Artificial Limbs repaired 15 23 37 38

6 Bed days used for Ulcer Patient 34 30 39 47

Source: P.L.Hospital records

Cost of Ulcer Care at P L Hospital, Salur for One Patient:

Activity Total Budget (INR)

Lab Medication 120

POP Roll 6” 600

Orhthosis 875

Splint 475

Crutches 150

I.V Fluid 50

I.V Set 60

Venflow 75

Suture 20

Artiflex 1500

MCR Chapels 350

Nursing care for 35 days x Rs.100 Per day 3500

Exercise charge 360

Dressing charge Rs.130 x 35 days 4550

Food and other operational cost Rs.150 x 35 5250


days

Doctor Cost 1000

Therapist cost 300

Total 19,935
Support Request for 10 Patients

Rs.19, 935 x 10 patients = Rs. 2,00,000

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