Richard de Soldenhoff is the Netherlands Leprosy Relief's Regional Medical Officer for Eastern Indonesia. Always a "field man", he completes 27 years in leprosy control when he retires at the end of this year.

Pasangkayu - 1 degree South

There has been a proliferation of newly created provinces in Indonesia and the head of the National Programme was making her first visit to West Sulawesi. We parted yesterday afternoon, she to drive the eight-nine hours back south to Makassar, where she will close one of the regular, one-week, courses for doctors at the National Leprosy Training Centre and me, with the field team, to continue the eight hours north. We met the District TB & Leprosy Supervisor, Irjan, at the border of Mamuju and Mamuju Utara (or Matra - Indonesia is full of acronyms) on his GFATM supplied Honda Karysma (the local 125cc all-purpose motorcycle, which I also have, but for town use only). We started the morning with visits to two of his health centres. The new province now has a budget for training their own health centre staff and both field workers, who are also multipurpose nurses, had recently attended the one- week session, with trainers from the province and also borrowed from the National Training Centre. One had identified three new leprosy patients in the past month and the other had arranged the transfer of a young man from the district headquarters to the health centre, only one kilometre from his home.

It never ceases to surprise me how every patient is so full of interest, has special problems which are always slightly different from anyone else's, and how every patient provides an excellent resource for teaching. At Bambalokka Health Centre there was a frail, 60 year old lady with an extensive, ulcerating, type 1 reaction, responding well to steroids and simple dressings; the second was a 20 year old woman with now quiescent macules, the largest slapped right on top of her right facial nerve and who wants to get pregnant; the third a football mad schoolboy of 17, now released from treatment and with bilateral, complete, plantar sensory loss.  At Tikke Health Centre, the 21 year old cocoa farmer is on his fifth month of MDT. Careful exercises have resulted in a fully mobile hand, which may be suitable for surgery later, even although the relevant hospital is over 700 km away. However, his juvenile bilateral cataracts are of greater concern and seeing him wobbling off on his ancient bicycle, I think I agree with him.

Getting doctors to work in remote health centres in remote districts is difficult. A six month contract, at over six million rupiah per month (around US$ 650) seems to work, but keeping leprosy trained doctors at the health centres is proving to be nigh impossible. The key leprosy field workers are usually nurses, more likely to be local, and therefore to stay.  How gratifying it is, to see these young field workers doing routine but carefully executed nerve function assessments, diagnosing leprosy reactions, managing complicated treatment regimens and fine-adjusting the dose of prednisone according to the development of the reaction. Inevitably, the downside of this is, of course, that there is a risk of some over-diagnosis of reactions and prescribing of steroids for some patients, despite contraindications.

My counterpart and I and sit on the sea-wall watching the sunset, each with a can of (non-alcoholic!) shandy, discussing tactics. There will be an evening meeting with the provincial and district staff. Tomorrow is Saturday and three health centres are waiting for us before their weekend begins.

Why have I got a bed bug carcass in my hair?

E-mail: rdesoldenhoff@hotmail.com    

Categories: Field Activities