One of the remaining challenges for leprosy control activities at country level is to build capacity by maintaining expertise among general health care workers, particularly in countries where endemicity of leprosy is low. In this article some representatives of ILEP Members explain the utility of ILEP publications as an additional resource or source of reference for their training sessions.

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Jannine Ebenso is a Chartered Physiotherapist, working for The Leprosy Mission International in Nigeria. She describes below how she is making use of ILEP publications as training resources.

In Nigeria we make good use of the materials in various settings:

• Formal training sessions at the National Tuberculosis/Leprosy Training Centre in Zaria.
• Semi-formal training sessions in the leprosy control programmes in the 37 states in Nigeria
• Informal ‘on-the-job’ training sessions during supervisory visits.

NLR Nigeria has been able to identify a printer who can produce the materials locally and all ILEP Members in Nigeria order from the same source. The books are printed relatively cheaply and so we can afford to let trainees have their own copies to take home as a reference material back in their own clinics and hospitals.

During training sessions for general health care workers we make sure that we have copies of the Learning Guides One and Two available. The lesson plans that we use make use of the Learning Guides.

Future lesson plans for other staff or other trainings may include Learning Guide Four: How To Prevent Disability in Leprosy.

Personally I have no experience of using Learning Guide Three: How To Do A Skin Smear. I do, though, print off copies from the ILEP website so I can give them to laboratory staff when I am visiting projects.

With the electronic versions available on the ILEP website, we are able to download onto our PCs and so always have a source of good photographs and clear graphics available for training.

As French is a new language for me, I particularly appreciate the translations of the learning materials.  They provide memory aids to me for the vocabulary when I am stuck for the words to use, and they also make it easier for the people for whom French is a more familiar language than English – I am able to give them a learning material they can better understand.

The simple language, clear and logical format and the great photos make the learning guides easy to use.

Jannine Ebenso
E-mail: janninee@tlmnigeria.org

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Ellie and Henk Plomp, also based in Nigeria, are employed by Netherlands Leprosy Relief (NLR). Here they explain briefly how they have been using the ILEP Learning Guides to facilitate training sessions.

ILEP Learning Guide One: How To Diagnose and Treat Leprosy
In the area of Nigeria supported by NLR the ILEP Learning Guide One is widely used. In 2007 we printed 11,000 copies and sent 2,000 to the German Leprosy Relief Association, 2,000 to The Leprosy Mission International and 1,000 to Damien Foundation Belgium.

During the training about multi-drug therapy (MDT) the book is given to all participating general health care workers – around 800 trainees annually. Furthermore all staff of the National Tuberculosis and Leprosy Control Programme and all MDT clinics have received a copy. The National Tuberculosis and Leprosy Training Center Zaria also received copies, which are given to all students who attend their courses.

NLR has provided Zaria with a number of copies to be distributed to universities, schools of nursing and schools of health technology throughout Nigeria.

ILEP Learning Guide Two: How to Diagnose and Recognise Reactions in Leprosy
We printed about 5,000 copies in 2007. About half of them were for our sister organisations (as above), the other half will be used in the Netherlands Leprosy Relief supported area.

Up to now we have used the book whilst training general health care workers as reference material. Due to the limited number of copies available, we could not give copies to the students to take away. However, in 2008 we plan to give the book to all tuberculosis and leprosy staff, to general health care workers who are working in MDT clinics, to the National Tuberculosis and Leprosy Control Center Zaria and, of course, through Zaria to the same training institutes as mentioned under Learning Guide One.

ILEP Learning Guide Three: How To Do A Skin Smear
The skin smear is hardly used in the Nigerian Tuberculosis and Leprosy Control Programme. At the moment we have no plans to print and distribute this Guide. However, we will ask the medical advisers of the four ILEP Members active in Nigeria to discuss this issue and to advise their Representatives appropriately.

ILEP Learning Guide Four: How To Prevent Disability in Leprosy
A sum has been reserved in the 2008 budget for the printing of this guide. We will contact our colleagues to hear whether they want to join in the printing. We plan to give this book to all tuberculosis and leprosy staff and again to the other training institutes.

In general we can say that we are very happy with the guides. The pictures are clear, the text is easy to understand. We feel that they are of great importance for the integration of leprosy services into the general health system.

Ellie and Henk Plomp
E-mail: ehplomp@yahoo.co.uk

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An Example of a Comprehensive Teaching and Learning Session

German Leprosy and Tuberculosis Relief’s Focal Person for Training, Dr Krishnan, shares a lesson plan:

Target Group: General health care workers.

Lesson: Diagnosis of leprosy.

General Objectives: At the end of the session all participants should be able to diagnose leprosy by using the clinical sign(s) and laboratory sign.

Specific Objectives:

At the end of the session all participants should be able to:
A] elicit loss of sensation on an anaesthetic patch by using cotton wool;
B] be able to identify an enlarged peripheral nerve; and
C] be able to identify Mycobacterium leprae under microscope.

Example of a Lesson Plan:

Learning objectives:	Content: cardinal signs of leprosy:	Teacher’s tasks and teaching methodology:	Time:	Student’s task to observe & ask questions:	Tools/learning materials:
Able to elicit loss of sensation on an anaesthetic patch	Loss of sensation	Demonstration of loss of sensation on an anaesthetic patch	10 minutes	To observe the procedure of testing  sensation, and practice	Cotton wool
Identify an enlarged peripheral nerve	Enlarged nerve	Demonstrate normal size of the nerve, an abnormal [enlarged] peripheral nerve	10 minutes	Palpate normal and enlarged nerves	Patient with normal and enlarged nerves
Identify M. leprae under microscope	Presence of M. leprae in a slit skin smear	Demonstrate M. leprae under microscope	10 minutes	Identify M. leprae under microscope	Microscopes with positive slit skin smear

Expected Learning Outcome:
§         Able to accurately elicit both the clinical and laboratory signs of leprosy.
§         Able to interpret the lab result with the clinical findings.

 
Practical Skills:
Practical skills to demonstrate loss of sensation identify an enlarged peripheral nerve, positive slit skin smear under microscope.

Decision-Making Skill:
Skills to make decisions to make diagnosis based on clinical/laboratory findings.

Learning Methods:
Clinical learning method, and by using laboratory methods.
(Learning objectives need to be matched with the learning methods).

Learning Materials:
Handouts, simulation, patients with normal, abnormal skin, nerves, positive slit skin smear, and microscope.

Settings:
Clinical setting in an outpatient department or in a ward, or in a room, laboratory.

Time for the Practical Session:
Depending up on the number of facilitators/trainees in the class: could vary from 30 minutes to 45 minutes.

Teachers’ Tasks:
To observe the overall understanding of the class, and the individual strength, weakness of the students and help the students to improve their skills.

Assessment Methods:
Objective structured clinical examination.

Model questions:
1] Demonstrate the procedure of testing sensation on the patch. or test for sensation using cotton wool on the patch on the right fore arm & write your clinical finding.
2] Palpate both radial cutaneous nerves and write your findings on palpation. 
3] Test sensation on the patch on the right arm & read the smear under the
microscope.

Write your final diagnosis of Mr John using both clinical and laboratory findings.

Evaluation of the Session:
1] What went well in the session?
2] What did not go well in the session?

Dr Krishnan
E-mail: drsark@hotmail.com  

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ILEP has published a Guide for those who need to develop an effective framework for training in an integrated setting. Click here to download Technical Guide: Training in Leprosy. 

Categories: News and Notes, Technical information