19.5.4  Measures to prevent and manage disabilities

Patients with insensitive hands or feet injure themselves without noticing it. They can develop wounds which can get infected and, over time, lead to irreversible deformities. It is the task of all health staff working with leprosy patients to preserve nerve function and to prevent further deformity and disability in those cases where there is some irreversible disability present at the time of diagnosis. The process and measures undertaken to preserve nerve function is often referred to as prevention of disabilities (POD) by:

• Early diagnosis and prompt treatment.
• Recognising signs and symptoms of leprosy reactions with nerve involvement and referring to a clinician for advice on what to do.
• Carrying out VMTs and STs regularly to detect nerve function impairment.
• Encouraging and training patients in the practice of self-care.
• Educating patients to recognise early signs of nerve function impairment and to report this immediately.

POD depends, to a very large extent, on the patients themselves. So, priority should be given to POD through training on self-care, i.e. what the patients can do themselves to prevent development and/or worsening of disabilities and by wearing protection on feet and hands. You should tell leprosy patients with insensitive feet not to wear closed plastic shoes because such shoes can lead to more sweating, formation of blisters and skin infections in the feet. Where wounds occur, you should manage them just like any other cuts or wounds, dry skin, or eye problems. Use Table 19.2 to guide you on simple measures you can take to prevent and manage disabilities at the community or health post level. Use it to teach your patients about self-care.

Table 19.2  Care of the hands, feet and eyes in people with leprosy.

Care of the hands
Injury on hand while working/cooking	Clean wound and apply clean dressing. Advise rest. Advise and teach patient to use a cloth to protect the hands when touching hot or sharp objects.
Hands with dry cracks and fissures	Advise and teach patient to soak hands for 20 minutes every day in water and to apply Vaseline or cooking oil regularly.
Care of the feet
Feet with dry cracks and fissures	Advise and teach patients to soak their feet for 20 minutes every day in water and apply cooking oil/Vaseline regularly. Advise them to use shoes or slippers to protect their feet from injury. Source: WHO, 2000, as for Figure 19.1
Blister on the sole or between toes	Dress blister with clean cloth. Apply cotton wool and bandage. Teach patient how to do the same.
Feet with ulcers without any discharge	Clean the ulcer with soap and water. Cover with clean dressing. Advise rest.
Feet with ulcers with discharge	Clean the ulcer. Apply antiseptic dressing. Advise rest. If no improvement in four weeks, refer to hospital.
Care of the eyes
Patient presents with red eye, pain, blurring of vision and discharge	Give aspirin or paracetamol. If available apply 1% atropine drops and steroid ointment. Keep eye covered with a pad. Whenever possible, advise to go to the hospital.
Patient with injury on cornea (corneal ulcer)	Apply antibiotic ointment if available. Keep eye covered with a pad. Wherever possible, advise to go to the hospital.