Neelam first came to the attention of staff at Lalgadh when her older sister Poonam was admitted for care to her foot in 2006. Poonam had previously had the serious multibacilliary type of leprosy and her feet had become damaged through anaesthesia. Poonam was just 12 years old then and Neelam would have been about 5. Even at that age Neelam already had anaesthesia on one foot with damage beginning to take effect.
Since then, Neelam has been to Lalgadh about 10 times for further foot problems caused by her anaesthesia. At home she still has to do housework and is not able to rest her feet enough so that they begin to break down regularly. This leads to new ulcers which then become infected but still cause no pain, and tissue is further eroded. Now 11 years old, Neelam has serious damage to both feet despite the best efforts of the health staff involved, and it seems unlikely that she will be able to avoid amputation in a few years time which is a tragedy for such a young woman.
Neelam has very recently been admitted again with badly infected ulcers, and Lalgadh staff were crying over her and asking why she had not come in sooner – 3 weeks earlier could have made so much difference! She had not done anything because it didn’t hurt and was not bothering her. However, the infection had then spread to the rest of her body and Neelam was very ill and thin when she was brought in, and had to be put on intravenous antibiotics and fluids to deal with the infection. She has also had surgery to clean out all the infection from her ulcers, but her feet are now damaged further and will be even harder to keep clear of ulcers.
The futures of Poonam and Neelam are going to be very challenging. Although their family has not ostracised them, they still have to have to do their share of the housework, which is very hard for their damaged feet. They have been supported in some study but it is very hard for them to focus on that with their other problems looming so insistently. There are no easy answers.
The situation faced by these girls is a common one for people who are affected by leprosy. They may be officially “cured”, but often have permanent nerve impairment which can cause anaesthesia in hands or feet or even faces, and this in turn makes them very vulnerable to damage. “Painless” mechanical stress leads to ulceration and infection, and only very good self care strategies can combat this. If a patient is not careful (which is very difficult anyway in Nepali living conditions), and if the home situation is not sympathetic, ulcers and further damage will inevitably occur. For people who have to earn a living with manual labour (the majority of Nepalis) the risks of further damage are high. Several thousand of our patients have permanent nerve damage and all the consequent risks of ongoing ulceration.
Please pray for Neelam – and her sister Poonam who is now aged 19.