1. Topics for Today Who am I What is Epidemiology? Research & Politics What is Leprosy? Leprosy Research Impact of Leprosy Surgery Who am I What is Epidemiology? Research & Politics What is Leprosy? Leprosy Research Impact of Leprosy Surgery

3. Johan Velema Nutrition & Statistics / Anthropology Bible & Mission Epidemiological Methods Heart Disease Cancer Research Mother & Child Health Tropical Diseases Leprosy, Disability, CBR Theology Nutrition & Statistics / Anthropology Bible & Mission Epidemiological Methods Heart Disease Cancer Research Mother & Child Health Tropical Diseases Leprosy, Disability, CBR Theology

4. God is International! (education & health care)

5. Epidemiology is medicine at the population level What is Epidemiology?

8. The Politics of Health Research How to set the priorities? Does an American die of it?

9. The Politics of Pharma Research Who will buy the product?

12. LAMB Project Bangladesh Disaster Risk Reduction Impact of Safe Delivery Care Is this Epidemiology? (From Home to Hospital, 2011) Disaster Risk Reduction Impact of Safe Delivery Care Is this Epidemiology? (From Home to Hospital, 2011)

13. Father Damien

14. Leprosy: The Disease Mycobacterium Leprae Transmission: droplets ? Incubation: 3-25 years Virulence: 5% Affects skin and nerves Mycobacterium Leprae Transmission: droplets ? Incubation: 3-25 years Virulence: 5% Affects skin and nerves

15. Disabilities peripheral sensory loss damage (heat / sharp / pressure / friction) -> ulcer, inflammation, bone resorption paralysis enhances these processes peripheral sensory loss damage (heat / sharp / pressure / friction) -> ulcer, inflammation, bone resorption paralysis enhances these processes

16. Prevention of Disabilities Early detection! Teach patient how to prevent damage Footwear Self Care Treat reactions / neuritis promptly Early detection! Teach patient how to prevent damage Footwear Self Care Treat reactions / neuritis promptly

18. Historical Overview 1874: Hansen discovers M Leprae 1874: Exclusion, no Treatment 1948: Lifelong Dapsone 1982: Multi Drug Therapy (MDT) 1991: Elimination Goal 2001: Integration into General Services 1874: Hansen discovers M Leprae 1874: Exclusion, no Treatment 1948: Lifelong Dapsone 1982: Multi Drug Therapy (MDT) 1991: Elimination Goal 2001: Integration into General Services

19. New case detection 1985-2012

20. Stanley Brown

21. Paul Brand

22. Research in Leprosy Occurrence / Control Transmission Chemoprophylaxis Diagnostic Tests Vaccine Impact of Interventions Occurrence / Control Transmission Chemoprophylaxis Diagnostic Tests Vaccine Impact of Interventions

23. 16-05-2007 Postoperative outcomes one year after tendon transfer surgery for ulnar nerve paralysis in leprosy patients Tendon transfer surgery Introduction (2)

24. 16-05-2007 Postoperative outcomes one year after tendon transfer surgery for ulnar nerve paralysis in leprosy patients Postoperative Outcomes Methods (2) Impairment correctionFunction

25. SALSA 5 Continents 5 Years 3 Meetings 20 Questions Universal score 5 Continents 5 Years 3 Meetings 20 Questions Universal score

26. SALSA scale Screening of Activity Limitation & Safety Awareness Tick one box on each line in response to each question. If Yes, how easy is it for you? If No, why not? Easy Little difficult Very difficult I don’t need to do this I physically cannot I avoid because of risk 1Can you see (enough to carry out your daily activities)? 1234 2Do you sit or squat on the ground? 123044 3Do you walk barefoot? e.g. most of the time 123044 4Do you walk on uneven ground? 123044 5Do you walk longer distances? i.e. longer than 30 minutes 123044 6Do you wash your whole body? (using soap, sponge, jug; standing or sitting….) 123044 7Do you cut your finger or toenails? e.g. using scissors or clippers… 123044 8Do you hold a cup or basin with hot contents? e.g. drinks, food … 123044 9Do you work with tools? i.e. tools which you hold in your hands to help you work … 123044 10Do you carry heavy objects or bags? e.g. shopping, food, water, wood … 123044

27. 11Do you lift objects above your head? e.g. to place on a shelf, on your head, to hang clothes to dry … 123044 12Do you cook? i.e. prepare food both hot and cold 123044 13Do you pour hot liquids? 123044 14Do you open/close screw capped bottles? e.g. oil, water.. 123044 15Do you open jars with screw-on lids? e.g. jam… 123044 16Do you handle or manipulate small objects? e.g. coins, nails, small screws, grains and seeds … 123044 17Do you use buttons? e.g. buttons on clothing, bags… 123044 18Do you thread needles? i.e. pass thread through the eye of a needle 123044 19Do you pick up pieces of paper, handle paper or put it in order? 123044 20Do you pick up things from the floor? 123044 Sub total scores SALSA score (add up all sub total scores)

29. Int’l Classification of Functioning

30. ICF framework Condition Participation Work/livelihoods Relationships Education Participation Work/livelihoods Relationships Education Environment factors Love and friendship Culture / worldview Legislation / rights Perceived stigma (attitudes) Enacted stigma (behaviour) Personal factors Spiritual life Self-esteem / self-efficacy Anticipated stigma Internalised stigma Experienced stigma Personal factors Spiritual life Self-esteem / self-efficacy Anticipated stigma Internalised stigma Experienced stigma Activities Mobility Communication Learning Activities Mobility Communication Learning Body functions and structure Vision Hearing Mental function Body functions and structure Vision Hearing Mental function