June 2022. Even after treatment of leprosy, people affected by leprosy often require years of wound care, medical rehabilitation and treatment of reactions. People affected by leprosy in Indonesia experience barriers to adequate access to health services according to their medical and rehabilitation needs, both in terms of leprosy and other health issues. This situation has worsened in recent years after the transformation of the former referral hospitals for leprosy into general hospitals, the regulations of the UHC system in Indonesia, called BPJS, that do not see and do not recognize the need for special accommodation to enable access to rehabilitation and care for persons affected by leprosy after RFT, and the worldwide practice to declare leprosy eliminated as a public health problem, resulting in a lack of funds and capacities.
The Training in Reconstructive Hand Surgery and Physiotherapy for Leprosy, conducted 20-24 June 2022 in Makassar, therefore aimed to alleviate one aspect of this complex problem, namely the lack / absence of skilled surgeons and physiotherapists in this field.
As a precursor to the training, we ran 3 online training sessions in April, June and November 2021 together with the Dutch organization PUM, Tadjuddin Chaled Hospital (RSTC) in Makassar as host and with Dr Wim Theuvenet and Dr Ton Schreuders as trainers. The number of participants in each training reached 150 people.
Objective 1: Surgeons are able to independently carry out reconstructive procedures for the hands of persons affected by leprosy who have function loss. Result: 2 orthopaedic surgeons from RSTCwere trained.
Objective 2: Physiotherapists are able to work with persons affected by leprosy after reconstructive hand surgery. Result: 2 physiotherapists from Lanto Dg Pasewang hospital in Jeneponto district, 1 from La Patarai hospital in Barru district, and 5-8 physiotherapists from RSTC attended the training.
Objective 3: In view of the limited coverage by the national health care system (BPJS), a system is being set up that will enable reconstructive surgery for persons affected by leprosy. Result: 4 monitoring assistants were appointed and trained to support the patients after surgery at their homes: 3 persons affected by leprosy from PerMaTa and one leprosy health centre worker. To ensure appropriate post-surgery care we are collaborating with the hospitals to cover services not paid by the national health insurance as a temporary solution.
It turned out to be difficult to find enough patients, not because there are no persons affected by leprosy with hand function loss, but because there are no data. We asked the leprosy control programs in all South Sulawesi districts to cooperate in finding suitable candidates, but only one person was identified in this way (and successfully operated on), as the leprosy program today has no data on persons affected by leprosy after RFT and usually no contact with these people anymore. It was therefore the district members of PerMaTa South Sulawesi who went out to find more candidates. Here again, difficulties arose: people had chronic reactions and/or were dependent on prednisone, they had fixed contractures, their families did not give permission to surgery, they couldn’t afford to not work for 3 months, or they had moved away. In earlier times with better leprosy services, these problems would occur much less frequently.
From Monday 20th to Friday 24th, two tracks ran partly parallel, partly together: surgery training by Dr Wim and physiotherapy training by Dr Ton. Theoretical sessions were partly done together with all participants, until Dr Wim then left with the surgeons for the operating room. Consultations for the next day were held in the late afternoon.
Surgeons, physiotherapists and also nurses were able to gain experience on a number of different measures, apart from tendon transfers. It turned out that there is a great demand and need to know how certain problems in leprosy can and should be tackled.
During the week other persons affected by leprosy came, who wanted to use the opportunity to consult their health issues with Dr Wim and Dr Ton. Even after the training, we continue to get inquiries from people who are now coming out and asking if they too can have surgery. Something was set in motion. The leprosy ward, which has been empty for years, filled up. The PT department, which for leprosy patients is separated from the general population, came to life. The old staff of the former leprosy hospital – physiotherapists, nurses, admin staff – were enthusiastic and cared for the new patients with dedication.
For PerMaTa South Sulawesi – YDTI, it is now up to us to continue to establish contacts step by step with hospitals in all districts as well as with the health and social services, which must be made responsible for taking on costs that the state insurance company does not bear. We hope to continue to find and refer people affected by leprosy with nerve damage or other health and rehabilitation issues to RSTC or district hospitals and work with the hospitals to find sustainable cost recovery solutions.
- Dr Wim Theuvenet is specialized in plastic, reconstructive and hand surgery among others in the field of leprosy. He has conducted training in Indonesia for NLR in the past on several occasions. Dr Ton Schreuders is a physio and hand therapist specialised among others in leprosy.
- PUM (Programma Uitzending Managers) is a Dutch organisation that helps to send senior experts to countries where they can teach younger generations.
- TLM Netherlands supported us in patient identification, patient care and the organisation of their holistic treatment which includes monitoring and quality therapy
- Tadjuddin Chaled Hospital (RSTC) is a general hospital in Makassar that used to be one of the three state referral hospitals for leprosy in Indonesia. Nowadays there are no state hospitals with the specialisation leprosy anymore. RSTC still has a special ward for persons affected by leprosy however very little staff capacity for leprosy and is very limited in their possibilities to treat persons affected by leprosy because of the new regulations of the state health insurance (BPJS). RSTC is the host of this training.