Towards Zero Disability

Our target for 2035:

Reduced disability burden in people affected by leprosy
Transformation of physical, mental, emotional and spiritual wellbeing of people affected by leprosy

We delivered over a million disability interventions in 2022

In 2022, TLM projects reported over 1.2million disability interventions (both leprosy and non-leprosy). We delivered these services through TLM hospitals and partner hospitals; but where these do not exist, we supported their delivery through government and private medical facilities.

Thanks to your support, hundreds of thousands of people were given healing and reasons for hope last year

Supporting self-care

We are celebrating increasing numbers of people with leprosy-related impairments who were trained in self-care and encouraged to practice self-care at home or in groups.

Self-care training is usually done in groups, but mainly practiced individually at home with support of family members.

Patients may receive basic self-care equipment, protective footwear and assistive devices to prevent further impairments and promote greater mobility and independence.

Self–care is sometimes the only means to manage existing impairments and prevent further impairments, especially in remote areas, where access to care for primary and secondary impairments is challenging or almost absent.

Community Health Workers and TLM staff periodically visit the groups and communities to,

encourage people to finish taking MDT (the antibiotics that cure leprosy);
refer people who have severe ulcers, neuritis and reaction to districts hospitals for treatment; and
identify individuals who would benefit from reconstructive surgery, prosthetics and orthotics

The next step in the evolution of self-care groups would be for members of the groups to monitor themselves; to encourage each other to complete MDT, to highlight when someone’s condition has changed for the worse, arrange for them to see a healthcare professional, and to support the inner wellbeing of their peers.

A great example of this is the job TLM Bangladesh has done in developing remote consultations conducted over video calls.

Such was the success of this innovation that they were the winners of the American Leprosy Missions’ NTD Innovation Prize at the NNN Conference last year.

The initiative was carried out by ALO, Bangladesh’s national organisation of people affected by leprosy that oversees 100 federations of 1500 self-help groups developed by TLM over approximately 15 years. After dedicated training and mentoring, hundreds of these groups are now operating almost by themselves under the ALO umbrella.

This project works with ALO Members' Community Resource Persons (CRPs) visiting the homes of persons affected by leprosy to check for complications. If they find any, they arrange a video call with a TLM medical professional.

Then, the doctor examines the complication, often in the presence of the CRP and family members and makes suggestions for self-care and recovery.

The outcomes of our increased focus on leprosy and mental health

©Ricardo Franco

The link between leprosy and mental health

The link between being diagnosed with leprosy and poor mental health outcomes is undeniable.

This is for a number of reasons. One reason is that patients face setbacks in their physical health, meaning they have to learn to live with life-long, life-altering disabilities, whilst also spending extended periods of time hospital.

Beyond this, far too many people still face overwhelming stigma and discrimination in their communities because of leprosy. As people face discrimination within homes, schools, workplaces, and places of community life, this has an inevitable impact on mental health.

As we have heard from persons affected by leprosy in recent years about the impact that being diagnosed with leprosy had on their mental health, we have expanded our programmatic work to meet that need.

In 2022, the second batch of TLM staff completed their post-graduate diploma in mental health through the distance education unit of Christian Medical College (CMC) Vellore, India.

We have committed to consciously integrating mental wellbeing into our services in many countries through the training of staff, community workers and persons affected by leprosy.

©Ruth Towell

In addition, we are supporting the training of health care workers to develop this capacity in the health care systems.

The Leprosy Mission Nigeria supports a number of initiatives for mainstreaming mental health awareness and service provision. The picture on the left is from a workshop that The Leprosy Mission Nigeria organised on Mental Health for persons with disabilities.

I have come so that they may have life and have it to the full”

John 10:10

Delivering innovation to improve disability outcomes

Several of The Leprosy Mission’s excellent research teams are looking at opportunities to improve disability outcomes through research.
This includes Dr Indra Napit’s LPRF method for healing ulcers, a method in Nigeria that is exploring the use of honey to heal ulcers in very low-resource settings, and an innovative offloading device that is being developed in India.

Removable offloading devices: a simple, elegant solution

Ulcers on the sole of the foot are a serious complication of leprosy. This happens because touch and pain sensations are lost due to nerve damage. The prevalence of ulcer ranges from 20 percent to as high as 50 percent of people requiring frequent hospital visits and admissions.

One out of every two admissions and over 50 percent of bed days in leprosy hospitals are utilised for ulcer care, draining the existing resources.

The chronic nature of the ulcers forces patients to make a trade-off between work and treatment. The affected individuals often continue to walk and work as they do not feel pain or discomfort and report to the hospital for treatment very late,

when the situation has become quite dire. Ulcer care is almost always institution-based and provided by leprosy centres, which are often located far from patients’ home addresses.

Total contact plaster has been accepted as the gold-standard strategy for healing of ulcers. This reduces the pressure on the ulcer (referred to as ‘off-loading’), which allows the wound to heal.

The challenge with this method is that a clinician needs a high level of skill to apply total contact cast and improper applications can lead to serious complications.

Once the cast has been applied, it cannot be removed, which causes complications for patients once they return home, especially when they live in homes that don’t have clean running water and their local environments are dusty or humid and there are lots of insects that can get inside the cast.

It is not uncommon for patients to return to the leprosy centres and demand that the cast is removed before treatment is finished because they cannot stand having it on.

In this trial by our research team in India, the researchers will compare the existing method to a

removable cast that has an imbedded, excavated insole under the wound area.

This alternative device is easier for health staff to customise and can be used and removed by patients once they return home. If this more flexible, user-friendly, alternative device can be shown to heal ulcers at least as well as the current gold standard, it will be a win for patients globally.