Referral or consultation facility to improve the quality of patient management in leprosy

Leprosy Mailing List, December 10th, 2008

Ref.: Referral or consultation facility to improve the quality of patient management in leprosy.
From: Vijayakumaran, P., Chennai, India


Dear Salvatore,

Greetings from Damien Foundation India Trust. I would like to comment on the debate about the use of steroids for management of reactions in leprosy.

All the experts agree that dose of steroid and duration of therapy may be decided on individual patient basis. This is possible in specialised institutions. What about the field situation ? Where:
- management is mainly by non-medical personnel trained in leprosy;
- specialised referral centres are not available.
Even a medical person in general health care system may not be able to assess the needs in many situations. They need a simple straight forward steroid regimen. That is what many agencies including WHO have done.

This argument will never end. Experts in this field need to help those in need. The problem in the current scenario has been well recognised by the statement in the communication: << "there is a threat that field staff with good clinical knowledge of leprosy are tending to extinction; there is in addition an on-going debate regarding the threat of not having dedicated training facilities!" >> (Kawuma J, LML Dec. 8th, 2008). I would also add that it is not possible to clone Naafs and Kar!

Let us try to establish referral facility or consultation facility to improve the quality of patient management in leprosy.


Dr. P. Vijayakumaran
Director (Prog)
Damien Foundation India Trust
Chennai 600031, India