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A Guide to Health
Education
in Leprosy
All AFRICA
LEPROSY
AND
REHABILITATION
TRAINING
CENTRE,
ADDIS ABABA
ETHIOPIA.
A Guide to Health Education in Leprosy
by P. J. Neville, M.B.A.O.T., M.P.H.
drawings by D. Ottaway
All Africa Leprosy and Rehabilitation Training Centre.
P.O. BOX 165, ADDIS ABABA, ETHIOPIA.
CONTENTS.
Page.
(i) Introduction.
1.
Notes on Preparation and Delivery of a Talk.
3.
Introductory Talks for New Patients.,
5.
Early Signs of Leprosy.
6.
Facts about Leprosy.
7.
Care of the Skin.
8.
Prevention of Plantar Ulcers.
10. Shoes.
11. Hand care.
13. Eye Care.
15. General Hygiene.
17.
First Aid Treatment of Wounds.
18.
Care of a Walking Plaster.
19.
Sample Form for Injury Survey
Presented by German Leprosy Relief Association,
Printed by Rakshabandhu Trust, Printing Division, Friend of the physically handicapped,
151/1, Annai Velankanni Church Road, Besantnagar, Madras-600 090 / S. India,
Phone 411847—4th Edition 1980
INTRODUCTION
Health Education plays an important part in the treatment and control of Leprosy. It
should be directed towards the general public, (especially receptive sections such
as school teachers, students and school children) ; physicians, medical students and
leprosy auxiliary personnel; and the leprosy patient and his family. The following notes
have been compiled in order to assist the health worker in his task of health education
Health Education is essentially team work. It must be the concern not only of the
health worker or the rehabilitation worker who takes the formal classes, but the
whole medical team. Health Education can only be effective if all the staff are
conscious of its importance, and it is not only a subject for class-room teaching, but
must be stressed whenever the opportunity arises.
Health Education must be team work.
HeelthEducation aims to help people achieve good health by their own action and effort.
'In order to do this, they need to learn certain facts. The method of teaching
these facts must be carefully selected.
People will learn by what they hear, see and do.
But it is important to remember the Chinese proverb,
“What we hear, we forget.
What we see, we remember,
What we do, we know."
Therefore, visual aids of all kinds are important and should be used during talks.
Wherever possible, there should be practical sessions, so that people can put into
practice what they have learned : i.e. cooking classes for women patients with
sensory Joss of the hands.
The leprosy patient must be helped to understand what causes the disease, what it is
doing to him, because he must subsequently play an important part in his own treatment
Much will depend on his co-operation and understanding, particularly when there is
eensoryloss of the hands or feet.
But teaching facts about health probably plays only a small part in motivating people to
change habits which are harmful to health.
People must—understandthe reason for change.
—want the change.
—and see some personal benefit from the change.
(ir)
PREPARATION AND DELIVERY OF A 10 MINUTE HEALTH
EDUCATION TALK
At each clinic a scheme of talks should be planned ahead for a period of 2 or 3 months.
This is recorded in the Clinic diary, where the health worker can also write hiscomments
about the progress of the health education programme.
1.
Prepare each session carefully.
2.
A talk should include :—
1) Introduction
2) Teaching points
3) Summary
3) Put the talk into note form.
4. Never teach more than 3 new ideas.
5. Look at the audience—do not look at your notes all the time.
6. Do not talk too fast.
7. Check your visual aids before you start.
8. When appropriate, include a local story orproverbtocatchthe interest of,the audience.
9. Prepare one or two questions related to the most important teaching points.
(The answers and discussions that follow may provide ideas for future health
education sessions.)
DO NOT MAKE YOUR TALK TOO LONG.
The person giving the tqlk should :—
— be in a position (o see all the audience.
— use simple language.
— make frequent pauses.
— remember that facial expression is important. Make the audience
understand that you are enjoying giving the talk.
— remember that enthusiasm is infectious I
PRACTICAL HINTS FOR GROUP TEACHING
1.
2.
3.
4.
5.
6.
7.
8.
2
The audience should be seated comfortably in a small group.
Make sure that you can see each person.
Create a friendly atmosphere by greeting the group.
The talk should be short and not contain more than 3 new points.
Leave time for questions and discussion.
Encourage the audience to voice their problems.
Never make a person look foolish in public.
Use visual aids as much as possible and plan them carefully.
INTRODUCTORY TALKS FOR NEW PATIENTS.
It is particularly important to take time to teach naw patients, so that they may know
what to e'.pect from their treatment. New patients are usually eager to learn and are
willing t , take advice.
INTRODUCTORY TALK 1.
Important Facts about Laprosy.
The Cause.—a bacillus, not a curse or an evil spirit.
The Treatment.—3 Important Rules.
Take treatment REGULARLY.
Take the RIGHT DOSE.
Take treatment for a LONG TIME.
The health worker will discuss the treatment with the patient and explain the
importance of taking the tablets regularly.
Leprosy can be cured.
Leprosy is a slow disease.
Leprosy takes a long time to come and a long time to go.
Tablets can cure leprosy patches, but not deformity.
INTRODUCTORY TALK 2.
Examination of Contacts.
If the patient is living with his family, advise him to bring them for examination.
General Hygiene.
/
Patients may neglect to wash their bodies and clothes.
cleanliness.
Teach the importance of
Self Respect.
Leprosy is not the result of sin. Patients are not different from other people. The
disease is not hereditary. You need not leave your family, or land and jcb. Do not
neglect your body and your clothes. Leprosy can be cured and deformity prevented.
3
INTRODUCTORY TALK 3.
1.
Explanation about Loss of Feeling.
Loss of feeling in the hands or feet is usually permanent.
There is no medicine to bring back the feeling.
There is no pain to warn that the hand is near the fire.
The patient must learn to be careful, and to prevent wounds occuring.
2.
Signs of Neuritis.
Pain. (Show the sites where this occurs; ulnar, median, radial, lateral popliteal nerves)
Loss of feeling.
Tingling in the hands.
Weakness.
Report any of these to the health worker.
3.
Signs of 'Reaction'.
Itching all over the body. (The patjent may call it 'burning')
Fever.
Lesions may become painful; new lesions may appear.
Often acute pain in the eyes, nerves and bone.
Sometimes pain in the testicles.
DO NOT NEGLECT ANY OF THESE SIGNS AND SYMPTOMS,
BUT REPORT THEM TO THE HEALTH WORKER.
4
EARLY SIGNS OF LEPROSY.
Leprosy is a common disease in parts of the country, but many people do not recognise
it in the early stages. Like many other diseases, if it is recognised and treated early,
it can be cured. Leprosy takes a long time to come and a long time to cure.
What are the early signs of leprosy?
Leprosy can begin in any one of 4 ways:
Light coloured patches appear on the skin; the patch has no feeling.
itchy patches are not leprosy)
2. Thickening of the skin, especially the face and ears.
1.
3.
4.
(White or
Loss of feeling or weakness in the fingers or toes.
Pain in the nerves.
Why should you go immediately to a clinic if any of these signs appear?
1.
Because the best time to start treatment is immediately the disease appears.
2.
Because if you do not delay getting treatment, you will be less likely to spread the
disease to your family and friends.
3.
Because the disease can be cured and deformity of the hands and feet prevented.
If you delay taking treatment you make it much more difficult for the health worker
or doctor to treat you.
Why do people delay in seeking treatment for their leprosy?
Because they are afraid to show that they have the disease.
Because they do not know what the early signs of the disease look like.
Because they think there is no cure.
What are the other reasons for people not coming early for treatment?
5
FACTS ABOUT LEPROSY
There are many different beliefs about the cause of leprosy. Some people think that
it is a hereditary disease; others think that it is caused by drinking water from the
same well as an infected person; and there are many other wrong beliefs.
THE CAUSE
Doctors now know that these beliefs are not true because scientists have discovered
that certain bacteria (germs) cause leprosy.
THE TREATMENT
Doctors know how to kill these bacteria and so cure the disease. A person with leprosy
must take tablets to destroy the bacteria. Unfortunately, the treatment takes a very
long time. Some people do not understand that they must visit the clinic and take
medicine for years before they can get better. Many patients who could get better
get tired of going to the clinic and they give up treatment before it is finished.
THE CURE
The best time to treat leprosy is when the disease has just begun. If a man goes
for treatment immediately he finds he is ill, he will be cured more quickly.If he does
not get treatment he may lose all sense of feeling in his limbs, and burn and cut
himself without feeling any pain.
CAUSE OF DEFORMITY
If these burns and cuts are neglected, they soon become infected and turn into ulcers,
which eventually cause deformity. Sometimes, after many years, the bacteria die
but the deformities are left after the patient has got rid of the harmful disease. He
cannot spread the disease, but he still needs the health worker to show him how to
avoid wounding his hands and feet.
SPREAD OF THE DISEASE
Leprosy is the least infectious of all infectious diseases. There are 2 kinds of leprosy
and only people with one kind, lepromatous leprosy, can spread the disease. At an
early stage it is easy to hide leprosy, and sometimes people try to do this. But
it means they may pass the disease on to their friends.
SOCIAL ASPECTS
Leprosy patients do not only suffer because of their disease. Sometimes they suffer
because people will not talk to them; sometimes tfiey suffer because people may not
want to eat, or work with them.
If you have a relative or friend who you think has leprosy, do not leave him to suffer
alone. Advise him to go to the nearest health clinic at once. Perhaps you can save
him a lifetime of unhappiness.
REMEMBER...LEPROSY CAN BE CURED.
6
CARE OF THE SKIN.
WASH .... SOAK . . .OIL
When the hands or feet have lost sensation it is important to prevent them from
becoming dry and cracked.
1.
Wash the feet and hands every night after work. Use soap if possible.
2.
Soak the hands or feet in water for 20 minutes at least, but not less than this time
3.
After soaking, remove any dead skin with a stone or the fingers, but do not use
a razor blade.
4.
Oil the skin. Use either cooking oil cr vaseline but do not use butter (This will
attract the cockroaches.) It is ecser.tial to soak first, then rub in the oil.
REMEMBER .... WASH . . . SOAK ... OIL
PREVENTION OF PLANTER ULCERS.
There ere 3 Important things to do:
INSPECT...REST... PROTECT
What causes ulcers of the feet ?
a) Walking on feet that cannot feel.
b) A thron or stone enters the foot and you do not feel it.
c. Badly fitting shoes; shoes which are too narrow or those with nails sticking out, or
badly repaired shoes.
It is rot the leprosy germ that causes ulcers, but walking on feet that have lost their
feeling.
Remember ...No injury means no ulcer.
What must you do to prevent ulcers from coming 7
1.
Inspect your feet every night after washing them. Press with your thumb on the
6 places marked with an X on the diagram. If you find any part red or painful on
pressure, or swollen, these are danger signs. There is an ulcer coming, but you
can prevent it by not walking.
2.
Rest the foot at home.
Do not walk to the clinic to get a bandage, because
bandages do not cure ulcers. Rest is the treatment.
3.
Protect feet that have lost feeling by-wearing the right kind of shoes. Walk with
short steps and this will not give the feet such hard work. Watch the path when
walking and so avoid walking on rough ground.
8
Home Treatment for ulcere.
1.
2.
3.
Soap and water soaks for at least 20 minutes daily.
Rest the foot—this means do not walk on it.
Wear the right kind of shoes.
REMEMBER . . . DRESSINGS WILL NOT HEAL ULCERS.
9
SHOES.
Shoes are good medicine . . . shoes prevent ulcers.
If your feet cannot feel, it is very important that you wear the right kind of shoes,
the kind ordered by the health worker. Shoes can protect feet with no feeling against
thorns and stones. These may injure the feet and because there is no feeling the
wound is neglected. If your feet cannot feel, do not walk even one step without shoes.
The wrong Type of Shoes.
1)
Badly fitting shoes. Shoes which are either too tight or too big, will rub the feet
and cause ulcers.
2)
3)
Rubber boots are not the right type of shoes.
Shoes which have the straps fixed with nails can cause ulcers on feet that have
no feeling.
The Right Type of Shoes.
It is not enough to wear any type of shoes —they must be the kind ordered by
the health worker or doctor. Shoes are like madicina — to ba effective you must
have the right kind.
If you have had an ulcer on your foot and it has healed, the only way to prevent it
coming back again is by wearing shoes.
These may be one of the following types :
1) Wooden shces with a soft rubber insole,
2) A canvas boot with a soft rubber insole.
3) A simple sandal with a soft rubber insole.
4) Shoes that are made so that they are the exact shape of the foot.
Care of Shoes.
Your shoes will serve you batter if you look after them.
Clean your shoes — remove mud with a stick. Wipe mud off the leather with a
slightly damp cloth. Do not dry near the fire. Put polish on the leather straps and
this will keep them soft.
Repairs.
Try and get a broken strap repaired immediately.
If a strap rubs the foot, do not neglect it: get the shoemaker to adjust it.
All repairs should be done by the shoemaker who comes to your clinic or by the
one in the workshop. He will not use nails in your shoes.
Remember—Shoes ordered by the doctor are to be worn, not left at home!
10
HAND CARE.
THINK ’...LOOK ’...TAKE CARE !
Under the eyes of medical workers, patients are slowly losing their hands. Why is
this? Neither the patients nor the staff take the problem of loss of feeling seriously.
Many patients, seeing l wound on the hand, say that' it is the disease' or 'it came by
itself'. They do not know that all wounds have a cause and that it is not the disease
but carelessness which causes loss of fingers.
3 Important Rules.
Think before acting — 'Is this hot or dangerous for my hand?'
Look while working near hot things. The eye is the mother, who watches the child,
the hand.
Take care. Use a cloth, a glove or a padded handle.
5 Ways in which the hands are spoiled in leprosy.
Burns or Wounds.
1.
What are the common causes of injury in your clinic? (Do a survey to find out.
See page 19 for a sample survey form).
By using the hands after they have been burned or wounded.
2.
Pain in a normal hand acts as a splint. You do not use a painful hand, you rest
it. A wound on an insensitive hand must be rested; either by tying it to the next
finger or by a plaster of Paris splint. No heavy work until the wound is healed.
Hands which have no feeling are used too strongly.
3.
A man whose hands feel knows how hard to hold his hoe so that it does not slip
out of his hand. A patient with loss of feeling and a claw hand holds the hoe
very tightly. This damages the tips of the fingers and after some time the fingers
become short.
4.
The leprosy germs may invade the hand.
The leprosy germ causes infection. There is swelling of the fingers. Joints may
become thickened. Pain in the hand means Danger. No heavy work,and the hands
must be looked after very carefully.
5.
Hands become deformed because they are not used.
The fingers and the joints become stiff and contracted. Some people give up work
when their hands become weak. They think they will not be able to work again,
and that their hands are only useful for begging. Simple exercises done at home
every day can prevent contractures of the fingers.
12
EYE CARE.
The Eyes and the Eyelids of a leprosy patient are often affected by leprosy. Some
times the germ settles in the eye and causes:
1.
2.
3.
4.
5.
6.
Burning.
Redness.
Watering of the eyes.
Pain, in or around the eyes.
Some loss of vision.
Photophobia—inability to look at sunlight.
If any of these things happen to your eyes, report them to the health worker or
doctor immediately, as this may be the beginning of blindness.
The Eyelids.
Sometimes the eyelids are affected in leprosy. Some patients do not able to close
their eyes or cover the eyeballs completely with the eyelids. The white of the eye
can be seen
The Eyeball.
It is in danger if it cannot feel. Some patients do not feel if a small piece of dust
touches the eyeball, so tney do not blink, and the dust stays attached to the eye
and may cause a wound. This happens more easily if the patient cannot blink. He
cannot reach the piece of dust with his eyelids and the dust is not washed away by
the tears. This can cause an ulcer which may blind the eye.
Blinking.
Normally a person blinks regularly with his eyelids. He closes his eyelids, without
thinking, many times a day. This movement of the eyelids helps in spreading the
tears over the eyeball and in washing away any dirt which may be attached to the
eyeball. When a small piece of dust touches the eyeball, you will close your eyes
quickly, if it hurts, tears will flow from your eyes and so the dust will be washed
away by the tears.
13
What can you do to protect your eyes?
1. In the early stages of eyelid weakness, daily exercises can help. Close the eyel ids
20 times, three times a day.
2.
If the eyeball has no sensation, inspect your eyes every day. Use a mirror to see
if there are any pieces of dust in the eye; if so remove them with a clean piece
of cotton.
3.
At night, cover the eyes with a clean cloth or the bed sheet. This will prevent
dust from dropping from the roof of the house into the eyes which cannot feel.
4.
If the eyes are dry, wash your hands then put some clean oil into the eye. Eyes
that are dry are in danger.
5.
In bright sunlight, wear an eye shade or a hat with a wide brim.
6.
Wash your eyes carefully every day to keep flies away from your eyes. Flies spread
eye disease.
14
GENERAL HYGIENE.
Dirt brings disease, or sickness. People with dirty habits are more likely to catch
leprosy than those with clean habits. Every disease has a cause. It is not a punishment
sent from God. Dirt can bring disease. Dirt brings insects which carry disease. It is
better to prevent your child from becoming sick, rather than having to take him to
the hospital for treatment.
4 Things which we must keep clean.
OUR BODY.
It is important to wash daily, with soap. In hot weather we must wash the parts of
the body where we sweat. Wash every day. Take special care of hands or feet that
cannot feel. People who wash their bodies do not get diseases like scabies.
OUR CLOTHES.
Dirty clothes are a good place for fleas, lice etc. to live. These cause itching, then
you scratch the skin, and then germs can enter the skin where you have scratched.
If you wash your clothes this will not happen. It is very important to wash ths
clothes of babies and small Children.
OUR HOUSES.
Each day sweep the house. Sweep the dirt from the corners. Everybody can get or
make a brush to do this. Germs like to live where there is dust and dirt. Open the
window, to let in the air. When you have swept the house do not leave the rubbish
outside the door—take it away and bury it in a hole.
OUR COMPOUND.
(Around the house.) Keep the grass cut. Do not throw rubbish from the kitchen into
the compound. Put it in a rubbish pit. This should be as far away from the house as
possible. Rubbish attracts flies—and flies bring disease. The fly sits on the rubbish
then comes and sits on your food. You eat the food and tne next day you have a
15
pain in your stomach and diarrhoea. It is the germs carried by the fly that has
caused this. It is good to have a latrine in your compound, and if you have one be
sure that there is a piece of wood to cover the hole. This will stop the flies from
getting into the latrine.
Remember . . .
Dirt brings disease . . .
the only good fly is a dead one.
. 16
FIRST AID TREATMENT OF WOUNDS.
WASH .. . COVER . . . REST.
Many patients with sensory loss of the hands will come to health education classes '
and listen to your advice. They go home and even the most careful person will at
some time wound his hands. He may be a long way from the health centre, so he
must know how to do first aid treatment at home. Teach that even tne smallest wound
is serious and must not be neglected even when there is no pain. It is the small'
wounds which become big ones, then become infected and this causes the loss of
fingers. Teach patients the importance of inspecting their hands every nightafter work. ■
Common types of wounds are :
BURNS.
Treatment : When the skin is not broken and there is a blister, do not break the '
blister. Rest the burnt finger by applying a splint or by tying it to the next finger.
CUTS.
Treatment : Wash the cut with soap to remove any dirt. Wrap a clean cloth around
the cut; (not a dirty one.) Raise the limb to stop the bleeding. Do not put the hand
into the fire to stop the bleeding. Apply a splint.
BLISTERS.
Treatment : If the blister is-broken, cut away the skin. (Do not cut a blister that is
not broken.) Cover the blister and splint the finger. Do not do any heavy work—
i.e. digging with a hoe, until the wound has healed.
SPLINTERS.
Treatment: In a good-light remove all the splinter, or ask someone to do it for you.
Wash the place very well with soap and water.
CRACKS
Treatment: These are difficult to treat and will not heal in a day, so go on with
treatment for quite a long time. Soak the hands (or feet) every evening for at least
30 minutes. Rub in oil. For some cracks a splint may be necessary. Remember, the oil
will not help unless the skin is first soaked in water.
MAIN THINGS TO REMEMBER :
f.
WASH - the wound'tb remove dirt, (but do not wash burns)
2.
COVER - with a clean cloth.
3.
REST - the wounded finger. Use a splint or tie it to the next finger. Do no heavy
work until'the wound has healed.
17
CARE OF A WALKING PLASTER
Why do you have a walking Plaster on your foot ?
You have an ulcer on your foot, but you do not get an injection to cure it. Instead.
you have a plaster put on your foot and leg. Why? A plaster is the best medicine
because it rests the foot. Rest is the correct medicine for an ulcer of the foot.
Plaster is expensive - so look after it.
Do not put your foot on the ground for 2 days. Do not walk for 2 days until the
plaster is quite dry. Why? If you walk with a wet plaster it will break. Use crutches
until the plaster is dry.
Avoid getting the plaster wet - do not go out in the rain or walk in the wet grass.
When you are discharged home with your leg in plaster ’•
Do not walk more than you have to. Do not walk to market or go long distances
When you can, sit down, do not stand up. A plaster will not work a miracle - you
must help it do its work well.
If the rocker or iron comes loose, do net just leave if. Come back to hospital and get
it fixed at once. If you see a small sore on your, toes or blood on the plaster, go
immediately to the clinic or hospital.
When the plaster is taken off your leg :
You must wear shoes immediately — do not walk one step without them.
Do not walk long distances for 3 weeks after your ulcer has healed. This is very
immportant. The skin where the ulcer has healed will break if you walk a long way.
Wash your feet every night, then inspect them.
It is now your work to keep your feet from getting another ulcer.
18
SAMPLE INJURY SURVEY FORM
Place:
No.
Date:
m/f
Site of Injury.
Type of Injury.
—
—
——
—
Cause
—
—--------------------------
—
—
—
—
_ __
Signature
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