Scott’s Elective – Leprosy Wards

During my stay at Anandaban I have spent some time on the leprosy wards. The hospital has 4 wards specifically for patients affected by leprosy. Two ulcer wards, one male and one female, and two reaction wards, again one male and one female. In total there are up to 80 patients at any one time on these wards. The division of wards into ‘ulcer’ and ‘reaction’ is based on the complications of leprosy.

For those not familiar with Leprosy, it is a bacterial infection which damages structures such as skin, nerves and nasal membranes. If untreated, the nerve damage can lead to patients loosing function and sensation in their limbs, usually starting peripherally in the legs. With reduced sensation, they develop ulcers through repetitive damage or injury to an area of skin. Over time, these can develop into large ulcers with a significant risk of infection. On the ulcer wards, most of the patient’s are otherwise well and independent. Each morning the patient will have their dressings changed by the nursing staff. This seemed to be a sociable group activity, with patients coming down to the dressings room in two’s or three’s. The patients will chat away to each other and with the nurses, and always appeared to compare and discuss their ulcers.

On the reaction wards are patients currently experiencing a Lepra reaction. This is when the body’s immune system causes a reaction against the Leprosy bacteria. Not all patients affected by leprosy will experience these reactions. Furthermore, reactions can occur before, during, or after taking antibiotics to cure the leprosy. This can cause a variety of symptoms including fever, skin lesions and  inflammation of organs (such as the kidneys, testies and eyes). Treatment involves steroid tablets where the dose is reduced slowly over a number of weeks.

While on the wards, I was surprised to see how independent the patients are. Patients will wash and dress themselves; make their bed; collect their meals; and wash their dishes. I found this amazing given how much personal care nurses perform back home. However, this is not due to poor staffing or lack of support. I believe it is in part due to the Nepalese culture and also the general health of the patients. Most of the patients are admitted to these wards  for dressings of ulcers or steroid treatment of reactions. This cannot be done in an outpatient setting as patients travel such a distance to come to the hospital. Therefore to commute daily for such treatment is not possible. The length of stay varies, but can range from around a month to 4-5months, depending on their response to treatment.

This leads to the wards each feeling like a small family. The patients know each other very well and can be seen passing the time knitting, playing games and talking. I have even seen the patients throwing leftover food to the monkeys in the forest behind the wards. The nurses do try their best to stop this behaviour, unsuccessfully. I have to admit that if I was an inpatient for a couple of months I’d probably be doing the same for a bit of entertainment.

Another factor different to home is the ward rounds. Back home, I would often follow a chain of doctors who loop round the ward to see every patient. Here, this works slightly differently. The medical team are based at the nurses station, and all the patients will come to the desk to be seen. The only ‘problem’ is that the patients bring in a couple of long benches, and all sit waiting to be seen. Therefore each patient is seen in front of a small audience of the other patients. This doesn’t seem to bother any of the patients, but I cant imagine it will catch on back home.

It has been a privilege to meet these patients, hear their stories, and see them cared for by the team. A snapshot of these wards might seem like nothing much is happening, but with patience over time you truly see the immeasurable improvement made to patient’s health and lives.

I am just back this evening from the wards from the small church service. This is held every Tuesday evening at 6pm on one of the wards. There is worship, prayer, a short sermon and offering. The small room is always full and it is wonderful to see patients and staff worshiping together.

*All pictures were taken with the patient’s permission*

The medical team ready for the ward round
The male ulcer ward round
The female ulcer ward, some patients passing time folding dressings

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14th May 2019

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Opinions are the authors own and not necessarily those of The Leprosy Mission Scotland.