LEPROSY SURGERY IN SUDAN
24th June 2011: By Dr. Sr. Marlene E. Long

The concept of Surgery for leprosy patients is not well understood by many people, especially in Africa. Amputation of a gangrenous (rotten) lower limb is what is familiar in most settings. Talking of rehabilitative or reconstructive surgery rather than an amputation in persons affected by Leprosy (PALS) is likely to elicit mixed reaction.
Rehabilitative surgery was started over 50 years ago in India by a pioneer missionary surgeon, Dr. Paul Brand.Dr. Paul developed techniques for correcting crippling and stigmatizing claw hands. Over the years new techniques have been developed in this area of surgery to correct deformities in PALS.
Even though a leprosy patient can be cured off the pathogen causing the disease with drugs, more often than not they end up with crippling deformities due to various reasons. These could be due to seeking treatment when the disease has already advanced, inadequate care by patients or not being able to handle reactions effectively .The deformities may lead to physical and psychological problems that greatly contribute towards the stigmatization of PALS.
Leprosy Surgery can be classified as preventive, rehabilitative/reconstructive or septic. An example of a preventive surgical procedure is tarsorraphy.This is where surgery of the eyelids is performed to allow the person to close their eyes so as to avoid eye infections which may eventually lead to blindness. Rehabilitative /reconstructive surgical procedures constitute a large proportion of leprosy surgery. These procedures aim at restoring the function of paralyzed limbs e.g. ‘claw hands’ or ‘drop foot’ deformed toes e.t.c.  While Septic surgery is a common type of surgical procedure that deals with chronic ulcers and other infected wounds.
Lack of awareness in health workers (doctors & surgeons included) and patients has led to a relatively small number of patients in Southern Sudan benefitting from these surgeries; this is despite the ability to perform such procedures i.e. septic surgery in low resource settings.
In 2006, AAA in collaboration with AMREF started an intense short course training on surgical correction of deformities and prevention of deformities (POD).Village volunteers, clinical officers, doctors and nurses were trained in several locations in Southern Sudan with an aim that they would carry out these procedures learnt once they return to their respective stations. Follow-up visits by the Consultant have led to the conclusion that more should be done to improve the care of the beneficiaries.
To date approximately 1,220 Leprosy patients have been examined in 14 locations running Leprosy control program. Many PALS have benefitted from rehabilitative and cataract surgeries since the beginning of this program .20 Community Health Workers,10 Clinical Officers /Medical Officers , 10 Nurses have been trained in septic surgery .Others trained include 10 Theatre Assistants, 10 Leprosy Assistants, and 1 Physiotherapy Aide
But more needs to be done as rehabilitative/reconstructive surgery is still urgently needed in about 30-40% of the PALS. For a successful outcome, trained physiotherapists are required otherwise surgery may not be of much benefit to the PALS. More health workers need to be trained on how to perform these surgical procedures so as to tackle the ever increasing number of PALS who develop deformities leading to disabilities. With proper Rehabilitation, PALS could contribute to the restructuring of not only their own lives but that of the New South Sudan as well.