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KMID : 0386319680050010009
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Korean Leprosy Bulletin
1968 Volume.5 No. 1 p.9 ~ p.11
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The Role of Institutional Care In Leprosy Today
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TOPPLE,S.C
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Abstract
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A. The Transition from Isolation Care for Leprosy.
Historically, not only in Korea but throughout most parts of the world, the approach to the leprosy problem has been to isolate its victims from society. This isolation has been basically one of social attitude
but has manifest itself most graphically in aggregates referred to as "leper camps", leprosy villages and leprosaria. As recently as 1960, Dr. Joon Lew reported 27,689 out of the 27,989 registered cases of leprosy as living in leprosaria or leprosy villages in Korea.
In a medically enlightened age this philosophy of mass isolation has been seen to be undefendable. Accordingly, the world-wide emphasis on leprosy during the past 15 years has been on Outpatient
clinics; case finding studies and home care. The earlier accepted norm of isolation has now become air anathema in medical circles. World Health Organization, government and mission agency funds in recent years have been increasingly directed´ toward non-institutional care and survey studies in leprosy.
This new emphasis has been both laudatory and inevitable. There, can be found no serious worker in the field of leprosy who does not see the necessity and wisdom of this shift in emphasis. Nevertheless the eexdusion of institutional care for the sake of him care and treatment creates a fresh set of problems which must be recognized and dealt with by responsible parties.
$: The Probleiu Facing Non-crippled Inpatients.
First let us consider plight of the institutionalized patient. For the younger patient who is capable of work and without need of institutional care he has lost his security. This patient no longer has a defensible position as an in-patient. Instead, he must face an hostile society where jobs, land, housing and charity are scarce. Having been away from home for many years he is at loss to make his way´ back into an unwanting home and village even though his disease is cured. The leprosy community means a roof over his head, a bowl of barley-rice on his table, and a circle of like friends. Life in society means rejection and not infrequently homeless wandering.
C. The Problem Facing Crippled Institutional Patients.
Now let us consider the old or more crippled patient in the colony. He is not likely to be pushed out the door but nevertheless faces problems of security. Funds previously provided to repair the leaking roof over his head or keep the food on his table are now very apt to be diverted to more exciting or "pertinent" uses. Granted, what it costs to support one man like this might suffice for medical care of ten leprosy patients being treated in their own homes but that doesn´t make our crippled victim less hungry at mealtime.
This problem can be solved by a simple increase in available funds but more complex is the problem of helpers for these who are impossibly cippled.´ Who is to cook his food, wash his clothes yes, even dress him; help him with his toilet and put food if this rnonth. These are vital problems to mark whos blind or with amputated stumps for hands and eet.
The Wilson Leprosy Center has 280 or 40% of its colony patients whe require some degree of physical help. It would be safe to estimate the number of such crippled cases as being 6000 to 8000 throughout the country.
In decades past it has been the tradition for new admissions to leprosaria to be assigned the unsavory role of caring for the crippled during their first 6 months to 2 years of residence. After this time if they had survived the system they would have worked their way to a more independent status and been replaced by more recent admissions. Usually this individual would go on to find a spouse and sink his roots deep into the leprosy community. With new cases of leprosy now being treated at home however, there is a vacuum of available assistants for the older, crippled folk. To hire adequate help for these debilitated ones would double the budget of the average institution.
D. The Outpatient´s Problem.
Second, let us consider a system of 100% outpatient care from the outpatient´s point of view. Where as previously this man would at least theoretically have his living and medical needs completely met in the shelter of institutional life he must now make
his way on his own. He must with monthly or even less frequent visits to an outpatient clinic take his drugs as prescribed, hide out from his neighbors during florid phases of his disease and devise a
system of extended quarantine. He is fortunate indeed if he is able to learn self-care of anesthetic paralysed hands and feet.
E. The System of Short Term Admission.
The complete answer then would seem to lie neither in the old system of long term colonization or in the other extreme of out-patient-only care. We have discovered this truth the hard, experiential way. The best solution lies in a system of temporary, short term admissions to a leprosy center. For the past 9 months the Wilson Leprosy Center has engaged in this type of program. Whereas the program is not new or unique to the pattern of leprosy work worldwide, it is not to be found as yet in Korea and would seem to be worthy of wider consideration and implementation.
Examining this system of temporary admission it is seen as follows. First, the prospective case must be recommended for admission by a leprosy outpatient clinic. This is usually our own mobile clinic but may be from a clinic in another part of the country. There must be a clear medical or social problem that will have its solution met during admission. This problem may be control of difficult
lepra reaction, florid nodules preventing acceptance in the patient´s community, the need of an artificial
leg, the need of hand surgery, a foot ulcer, etc. The patient and his guardian at time of admission
signs a contract. This contract states the financial terms and duration of his admission. He may pay a minimum of 100 won to a maximum of 2000 won per month. Admission terms are usually a maximum of
6 months but infectious school-age children are
admitted for several years to attend our colony school until they become negative. This is with the
firm written pledge of the patient´s family to accept him back when his admission term is ended.
During the patient´s admission he is exposed to as complete a course of care as possible. He is introduced
to each department of the hospital where a chart form is initiated for him. If physically able, he is
assigned the task of caring for fellow patients who are crippled.
The patient becomes related to the following departments of the institution: physical therapy, medicine, eye, surgery, the chaplain´s office, laboratory and photography. He is brought into regular classes for self-care of anesthetic or paralysed limbs. He is given necessary physical therapy daily. Required surgery is planned and carried out. Ulcers are treated with dressings, plasters or skin grafts if needed. The patient is counselled regarding his social problem. He is brought into the program of the community church. Drug dosage is regulated. Visual acuity and slit lamp examination is done for signs of early eye damage. Hospital ward admission, ulcer ward admission or domicilary status is assigned
as the situation dictates. In short we ,would attempt to carry out a program of total patient care.
The advantages to this system are obvious. The mobile clinic and survey workers are left unhampered
in their primary task of public education, leprosy case finding and treatment of uncomplicated cases. The old and crippled patients with disease long since inactive are brought some continuing measure of custodial care. The active cases are brought temporarily under an umbrella of specialized and intensive medical-social care during critical stages of their ddisease.
In addition to the above, the role of a leprosy institution of today would be incomplete if the importance of clinical research, vocational and occupational training and the training of leprosy paramedical workers was not mentioned. These subjects however are set aside for discussion elsewhere.
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