The combined approach concerning persons affected by leprosy and lymphatic filariasis (LF) was implemented as a pilot in Zambezia province in 2015 with financial support of Lepra, and adopted in Niassa and Nampula provinces in 2016. This resulted in support to a total of 100 self-care groups (SCGs), 368 hydrocele operations in the 3 provinces and 137 health workers being trained in leprosy and LF-related matters. The project in Zambezia benefited from an exchange visit with India; an experienced staff member of Lepra India visited the Zambezia project to promote mutual learning and knowledge exchange regarding the combined approach.
The year 2016 counted 335 consultations and ophthalmologic treatments for patients with eye problems. An ophthalmologist was added to the team to assist members of SCGs.
An important element of the combined approach is teaching SCG members how they can support each other in their physiotherapy and exercises. In addition, 8 government staff as well as staff of Disabled People’s Organizations (DPOs) were trained by NLR in developing appropriate footwear for persons affected by leprosy or LF. These skills and knowledge were shared by Lepra India and are now applied in Zambezia. As a result of this training, the SCGs received more frequent visits from government physiotherapists and about 293 patients were assisted.
A few 2016 targets for the Zambezia project had to be adjusted due to inflation and subsequent price increases for materials. As a result, it was decided to move up the project’s end date from March 2018 to December 2017.
NLR facilitated 350 self-care group (SCG) members to become members of the Disabled People’s Organization (DPO) ADEMO in Nampula; this is a very practical way to ensure that persons affected by leprosy as well as other persons with disabilities living in remote rural areas become involved in a DPO. For ADEMO it is important to have a good representation of members living in remote areas, while it is also important for those affected by leprosy and LF to share their specific concerns with the DPO. With support from NLR the DPO ADEMO had an opportunity to contribute to the mapping of as yet unknown persons with disabilities; in Zambezia 153 persons were mapped and in Nampula 350 (mainly persons with LF).
Number of new cases detected 564
Proportion of new cases presenting with grade-2 disabilities 36%
Number of new cases detected in the area where we work 276
Number of people receiving leprosy-training 147
Number of people informed/educated (awareness raising) on leprosy 1,000,286
Number of people from communities informed/educated (awareness raising) on general disabilities 192,064
Number of self-care groups supported/formed:
a) Existing groups (formed before 2016) supported in 2016 81
b) New groups formed and supported in 2016 19
Number of persons disabled by leprosy and other diseases trained in self-care 1,361
Number of Disabled Peoples Organizations (DPOs) receiving assistance from NLR 1
Number of people provided with reconstructive surgery 368
Number of people provided with assistive devices (wheelchairs + crutches + sunglasses + protective/ orthopaedic footwear + prostheses) 435
Number of persons with disabilities oriented on their rights 293
The combination of support to persons affected by leprosy and those with lymphatic filariasis (LF) has resulted in an increased project impact. Thanks to this approach a larger number of people can be reached. Combining persons with different disabilities, leprosy and LF in self-care groups (SCGs) has created social care for each other and contact between these different groups, which previously did not exist. The project is not only benefiting the 4 districts this project is targeting: through the involvement of the government in this project, the combined approach is also being adopted in the other 18 districts in Zambezia.
The hydrocele surgeries have a significant impact on the Sexual Reproductive Health & Rights of men affected by lymphatic filariasis (LF). The impact of the 10-minute surgery is proportionate to the level of stigma and discomfort caused by disfigurement. When affected men cannot walk, sit, stand or have sexual intercourse, the condition affects not only their sexual health but it also threatens their family life and livelihoods. Surgery is a simple solution that has the potential to completely reverse health problems and the negative economic and social consequences. However, lack of access to the service remains a major obstacle and has been identified as such by the World Health Organization (WHO).
Bento Manuel from Muiravale, Monapo district is 48 years old, married to Natalia Lauia and has 3 children. Bento suffered from hydrocele and felt ashamed when walking through his village, because people would make fun of him. Before NLR started the project, he appealed to the health services for support, to no avail. He is one of the 30 persons who underwent surgery for hydrocele repair in August. Today he is a happy man: ‘I spent many years feeling ashamed, especially around women in the village. There were people who wouldn’t speak with me, or who made fun of me. Today I can walk freely, I am beautiful, I go to my farm, I can have sexual relations with my wife without any problems.’
I spent many years feeling ashamed. Today I can walk freely, I am beautiful, I go to my farm, I can have sexual relations with my wife without any problems
In Nampula it is impossible to train the surgical technicians in hydrocele repair, because they are too busy performing emergency operations. At the suggestion of general practitioners themselves, it was decided to train general practitioners to perform hydrocelectomies instead. Last year’s hydrocelectomies have helped communities understand that hydroceles can be treated and that patients have a right to treatment. Those affected who have not had an operation yet, are now appealing to the government to improve their health status. They are no longer afraid of the operation, because they see the positive results with others.
Regarding our work with the Disabled People’s Organization (DPO) ADEMO, we have worked with ADEMO members based in the regional capitals until now. This has helped them to learn more about leprosy and LF and about the problems in the remote areas of the provinces. However, NLR taught us that it is more effective if self-care group (SCG) members themselves can play a role in the DPO and if they can share their own challenges with those in regional capitals. This is why NLR has supported a number of SCG members to register as DPO members.
2017 is the last year of the project carried out in Zambezia in partnership with Lepra. An evaluation will take place to benchmark against the target areas’ situation at the start of the project. Through monitoring we realize the project has had an important impact on the lives of persons affected by leprosy and LF. SCGs have learned how to manage their disease and/or disability and this helps them and their families to increase their productivity. To ensure sustainability for persons affected, NLR is looking for an NGO in Zambezia province that can support the SCGs in the rural area. NLR and Lepra are planning to apply for funding to ensure financial support for a livelihood project for the SCGs.
Several changes are planned for NLR Mozambique in 2017: a visit from NLR Brazil is planned to provide support to the financial team in Maputo. Furthermore, a program manager who joined in 2016 will stay on during 2017 and a new Country Director will be recruited in 2017.This will strengthen the management and resource mobilization of the team in Maputo and enable the current Country Director to pay full attention to technical aspects of NLR’s work in the capacity of Technical Director.