The Koraput Centre, Odisha
2023 Annual Update provided by Lepra
Beth Bearman May 2023
The general situation in India has improved greatly since the last report 12 months ago, thanks in part to Covid19 no longer causing disruptions and difficulties. Autumn 2022 also represented the one-year anniversary since the Koraput Care Centre
re-opened: its services are now very much re-established and functioning effectively, providing access to vital healthcare for local people affected by Leprosy and Lymphatic Filariasis.
The Centre is now operating at full capacity. Its annual targets largely doubled those of the previous year, when it was only open for 6 months, and in general the numbers treated have done the same, as logically one would expect. Thus 498 people attended the Out-Patient Department in this period, whilst total In-Patient Admissions numbered 185.
These numbers really emphasise just how essential the Centre is, given how many people it has served over the last year for
a whole range of different issues associated with leprosy. This is especially true given that Koraput is in a remote and underdeveloped rural area of India. It is also an amazing example of how many people can be helped with a relatively small amount of money, if invested properly.
In many service areas the Centre is actually treating more cases than its annual target, with subsequent budgetary implications. Thus the cost of running the Koraput Care Centre in 2022/23 was approximately 4.6% over-budget at £12,383 for the year, against a budget of £11,840. A donation of £6,000 was received from The Ann, Ciara & Niamh Copeland Trust in 2022/23.
The projected cost has risen by 11.5% in the space of 12 months, thus the confirmed budget for the Koraput Centre for the 2023/24 financial year is £13,203, of which £5,000 will be supplied by The Ann, Ciara & Niamh Copeland Trust.
The Koraput Centre, Odisha
2022 Annual Update provided by Lepra
Beth Bearman May 2022
The in-patient department (IPD) and out-patient department (OPD) both reopened in October 2021. They are currently staffed by a team comprising of a medical consultant, a nurse, a ward attendant and support staff. The Centre also has a laboratory and technician, specialist footwear maker and physiotherapist on site. It also provides outreach services to six districts in the state of Odisha, where given the average annual detection rate in these districts, 605 new leprosy cases are expected each year.
When the OPD re-opened at the beginning of September 2021, the aim was to support a minimum of 180 people who would drop in to access support for their needs. It is fantastic to report that in total, 242 people accessed the services at the OPD, including three children.
85 people were admitted to the IPD between 2nd October 2021 and 31st March 2022, demonstrating just how important it was for this facility to re-open. The vast majority of them (64) were from Koraput District itself, but the Centre serves a much wider area. For now, the IPD can host five patients at any one time, but there remains an ambition for the facility to increase to 20 beds.
Individuals were admitted for a variety of reasons, including for complicated ulcer care, management of inflammatory reactions, and pre- and post-operative care. Reconstructive surgery is carried out at Nabarangpur District HQ Hospital, about 60 km away, but patients are then cared for at the Koraput Centre whilst they recover.
The laboratory at the Centre provides confirmatory testing to support the diagnosis of leprosy across the six districts. In total, the lab technician conducted 196 diagnostic tests over the course of the year, close to the annual target of 200. This is a fantastic achievement given that about three quarters of these tests were done in the latter half of the year on account of COVID-19 disrupting travel and couriering of samples to the Centre. Of the 196 tests conducted, 51 were returned as positive, with those individuals referred to their local Primary or Community Health Centre to start multi-drug therapy (MDT) treatment. This will cure them of the disease and prevent them from being infectious.
The physiotherapy technician provides support to out-patients and in-patients at the Centre, and also conducts self-care camps and ‘Disability Prevention and Medical Rehabilitation’ (DPMR) clinics at the local government-run District Hospitals. In total, the technician provided 279 physio sessions, including support for 93 people who were undergoing reconstructive surgery. Physio is vital to enabling people to retain and recover the mobility of their hands and feet when they have been affected by nerve damage. This can make all the difference to ensuring someone is able to continue their everyday activities, such as working, cooking and getting out and about in their community.
The shoe technician at the Centre custom makes specialised footwear on site. These shoes are so important to people affected by leprosy as they help to prevent and manage disabilities in their feet. Once made, Lepra’s field coordinators distribute the shoes during their visits. The shoe technician worked tirelessly throughout the year, in total producing 1,800 pairs of shoes for people with Grade II disability.
The total cost of running the IPD and associated services at the Koraput Centre in 2021/22 was £11,253. This is broken down into £9,604 for the IPD alone, and £1,649 for staffing and equipping the clinical laboratory and shoe workshop. A donation of £8,761 was received from The Ann, Ciara & Niamh Copeland Trust in 2021/22.
The confirmed total budget for the IPD at the Koraput Centre for the 2022/23 financial year is £11,840, of which £6,000 will be supplied by The Ann, Ciara & Niamh Copeland Trust.
The Ann, Ciara and Niamh Copeland Trust Fund
The Koraput Centre, Odisha
Update provided by Lepra
Geoff Prescott CEO October 2021
The planned activities for 2021/22 were to reach over 3,000 people affected by leprosy, both existing and new cases, through outreach activities and care in the community. Despite the COVID-19 related lockdowns and temporary closures of the government health centres to non-urgent care, during the first six months over 1,325 people affected by leprosy have already been reached and supported through the project. We are therefore on track towards our plans being realised to reach 3,000 people by the end of the financial year.
We are also delighted to report that as the pandemic eased and the demand for services for people affected by leprosy in Koraput District regained momentum, the Koraput Centre re-opened to out-patients at the beginning of September 2021. Patients are now visiting the Centre for services such as management of nerve function impairments (NFI) and reactions, ulcer dressings, physiotherapy, and training in ulcer care. A total of 32 patients attended the out-patients department in its first month of operation.
The re-opening of the in-patient department (IPD) followed shortly after on 2nd October 2021, a significant day as it was also the 31st anniversary of the Centre’s foundation. Since the last quarter’s report, the plans for the remainder of 2021/22 have been revised and refined. As such, the ward currently has five beds to accommodate patients who require ulcer care and reaction management over shortterm stays (up to 10 days). It is staffed by a newly employed nurse, another physiotherapy technician, and the consultancy services of a medical officer.
In due course, people undergoing reconstructive surgery (which is carried out at the District Hospitals) will also be received for preand post-operative surgical care which will require longer stays of one month or more. Thus the target for the remainder of 2021/22 is to receive a total of 82 in-patients at the Centre.
In 2022/23, the intention is for the facility to increase to 20 beds at 80% occupancy rate in order to provide physiotherapy support for 96 patients undergoing reconstructive surgery per year, plus 60 patients with complex ulcers / reactions.
The confirmed total budget for the Lepra project called Swabhiman 2.0, of which the Koraput Centre is a part, is £47,396 for 2021/22, although this figure excludes the costs of running the IPD (£7,632). Within this, the annual budget for the Koraput Centre alone is £14,575, or about 30% of the overall Swabhiman 2.0 budget. So the total cost of the Koraput Centre for 2021/22 will be £22,207, of which £8,761 (or 39.45%) has been donated by The Ann, Ciara & Niamh Copeland Trust.
Below is a summary of how Lepra proposes to allocate The Ann, Ciara & Niamh Copeland Trust’s funds for this financial year. As per the wishes of the Trust to prioritise in-patient services at the Koraput Centre, we propose to reallocate the majority (87%) of the Trust’s generous donation to the current costs of running the IPD. The balance of the Trust’s restricted contribution (13%) will be directed to other essentials needed by the Koraput Centre, including drugs and ulcer care kits.
Update on Koraput and the situation in India, provided by Lepra
Geoff Prescott CEO July 2021
The planned activities for 2021/22 were to reach over 3,000 people affected by leprosy, both existing and new cases. Despite the COVID-19 related lockdowns and closures of the government health centres to non-urgent care, during the first three months over 700 people affected by leprosy have already been reached and supported.
Services Provided between April and June 2021
Services at the Koraput Centre were disrupted in the first quarter of the current financial year by the severe government lockdowns and because many of the Centre’s and affiliated staff such as Lepra’s Field Coordinators, fell ill with COVID19. The delta variant of the virus hit India very hard in the first quarter and despite all of Lepra’s staff being vaccinated, many succumbed to illness, though thankfully none fatally so.
The lockdowns also greatly reduced active and passive case finding for diagnosis. Lab services, in particular, have been affected. They predominantly support active case finding by providing confirmatory testing of difficult to diagnose leprosy cases in the six districts. Field coordinators collect and send samples for slit skin smear tests which the lab technician analyses to provide an accurate leprosy diagnosis, thereby enabling prescription of an appropriate treatment regime. Collecting and analysing slit skin smear tests is now a very rare skill in India and elsewhere. In total so far this year, with active case finding activities interrupted by COVID-19 related lockdowns only 18 out of the 30 planned slit-skin tests took place.
The physiotherapist located at the Koraput Centre has a wealth of experience in leprosy care and provides technical support to the government-run ‘Disability Prevention and Medical Rehabilitation’ (DPMR) clinics at the District Hospitals in the six districts. Between April and June 2021, the physiotherapist followed 13 patients undergoing reconstructive surgery, providing a total of 41 sessions, most of which were for post-operative patients who had undergone surgery prior to lockdown.
Prevention and management of disabilities often requires specialised footwear, custom-made by the shoe technician. The shoe technician’s work is supported by the field coordinators who collect and send footwear measurements to the Koraput Centre, ensuring wider and more effective coverage of the footwear making services. Between April and June this year, 519 pairs of customised sandals for patients with grade II disability were produced. In addition, assistive devices, for example splints, were produced by the physiotherapist and distributed to a total of 43 patients.
Overall therefore targets for the first quarter could therefore not be reached in full, but activities of the Koraput Centre are thankfully returning to capacity.
Planned Activity 1st October 2021 - 31st March
Reopen In-patient ward at Koraput Centre from 1st October 2021. Bed occupancy to increase over time. . Now with the end of the COVID-19 lockdown in Odisha, the full project activities are returning to ‘normal’ and focusing on the existing targets for the remaining part of the year.
In quarters three and four of 2021/22, it is planned to start with two nurses, five beds (occupied for 2 months at the time) and 30 patients per year, i.e. 15 for the two quarters. In 2022/23 the plan is for the facility to provide 20 beds at 80% occupancy rate and physiotherapy support for 96 patients undergoing reconstructive surgery per year, plus 60 patients with complex ulcers
We are aiming for a long term sustainable solution whereby the government accepts the responsibility for the majority of the costs of the in-patient care while Lepra continues to support the Koraput Centre’s core services: a physiotherapist, shoe technician, a lab technician and if necessary, non-staffing costs of the in-patient ward. As the situation therefore evolves in future years, we will stay in close touch with The Ann, Ciara and Niamh Copeland Trust to ensure that restricted funds that may be forthcoming in future are pro-actively allocated efficiently and effectively.
Update on Koraput, the situation in India and Lepra UK April 2021
The effects on Lepra UK can best be illustrated by the fact that it currently has 14 employees in the UK (comprising of fundraisers x 6, Communications x 2, SMT x 4, Project Team x 2), whereas pre Covid there were 33 people working for the charity.
BUT ALL THE PROJECTS OVERSEAS HAVE CONTINUED! However things are pretty desperate.
Evidence that up to 60 - 80% of new leprosy cases in India could be missed this year, only 8,270 new cases reported between April & September 2020, compared to about 22,000 in same period in 2019 – a fall of 63%
Leprosy patient clinic numbers in India and Bangladesh down below 50%, thus people are undiagnosed, continuing to transit infections and their disabilities are worsening
Lepra has provided access to Personal Protective Equipment (PPE) and disability support for those affected by leprosy
Purchase of a PCR machine at the Lepra run Blue Peter Public Health & Research Centre in Hyderabad, allows study and testing for both leprosy & Covid19 with Coved19 results in 40 minutes
Lepra has stepped in to provide emergency food supplies in remote rural areas
Sources: Phone conversation with Olivia Egan (Lepra UK South West England Fundraiser) 6/4/21
Extracts from Lepra News Spring 2021
A strict lockdown meant that people had to stay at home for the first two months, but even once restrictions were lifted, there was no public transportation during the reporting period. Many patients who required services were unable to attend the project’s service points as they could not travel. Transportation logistics also meant that it was difficult to send any skin smear samples that were taken to the project lab in time.
Three Lepra project staff were affected by COVID-19.
Government health staff were fully engaged with coronavirus testing, awareness and management, meaning that leprosy services were of little to low priority. Clinics frequently remained closed. Planned training sessions for health staff at district level had to be postponed. Schools remained shut for the entire period, meaning that no school screening activities could take place. As a result of these challenges, progress against the project’s targets has been hampered and is lagging behind. However, despite all this, much has still been achieved, as can be seen below.
3,960 contacts examined from 1,025 index cases.
20,190 people examined in 111 villages where multibacillary leprosy cases had been found
88 community meetings conducted in which 1,013 people participated
IPC in community, 264 persons covered
Total cases detected 126
Disability prevention and medical rehabilitation
Provided technical support at DPMR clinics, providing services to 512 people.
Organised 9 self-care camps, with a total of 77 attendees.
Issued 419 pairs of Grade 2 disability footwear – 215 at Koraput, and 204 at Sonepur.
Supplied 90 adaptive devices to 74 people – these devices prevent further damage and maintain muscle power.
Attended 1,149 patients in follow-up home visits.
Mobilised 38 pre-operative cases for reconstructive surgery.
Followed up 43 post-operative cases.
Empowerment of people affected by leprosy
Formed 2 new village leprosy forums.
Assisted 56 people to access government social security schemes; including 46 people to the pension scheme, 9 people to the housing scheme, and 1 person to both schemes.
Assisted 20 people to acquire certificates to confirm that they have been cured of leprosy.
Source: Lepra Swabhiman Project Update Interim Report (April to September 2020)
20 April 2021
Update on Koraput and Lepra UK August 2020
The situation in India is extremely difficult. Whilst future funding is obviously precarious, there have been huge problems on the ground. As previously described, there has been a shift in emphasis in recent years to a more proactive approach focused on early case detection and disability prevention, but with medical treatment provided for those still unfortunate enough to require surgery.
The project thus focuses not just on active case finding but also screening those likely to have had close contact with someone affected by leprosy, with up to 20 households being screened whenever a case is detected. Extensive school screening programmes had also been developed. All of these of course have virtually ceased.
A nationwide lockdown was enforced by the Federal Government from March 25th to May 3rd and all critical aid activities in the field had to be deferred. The majority of the medical and public health services came to a grinding halt and as leprosy is considered a low priority, work in this area has been slow to restart. The major impacts are listed below:
Active case detection activities are on hold
No outsiders were allowed to enter villages
(Leprosy) Contact Tracing and Post Exposure Prophylaxis administration is on hold
Reconstructive surgery suspended
Access to Multi Drug Therapy (MDT), ulcer kits, customised footwear and self-care aids & appliances is very difficult for people who need support.
Active Case Finding interventions in new districts have not started
Movement of staff very difficult due to lack of available transport.
During each quarter of 2019 on average the project:
Diagnosed 71 people with leprosy per quarter. In the period April-June 2020 only 44 were detected.
Conducted 55 skin smears examinations. The corresponding figure for April-June 2020 is just 5
Treated 858 people with MDT, compared to 176 for April-June 2020
Provided 980 people with protective footwear, compared to 131 for April-June 2020
Performed 10 Reconstructive Surgeries as opposed to 0 in April-June 2020
Treated 32 people for post-operative management, rather than 12 in April-June 2020
One could go on and on with these statistical comparisons, but the essential point is that a lot of the population in this remote area are already some of the poorest, most disadvantaged people in India. Although many of the programmes will have been set back years or will need to start again from scratch, nonetheless work is still somehow being undertaken in the area, despite all of the difficulties faced and our funding is STILL MAKING A DIFFERENCE.
Covid19 has had a devastating effect on LEPRA Health in Action in the UK, which has had to develop a financial plan that will safeguard the organisation and its overseas work for the long term. This has entailed switching to remote virtual working and furloughing over 50% of the staff, with all the remaining personnel taking significant pay cuts of 20-40%.
Lepra has not yet run a formal assessment on the impact that the situation has had on current or future fundraising, but many significant events and activities have had to be postponed or cancelled. These include fundraising dinners, mass participant events such as the London Marathon or the annual Edinburgh to St Andrews bike ride, as well as all of its school or church engagements, all of which usually raise significant amounts of money. Nor is there any reliable timeline for when such activities may start up again.
The annual cost of running the Koraput Referral Centre itself has been roughly around £11,500, so this year’s donation of £5,500 is as always, a mighty useful contribution. Lepra will be struggling to provide the funds needed to meet these challenges and that is why our help is so desperately needed, more so now than ever before!
28 August 2020