Stories from the field

A Day in the life of the NLR Team in Vietnam.

By Jan Robijn, NLR Representative in Vietnam

Jan Robijn, the Netherlands Leprosy Relief Representative in Vietnam, has written about a day - every day - in the life of his team, which is a day spent supporting the projects in Vietnam and promoting knowledge about leprosy. The following three installments were written in 2007.

Contact: Jan Robijn nlrvietnam@hn.vnn.vn

PART 1

"Is leprosy still a problem in Vietnam?" is one of the frequently asked questions that they have to answer. "Hasn't this disease been eliminated for years already? Isn't there a cure for the disease nowadays? How can it still be a problem then?" They have to repeat it over and over again: "No! Leprosy has not been eliminated. Leprosy is still a real problem in the daily life of many people and these people need our and your attention."

It has not always been this easy for Hien, Han, Hoa, Lan, Quynh Anh and Hiep to talk about leprosy. Years ago, when they started to work for NLR, they often hesitated to talk about leprosy or about their work for NLR especially with their friends and family, fearing that they would not agree for them to do this work and that they would have asked them to stop. "Leprosy is a dangerous disease." "Aren't you afraid to be infected and then to be a risk to us?" "You should not do this work!"

But nowadays they do not find it difficult to face and answer any question. In their years with NLR they have studied the facts, talked with the medical advisors of NLR during their field visits, and met many patients under treatment and disabled ex-patients. They have learned that the disease is curable and, if treated in time, does not have to cause disabilities. They know that it is no longer necessary for persons affected by leprosy to lead life in isolation and that the stigma that so many ex-patients suffer is not justified, and that with the help of rehabilitation much can be done to improve the quality of life of the people who have become disabled by leprosy.

They now feel that they have a nice job with a good organization and that the work they do is useful and helps to improve the lives of many of their countrywomen and -men.

Compared with other countries Vietnam has a very large number of people who have been disabled by leprosy in the past, among whom many have had one or both legs amputated. Their need for aftercare is huge, especially for prosthetic care, physiotherapy, orthopaedic footwear and eye care. To address this need, NLR has helped to set up a large medical rehabilitation programme in co-operation with existing medical services in Vietnam. As part of this programme, rehabilitation outreach teams travel almost every week to leprosy hospitals, colonies and settlements where they help to provide rehabilitation care. In Part Two of A Day in the Life of NLR Vietnam, we will take you with us on one of these outreach visits. Much of the work of our Hien, Han, Hoa, Lan, Quynh Anh and Hiep is aimed at improving the lives of these people.

It is 8 o'clock in the morning now. I hear them coming up the stairs to the office talking loudly. I just know they are smiling too! That is one thing that has not changed since they started working for NLR. They are a noisy, happy bunch. Each day again eager to start a new working day.

PART 2

Today we are traveling with one of the rehabilitation outreach teams to the Song Ma Leprosarium in the northern mountains near the border with Laos. We sit closely packed in the back of the old jeep of the provincial health service. There are five of us: Thanh, the prosthetic technician, Huong the eye doctor and two physiotherapists Thuy and Dan. We are all from the General Hospital in Hanoi.

Jan Robijn continues his narration, in this part 2, of his series of articles describing the work of his team in Vietnam. 

We drove all day yesterday from Hanoi to this remote province and got up early this morning to drive the last three hours to this centre where more than 100 disabled ex-leprosy patients are living together with their families. Nearly half of them have had an amputation and their prostheses need checking regularly. The rest need to have their deformed feet and orthopedic footwear regularly checked. All of the people in this centre practise self-care, which is really important because it prevents blisters or small wounds on their feet getting infected, which could eventually result in an amputation of the foot.

As the jeep is arriving at the central courtyard of the Leprosarium we see a group of people soaking their feet in wash-bowls. Every morning they come together here to soak and check the skin of their feet for cracks or small wounds. They prefer to do that as a group and not alone at home. We walk over to say hello and see if there is anyone with a new wound. But that is unlikely. Although all of them would have had several wounds in the past, good self-care has made them a rarity nowadays.

Because there are no new wounds, we turn our attention to the main work of this morning: the prostheses, or to be more precise, the people who use prostheses. During our last visit, three months ago, we fitted seven people with a new prosthesis. Thuy and Dan, the two physiotherapists, see them first to make sure that they are walking well and are having no problems with the skin of their stumps. Then we check the other amputees, while Thanh is starting to repair some of the prostheses.

Dr Huong uses most of the morning to see people with eye problems. They need to do self-care too to prevent more serious problems developing to their eyes. Some of the eye problems need specialist care. Some of them will need surgery at the provincial hospital, including a few elderly people with a cataract. Although this eye problem has nothing to do with leprosy and is due to old age, we still make sure that they will be seen by the provincial eye department and that they will get surgery to prevent blindness.

With that, the morning and our visit have come to an end. For lunch we quickly eat a bowl of Vietnamese soup and then say our goodbyes until our next visit in some months' time. What happens in the afternoon we will tell you in Part Three of 'A Day in the Life of NLR Vietnam'.

PART 3

We do not have to drive far in the afternoon and the scenery on the way is breathtaking. Our destination is Pao No, a small village in a valley 30 km from the Song Ma Leprosarium where we were working this morning. It is the home village of three former inhabitants of the Leprosarium, three women. They had returned home many years ago after they had been declared cured of the disease. Even so they had remained under the care and support of the Leprosarium, because of severe deformities to their feet.

The condition of their feet had deteriorated over the years, despite the monthly visits by the health staff of the Leprosarium, and eventually all three of them had had to have amputations. This was done in the hospital in Hanoi where they also received their first prosthesis and gait training.

Their physical situation had improved greatly since the amputation. They had been walking almost normally again and they had expressed their desire to find work to earn their own income after years of receiving a small allowance from the provincial health service and relying on their families. But how to find suitable work in this mountain area where most people earn their income by working the land? Tilling the soil on the steep mountain slopes is not an easy task even with two sound legs, not to mention that it is extremely difficult if you are a prosthetic user!

A solution had been found by Dr Ban, the head of the provincial programme. He had discussed the situation of the three women with one of the local banks. Vietnam has several bank and financial programme systems that provide loans to the poor. One bank had agreed to give the women a loan to start a small orchard. They had bought young fruit trees to grow lychees and planted them on a piece of land outside the village that the village authorities had allowed them to use.

We learnt that they have had good and disappointing seasons, but overall the orchard has provided them well and within three years they had been able to pay back the loan and interest. Their once small orchard has become a sizeable orchard where they now also grow rambutans and longans and employ several of their family members. From being dependents they have become the providers for their families!

When we arrive we see Mrs Ut, So and La with some family members and neighbours resting in the shade of their houses after their morning's work. We visit them twice a year and they are always happy to see us. We quickly check their prostheses and their stumps. All looks well. Only the prostheses need new knee straps. After renewing the straps we talk with them a bit and, of course, taste some fresh lychees. Then we say our goodbyes and start our long drive back to Hanoi.

When we drive out of the village into the mountains, we turn around for one last glance and see the grandchildren of Mrs Ut playing against the background of the valley. The lives of the three women in Pao No have taken a turn for the better.