NLT’s Leprosy Hospital and Services Centre at Lalgadh (LLHSC), southeast Nepal, mainly serves the 2.7 million people in the four surrounding districts where leprosy is most endemic. However, many patients come from much farther away, including India.
Examination and diagnostic services (such as sensory testing, laboratory services, etc) for a range of leprosy-related conditions, This picture shows the waiting area at a quiet moment. It is often crammed full of patients, some of whom will have travelled for several days to get there. The record number of patient visits in one day is currently 904. From July 2014 to July 2015 there were over 87,000 visits to the centre, including about 3,500 visits to our satellite clinics.
Out-patient treatment services, including: multi-drug therapy (MDT); prevention of disability (POD); podiatry (foot-care) including specialized footwear and orthotics; physiotherapy; laboratory and Xray services, and now ultrasound scanning services.
Out-patient services also include diagnosis and treatment for a wide range of skin conditions and other primary health care issues, supported by a busy laboratory and pharmacy. Because patient numbers have risen steadily, and the original facility was only designed for the 12000 thousand annual visits from people affected by leprosy that were envisaged, the OPD facility is currently being expanded with help from the American Schools and Hospital Assistance Programme, and several new buildings should be coming into use during 2017. A new pharmacy extension opened in August 2016.
Inpatient services include the treatment of reaction, neuritis and the other serious complications of leprosy. Some of the treatment includes various kinds of surgery for the complex ulcers seen, nerve decompression, etc, and reconstructive surgery to correct deformity, and restore lost function to hands and feet.
In the background, there is the challenging job of recording all the patients and ensuring that their treatment is monitored and managed. In the 20 years or so since records began at Lalgadh, we have collected records for about 35,000 individual people who have been treated for leprosy at Lalgadh. Many of those come back from time to time for follow-up and further help.
To make it easier for people affected by leprosy who live in the rural parts of the area around us, and who need to access the services of Lalgadh, a number of satellite clinics have been established. These operate at strategic locations in our work area and teams of up to five staff regularly visit the clinics to provide specialist services at a local level. In the first year of these clinics, there were nearly 800 visits to them by people needing help and a few years later this number has risen to almost 3,500.
LLHSC also works closely with the Leprosy Control Programme of Nepal to ensure that the combined efforts of LLSC and the Government services can deliver the maximum benefits.
The Centre at Lalgadh records over 35% of all the new leprosy cases identified in Nepal, and is one of the two busiest centres in the world with regard to new cases. The facility has being enlarged to improve some of the services – in particular the Mother and Child Health services, and to give more inpatient space – especially for patients requiring isolation. A new children’s ward has been added to improve the accommodation for children and this should be operational in mid-2017.