Projekt Bombay Leprosy
1) Historie, Lage, Entwicklung, Beschreibung

2) ein Fotobericht von Joost Butenop - Arzt u. Fotojournalist

3) Report of Activities
1 Aug' 2001 to 31 Jan' 2002 (von der verantwortlichen indischen Behörde)
1 Febr' 2001 to 31 Juli 2003 (von der verantwortlichen indischen Behörde)
1 Aug' 2003 to 31 Jan' 2004 (von der verantwortlichen indischen Behörde)
Febr to July 2004
REPORT OF ACTIVITIES (August 2004 to January 2005)
4) Fotos von unserem Jeep mit mobiler Behandlungseinheit

5) 30 Jahre Bombay Leprosy Projekt

6) Auszeichnung des Projektes in 2010

7) HomePage der Organisation
 

Eine Flugstunde von Goa entfernt liegt die 17 Millionen-Metropole Mumbai (Bombay).
Hier unterstützt das Hilfswerk Deutscher Zahnärzte für Lepra- und Notgebiete seit zwei Jahren mit DM 100.000 ein Lepra-Prophylaxe-Programm, das unsere Consoeur Drs.L. Pannenborg Stutterheim, Niederland, anlässlich der Investiturfeierlichkeiten im Mai 1999 über den Editor Prof. Peter Schulz an das Hilfswerk Deutscher Zahnärzte herantragen ließ. Das Bombay Leprosy Project (BLP) hat zum Ziel, den Beschluss vom Internationalen Lepra-Kongress, der im Sept.1998 in Peking stattfand, umzusetzen: Eine Welt ohne Lepra.
Ein staatliches Projekt der indischen Regierung versucht seitdem medikamentös die Leprakranken zu heilen. Die Nerven-Schäden im Bereich der Augen, Hände und Füße bleiben jedoch häufig erhalten. Das BLP will durch ein eigenes Programm diese Krankheitsbilder zunächst erfassen und dann therapieren. Dazu wird medizinisches Hilfspersonal ausgebildet, das die Nervenschädigungen diagnostiziert und mit Steroiden nach Empfehlungen der WHO behandelt, die Compliance durch häufige Hausbesuche garantiert, Untersuchungs- und Behandlungspläne für Leprafälle mit frisch nachgewiesener Invalidität erstellt, die Möglichkeit der chirurgischen Behandlung bei Nichtansprechen auf Steroide festlegt und die häusliche Pflege bei invaliden Lepra-Patienten organisiert.
Da die Projektergebnisse in den Slums von Bombay in den letzten Jahren sehr positiv waren, sollen mit Hilfe des HDZ auch die ländlichen Gebiete um Bombay in die Lepratherapie und -prophylaxe einbezogen werden. Eine Finanzierungszusage für weitere zwei Jahre wurde während des Besuchs vom Leprosier mit den dortigen Verantwortlichen vereinbart. Auch hat das HDZ in diesen Tagen mit ca. DM 100.000 die Finanzierung der hierfür dringend benötigten Büroräume übernommen. Unser großes Vertrauen genießt der Gründer dieses Projekts und Arzt Dr.Ganapati (HomePage der Organisation) und sein Team, der uns während unseres Aufenthaltes begleitete.

Report of Activities
1 Aug' 2001 to 31 Jan' 2002 (von der verantwortlichen indischen Behörde)

Introduction:

Leprosy js a progressive disease, which may lead to loss of function and even incapacitating deformities in a significant proportion of leprosy patients. It is important that the leprosy workers recognize the fact that social and psychological factors influence the leprosy patients to a far greater extent and they should know how to respond to this unconscious demand. Since the priority is mainly focused on disease control, the activjtjes related to Prevention of Disabjljties (POD) should be practised without compromising the quality of work aimed at achieving leprosy eliminatjon. This project supported by The German Dentist's Sponsorship for Leprosy and Distressed areas (HDZ) has helped us to achieve this goal, where the disabled leprosy patients are being treated in the community. The following are the details of activities carried out during the reporting period.

Activities:

260 deformed leprosy patients living in the slums of Mumbai as weIl as in Raigad and Thane districts have received POD and disability care services at their doorsteps.
Service delivery was planned and implemented through the community volunteers with the help of local leprosy workers. 48 leprosy patients with signs of reaction (acute neuritis) were identjfied. Out of these 31 patients also had early or partial nerve function fmpairment who were treated with standard course of steroid therapy recommended by WHO (1998). Monitoring the progress of disability status using simple grading system was done at regular intervals by expert teams using Mobile Service Units (MSU). During this period, we have also conducted refresher-training programmes for the Community Volunteers at the Training and Research Centre (St.Lazarus Apartment). This has helped to improve the technical skills and knowledge of community volunteers to practise POD services to leprosy patients.

Observations:

It is observed that the transfer of technology would be possible if the techniques and the components of POD (Prevention of Disability) se/Vices are simple. The involvement of Community Volunteers who can act as a catalyst between the leprosy worker and the leprosy patients will ease the logistic problems prevailing in urban areas in parlicular, though in rural areas and tribai belts, recruitment of such volunteers is relatively more djfficult. This programme revealed that jnspite of the rapjd advancement of the superspecjalities in the urbs prima in jndis, viz. Bombay, the outreach se/Vices to the deprived rural segment which isjust at a 100 kilometer radius was so poor as to make us feel diffident about the possibility of our living up to the definition of a "World Without Leprosy".

Report of Activities
1 FEB' 2001 to 31 Juli' 2003 (von der verantwortlichen indischen Behörde)
BOMBAY LEPROSY PROJECT
11 VN Purav Marg, Sion-Chunabhatti, Mumbai – 400 022, India
Tel: 91-22-2522 0608/ 2522 3040; Fax: 91-22-2529 6486; Email: blproject@vsnl.net

INTRODUCTION
It is well known that leprosy is a progressive disease and in spite of treatment there is a risk of developing loss of function and even incapacitating deformities in a small proportion of leprosy patients. Bombay Leprosy Project (BLP) has developed a special strategy to practise Prevention of Disability [POD] activities, particularly in remote rural areas by involving Community Volunteers (CVs) to assist the trained para-medical workers of BLP. The techniques used for offering necessary POD services were extensively field tested by BLP and demonstrated for mass application by the leprosy workers as well as CVs. BLP has already gained some experience by instituting simple field techniques to treat the disabilities in leprosy that are delivered at the patients’ doorstep in urban areas. However the disabled leprosy patients living in far remote rural areas in Thane and Raigad districts adjoining Bombay are not provided with such services. The Government of Maharashtra manages these areas for basic leprosy control activities. These disabled leprosy patients are referred to established treatment centers in Bombay for POD and further preventing worsening of disabilities. As a result these patients neglect the care required for their disabilities and are struggling to cope up with the consequences of leprosy. Since the priority is mainly focused on disease control, it is necessary that the activities related to POD should also be practised without compromising the quality of work aimed at achieving leprosy elimination. To achieve this, BLP has implemented a special project with the aim of providing POD services to disabled leprosy patients living in the slums of Bombay as well as in adjoining villages of Thane and Raigad districts. This special project supported by German Dentist’s Sponsorship (Hilfswerk der Deutschen Zahnärzte, HDZ), Germany has helped us to offer POD services needed to prevent and treat disabilities at the field level. This report summarizes the activities that were carried out during the period from February to July 2003.

NEED TO OFFER POD SERVICES
In leprosy, considerable number of cases manifests with variable grades of physical deformities, which results in severe handicap, if they do not get proper treatment at the appropriate time. Despite the rapidly falling prevalence of leprosy, the disability and handicap resulting from loss of nerve functions, due to irreversible nerve damage, will remain a huge burden in terms of medical and social problem for many more years to come. Patients treated and cured by multidrug therapy may nevertheless present handicaps, such as deformities resulting from the disease, which have personal and social consequences. Cost-effective programmes for the prevention of disabilities in leprosy also require active involvement of the patients and their families as well as an integrated team approach. This therefore, necessitates review of the current strategy and calls for a feasible plan required to be practised within the existing infrastructure.

Considering the large number of leprosy patients with deformity and within the limited resources available, it is important that POD services are targeted towards those who are most in need. This is required more so with the objective of preventing the worsening of existing deformities. This programme has facilitated us to deliver doorstep POD services and has created tremendous impact in the disability status of the deformed leprosy patients. This project has also immensely helped us to offer disability care services and enable to improve the quality of life of the leprosy patients living in rural areas.

TASK-ORIENTED TRAINING OF PARA-MEDICAL STAFF & COMMUNITY VOLUNTEERS:
Community Volunteers who were recruited from the local area have been given task-oriented training on various aspects of POD & disability services by the senior staff of BLP. The training include demonstration of simple methods of identifying and managing risk prone cases for nerve function impairment and practical demonstration of all the service modalities for disability care. These CVs under the Supervision of BLP staff visited the patient’s house and provided disability care services.

PROJECT SITE
The project activities were mainly focused on the disabled leprosy patients living in the slums of Mumbai and rural areas of Thane & Raigad Districts. A few areas in these districts were adopted for POD programme, which are about 60 to 80 kms away from Mumbai and are easily accessible by public transport facilities.

PROJECT BENEFICIARIES
In 2001, the Government of Maharashtra reported that there are about 2200 and 860 persons with various kinds of disabilities due to present and past leprosy in Thane and Raigad districts respectively. However this does not include those patients who were cured with DDS monotherapy and also those who developed new disability after being declared cured and deleted from the active treatment register. Hence we undertook a disability survey mainly to identify and reassess all the disabled leprosy patients living in these areas. It is estimated that there may be about 5000 disabled leprosy patients living in these two districts. Since beginning, we have identified 1530 disabled leprosy patients from these areas. All these deformed leprosy patients have been offered disability care services at their doorsteps / villages using “Mobile Service Unit”. The following are the details of the disabled leprosy patients who were treated by the leprosy staff and CVs during this reporting period.

 

243 disabled leprosy patients with various types of deformities were offered POD services by the leprosy staff, which included 139 deformed leprosy patients who were offered services previously. The services were monitored by the Supervisory staff from BLP who made field visits to the villages along with the local CVs to assess the compliance as well as the progress in disability. The following are the details of services provided during this reporting period.

 

* No. of services will not tally with the number of patients as some patients have been given multiple services for their multiple deformities.

OUTCOME MEASURES
This project has helped to improve the technical skills and knowledge of leprosy staff and community volunteers to practise POD services to leprosy patients.
Improvement in the disability status after interventions has enhanced the functional capability; thereby improving their quality of life.
The methodology adopted in this project has facilitated to develop an operationally feasible plan for implementing a field based POD programme along with the basic leprosy control programme.

NEED TO SUSTAIN THE POD SERVICES
It is a known fact that leprosy leads to physical deformities, which eventually becomes a serious handicap thereby limiting the functional capabilities of afflicted persons. This emphasizes the great need for sustaining the services and intensive follow-up of all the disabled leprosy patients till they learn to adjust with the situation that will help to limit their disability and prevent worsening. The effect of self-care learning by leprosy patients in prevention of disabilities were found to be effective in containing occurrence of new deformities among high risk patients and healing of trophic ulcers in hands and feet. Strategy for service delivery to the disabled leprosy patients along with the routine leprosy control programme by concerned field personnel without prejudice to their routine work is feasible. In view of the integration of leprosy services with the Primary Health Care (PHC) system, this strategy in the long run will help to ease out the problems. Training of local health workers and volunteers will enhance their skills to offer POD services to leprosy patients. We propose to adopt few more areas in these districts and offer the POD services to the disabled leprosy patients [New] as well as to sustain the follow-up services to the previously treated disabled leprosy patients [Old] during the next phase of this project.

Project on ‘FIELD APPROACH FOR PREVENTION OF DISABILITIES THROUGH COMMUNITY VOLUNTEERS IN RURAL AREAS ADJOINING BOMBAY [PHASE – III]’  
[Sponsored by The German Dentist’s Association [HDZ], Germany] 
REPORT OF ACTIVITIES
[August 2003 – January 2004] 

 BOMBAY LEPROSY PROJECT

Vidnyan Bhavan, 11 VN Purav Marg, Sion-Chunabhatti, Mumbai - 400 022, Maharashtra State, India
Tel: 091-22-25223040; Fax: 011-91-22-25296486
E-Mail: bomlep@bom5.vsnl.net.in / blproject@vsnl.net
Web page: http://www.bomlep.org
REPORT OF ACTIVITIES

Introduction:

It is a sad fact that for some years to come millions of our fellow citizens will need physical and social rehabilitation in view of the consequences related to nerve damage. It is estimated that a quarter and a third of the estimated 1.5 million leprosy disabled patients in the world today already have some degree of sensory and/or motor loss, or may develop such loss in view of the permanent nerve damage. While the deformities characteristic of neglected management of leprosy constitute the most important physical component of the stigma attached to the disease, an additional number of leprosy sufferers bear the social consequences of historic attitudes of society towards them and their affliction. In addition, WHO's public announcements give a strong impression that by the end of 2005, all leprosy problems will be solved with the elimination of leprosy and nothing more needs to be done. The various issues facing us currently in relation to a realistically perceived final goal, which is defined as "A World without Leprosy” is yet to be tackled with a long way to go.  There is a need for sustained efforts to solve these which will contribute to improved human relationship in general in the community. Bombay Leprosy Project (BLP) implemented a field based disability care and prevention of disability (POD) programme for the deformed leprosy patients living in rural areas of Thane and Raigad district with the financial support from “The German Dentist’s Sponsorship [HDZ], Germany”.

Activities:

This project has helped to identify greatly the extent of the problems such as new leprosy disabled cases living in the community as well as to improve the service compliance of the disabled leprosy patients in rural areas of Maharashtra. A total of 296 disabled leprosy patients were evaluated and provided necessary interventions during this reporting period. The interventions consisted of educating the patient and his family and provision of disability aids.  Periodic contacts with the patients were maintained through regular visits. Most of the patients complied with the given advice and used the POD aids provided. Improvement was noted in physical and disability status and recorded in specially designed forms. About 25% patients with hand deformities indicated that they could now reasonably undertake activities of daily life and in 43% of patients, sole wounds were reported to have healed and they could attend to their occupation. Long-term follow-up is necessary to determine the sustainability of results.

Prevention of disabilities in leprosy

47 patients were monitored for possible nerve function impairment (NFI) through standardized clinical nerve function assessment. All these patients were treated with a standard course of steroid therapy (PREDNIPAC). Of these, 21 patients were found to have NFI and were put on a fixed regimen of prednisolone. Sensibility improvement in patients was also noted, however; motor function improvement was less satisfactory. This activity also indicated that with the field based practical training field staff and provision of disability care can be practiced effectively at community level.

Details of services provided to leprosy disabled patients: 

* Number of services provided will not tally with the number of patients as some patients have been given multiple services for their multiple deformities. 

 Results:

A simple information system (SIS) analysis was carried out in September 2003 to assess the improvement following POD activities.  It was observed that, while there was an appreciable improvement in the hand deformities, the healing of sole wounds being the only criteria of effectiveness of the dressing technique with the help of dressing kits was found to be very effective. However the follow-up of patients who received services previously are being continued to ensure service compliance.  It is also experienced that by involving the primary health care staff gradually through a long-term follow-up it will help to sustain the impact of services achieved during the project period.

INTRODUCTION

In spite of effective multidrug treatment (MDT) available to cure the disease, there is a risk of developing loss of function and even incapacitating deformities in a small proportion of leprosy patients.  Since the priority is mainly focused on disease control, the activities related to Prevention of Disabilities (POD) should also be practised without compromising the quality of work aimed at achieving leprosy elimination.  Bombay Leprosy Project (BLP) has already gained some experience by developing simple field techniques to treat and correct the disabilities by providing services at the patients’ doorstep in urban and rural areas.  With the objective of treating the disabled leprosy patients, BLP has implemented a special project with the support from The German Dentist’s Association (HDZ), Germany to offer POD services to leprosy disabled in slums of Mumbai and in remote rural areas of Thane & Raigad districts by involving local Community Volunteers.  This special project since last 5 years has helped us to identify new disabled patients as well as offer POD services needed to prevent and treat the disabilities at the field level.   This report summarizes the activities that were carried out during February and July 2004.

ACTIVITIES

Under this Project, retired Government field workers and community volunteers derived from local area were engaged following task-oriented training on various aspects of disability services by the senior staff of BLP.  These workers along with the Supervisory staff of BLP identified new disabled leprosy patients in villages and assessed their disabilities after visiting the patients’ house and provided disability care services. Mobile Service Unit (MSU) is used extensively to enable the workers to visit more remote villages.  MSU has been extremely useful in enhancing the mobility to serve a large number of disabled patients.  The Primary Health Care (PHC) staff were also given brief training on the POD aspects.  During this reporting period, 238 deformed leprosy patients have been contacted and offered disability care services at their doorsteps / villages by making field visits. Necessary materials for POD services were supplied by BLP based on the requirements.  The services are monitored by the Medical Officers and Supervisory staff of BLP who made field visits to the villages along with the local workers to assess the compliance as well as the progress in disability status of the patient.  

The following table shows the details of services provided.

* No. of services will not tally with the number of patients as some patients have been given multiple services for their multiple deformities.

Deformed leprosy patients being provided with (Splints / MCR footwear) services in the villages at Raigad district

TRAINING & RESEARCH CENTRE (ST.LAZARUS APARTMENT)

BLP has been recognized by several national and international organizations for its outstanding contribution in the field of operational research that has influenced the policy of Government in implementing the leprosy control programs especially in urban areas.  Our desire to have a separate unit was fulfilled by establishing a Training & Research Centre (TRC) at St. Lazarus Apartment in Bhakti Park, Wadala, Mumbai with the kind donation from HDZ.  This unit is equipped fully with a library useful for medical and paramedical students. Several training programmes were also conducted at this centre.

REPORT OF ACTIVITIES
(August 2004 to January 2005)

The German Dentists Sponsorship (HDZ)
Report: Aug’ 04 – Jan’ 05

“Field approach for prevention of disabilities through Community
Volunteers in rural areas adjoining Bombay”
(Sponsored by The German Dentist’s Sponsorship (HDZ), Germany)

INTRODUCTION
One of the issue that is often over sighted as a part of achieving
the goal of leprosy elimination programme is the occurrence of
physical disabilities. These deformities develop either due to late
reporting or delayed detection of the disease accumulated over a
period of time in a considerable number of leprosy patients. The
disabilities and deformities developed due to leprosy greatly
interfere with the ability of the affected individuals to work
efficiently resulting in economic loss necessitating a huge problem
of rehabilitation of leprosy patients. In fact, while achieving the
elimination of leprosy, it is necessary that prevention and deformity
should be given utmost importance. The essential impact of MDT
programme over several years has been a phenomenal decline in leprosy
prevalence, providing opportunities to deliver disability care
services to leprosy patients and to expand the coverage of the
programme, particularly in rural areas. However the underutilization
of available disability care services and other aspects of treatment
for disabilities can only be improved by using community based
approaches. At the community level, volunteers should be identified
and they should be involved in the process of delivery of disability
care services in a sustainable manner. To achieve this, Bombay
Leprosy Project has been running a special project with the support
from The German Dentists Sponsorship (HDZ), Germany to offer
disability care services to leprosy disabled in slums of Mumbai and
in remote rural areas of Thane & Raigad districts by involving local
Community Volunteers. The following are the activities that were
carried out from August 2004 to January 2005.
ACTIVITIES
The methodology used in this project is essentially community based
and necessary measures were taken into consideration basically to
adapt to the needs of the disabled leprosy patients living in urban
and rural areas. With the help of a team of community volunteers
derived from local area and a few retired Government field workers
who were engaged for this Project helped to deliver disability care
services under the supervision of the senior staff of BLP. The local
volunteers in Raigad district involved in POD service delivery were
provided training by the supervisory staff and the physiotherapist at
our POD center and as well as in the field area. The training focused
mainly on the simplified information system needed to evaluate the
outcome of the interventions and the impact of the services. These
workers along with the Supervisory staff of BLP identified 98 new
disabled leprosy patients in villages and assessed their disabilities
after visiting the patients’ house and provided disability care
services including supportive drugs. The Mobile Service Units (MSU)
are being used extensively to enable the mobility of the field
workers thereby enhancing the reach to serve a large number of
disabled patients living in 110 remote villages. Wherever possible,
the local Primary Health Care (PHC) is also involved following a
brief training on the POD aspects.

During this reporting period, 269 deformed leprosy patients have been
contacted and offered simple aids supplied by BLP for providing
disability care services at their doorsteps / villages through house
visits including follow up of patients, who required specialized
services for their disabilities were referred to the general
hospitals in Mumbai. The Supervisory staff of BLP monitored the POD
services by field visits to the villages along with the local workers
and assessed the compliance as well as the progress in disability
status of each disabled leprosy patient.
The following table shows the details of services provided:
 

   
Deformed leprosy patients are being provided with (Splints / MCR
footwear) services in the villages of Raigad district
 

Bilder von dem von uns gespendeten Jeep mit mobiler Behandlungseinheit zur Versorgung der Lepra-kranken Bevölkerung in abgelegenen Gebieten (Distrikte Thane und Raigad)

Bild-Klick!
	Bild-Klick!
Bild-Klick!