Saturday, 21 January 2012

Reconstructive hand surgery in Nepal

Nola Lloyd reports on hand surgery in Nepal.

On the dusty planes of Nepal under the shadow of Mount Everest small communities of farmers struggle to survive off the land. They live precarious lives with basic living conditions, little education, and minimal healthcare. In addition to these hardships, an illness of biblical shame stalks the weak and vulnerable. This is leprosy, a disease that remains a huge global health issue.

Many in the developed world believe leprosy no longer exists. They equate the disease with historical film footage of shuffling, voiceless corpses shrouded in muslin, loosing digits as they move. It comes as a surprise that over 12 million people are affected, many of them children.

The bacillus, Mycobacterium leprae, causes leprosy. It multiplies slowly in the human host, often resulting in a prolonged incubation period of five years or more. The chronic granulating infection affects the skin, peripheral nerves and eyes.

Unlike polio, it causes both muscle paralysis and sensory loss. The combination of paralysis and insensate limbs means that recurrent trauma and infection lead to ulceration and erosion of hands and feet. Loss of sensation and paralysis of eyelids causes blindness. De-pigmented skin patches, deformed limbs and a collapsed nose and coarsened features leave onlookers in no doubt about the diagnosis.

Along with their functional consequences, these stigmata of disease cause considerable distress and prejudice. Families can go to great lengths to hide afflicted relatives from public view.

Leprosy is easily treatable
The treatment for leprosy has been freely available from the WHO for many years. Multidrug therapy renders a patient no longer infective within a month and continues for 6 to 12 months for full treatment. However, established sensory loss and paralysis cannot be reversed.

It is for these problems that physical therapy and surgery can help to restore form and function. For example, this might enable a farmer with a paralyzed hand to return to work or correct a child’s claw hand so that she can feed herself and marry in the future.

Hand surgery
A visiting hand surgeon can reanimate these paralyzed hands. With the moving of muscles and tendons a claw hand can be corrected. In those missing a thumb, pollicization restores that ability to grip objects. Web spaces can be widened to allow spread of fingers and joints fused to allow strength and form. These operations can allow hands to function again and protect from trauma and ulceration ultimately allowing hands to work, care and caress.

There is also the opportunity to mentor local surgeons whilst they develop the skills to perform these complex operations. The hope is that this work continues after the visiting surgeon has gone.

Somewhere on the other side of the world someone is getting back the ability to hold there child’s hand, to work the land that feeds them and to fight back against the disease that produces so much disfigurement and fear.

The ideal is early diagnosis and treatment before the complications arise. In reality, the barriers to this are almost insurmountable. Governments need to change their approach and more needs to be invested in infrastructure and reducing poverty. Until that time the visiting reconstructive hand surgeon can give back the means to a life that everyone should have a fair chance to fight for.

The trips to Nepal are self-funded and 100% of any donations go towards providing patient care. To donate please contact Donald Sammut’s website has further information about the work his team does in Nepal and India.

Further information WHO Leprosy Fact Sheet
World Leprosy Day (Sunday 29th January 2012)

1 comment:

  1. Charitable activities like this traveling surgeon are always a welcome sight. However, that shouldn't excuse governments from exerting all possible effort to provide for as much of any citizen's needs as possible.

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