Leprosy Mailing List – January 24, 2017
Ref.: (LML) Silent neuritis. Nerve damage. Disability and deformity. Prevention and management.
From: Grace Warren, Sidney, Australia
Dear Pieter,
Interested in Cairns Smiths statement (LML, January 13, 2017) to give MFN testers to all workers doing field work for leprosy and even to the patients themselves.
Sounds ideal if they are used correctly BUT the COST of them! In many countries we do not have the funds for essentials and so why spend money on things that are not essential. I certainly believe and have seen evidence that many patients have been diagnosed and adequately followed up using a ball point pen and/ or opened paper clip to test the difference between sharp and blunt which does help a lot in testing for nerve function. In fact I suspect I have never seriously used MFN testers myself. But I know of many situations where we would have loved to have more funds for doing more case finding or for physiotherapy, etc., to reduce deformity and disability, and many other things.
Oh yes a set of MFNs will last a long time, if cared for, but I wonder who can show us that they really make a difference in the proportion of new cases found or the nerve damage picked up early so that permanent problems can be reduced or reversed. I have vivid pictures in my mind of trailing through the mountains of Nepal and mid Asia where the paramedical workers go looking for patients but It is hard to say if more patients would be diagnosed earlier by use of MFN. In these areas we need to stretch our resources as far as we can to find early cases that will prevent them passing on the disease, and to diagnose the progress of nerve damage while there is still the possibility of reversing it. Yes if the funds were available it is probably a good idea but if taught in the main teaching centre as the prime technique it would probably limit the effectiveness of the field treatments.
One of my main aims is reduction of deformity and disability - yes treatment initially may be effective but eventually many may need surgery. The use of MDT can hardly be compared with the use of MFNs - somehow we must find the funds for them and whatever other medication needed, such as Vit B1 that is often in really short supply in the Asian countries, and an essential for good nerve function and healing. How can we encourage more funds to be available to achieve the ideals !!
Best Wishes,
Grace Warren- Previously Superintendent and surgeon at Hong Kong Leprosarium( 1960-1975) and 1975-1990 Traveling Advisor for The Leprosy Mission in Asia,
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << editorlml@gmail.com
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