Karigiri: A village without pain.

"Leprosy (from the Greek lepi (λέπι), meaning scales on a fish), is a chronic disease caused by the bacteria Mycobacterium leprae and Mycobacterium lepromatosis. Leprosy is primarily a granulomatous disease of the peripheral nerves and mucosa of the upper respiratory tract. During the disease course, skin lesions develop that are lighter than normal skin color. These lesions have decreased sensation to touch, heat, or pain and often do not heal after several weeks to months. Patients also develop numbness in the hands, arms, feet, and legs and with long-term leprosy may lose the use of their hands or feet due to repeated injury resulting from this lack of sensation. The M. Leprae bacteria often causes a "lion like" facies due to a destructive infectious process in the nasal cartilage and eyebrow area. Loss of hair, respiratory difficulties and cataracts also develop. The exact mechanism of transmission of leprosy is unknown although the most widely held belief is that the disease is transmitted by prolonged contact between infected persons and healthy persons. Treatment is with a multidrug therapy of dapsone, rifampicin, and clofazimine. Worldwide, two to three million people are estimated to be permanently disabled because of Leprosy. India has the greatest number of these cases." -University of Maryland and Wikipedia online resources.
Karigiri is a leprosy treatment and research facility on the outskirts of Vellore,India. In the 1950's several physicians from CMC developed the concept for a center for leprosy and within 10 years they broke ground in a desert area known as "Elephant Hill" and completed plans for a 200 bed Inpatient facility, operating theater and laboratory. This week the Vellore Four have had the amazing opportunity to work at this facility. On Monday morning we were given the grand tour including a video over the history of Karigiri. The hospital boasts a specialized PT/OT department where patients learn how to complete daily tasks even with their disabilities. There is also an ophthalmology center for the treatment of cataracts and other leprosy related eye conditions. One of the coolest things at this facility is the reconstructive surgery center where many orthopedic surgeons provide hand and foot reconstructions for leprosy patients. One of these surgeons is Dr. Paul Brand, an orthopedic hand surgeon and author of the book "The Gift of Pain". This book is really amazing and describes the importance of pain in the human life and the devastating consequences for leprosy patients due to the absence of pain. During our tour we also saw an extensive lab where microbiologists are performing drug resistance research on mice. The leprosy bacteria cannot be cultured in a lab requiring the researchers to inject the leprosy bacteria into the feet of immune compromised mice to grow the bug. They then use the mice to see what meds are working for the disease. Another really cool thing about Karigiri is this really big prothesis and orthotics workshop area and agricultural and dairy farms that the leprosy patients work at. This outlet provides the patients a sense of duty and also a means for making a little cash on the side to pay for treatments. (Side Note: something I really appreciate about India is that they require patients to pay for at least a small portion of their healthcare. I mean they might only make a leper pay 5 Rupees for a walking boot but somehow it gives the patient's a little respect and ownership over their care and I think the U.S. could learn alot from that.)
Today we spent the morning doing surgery rounds with an orthopedic surgeon.(attached pic is of some nursing students and this guy teaching us about a non healing ulcer) The surgical wards house about 20 people per room and are separated into male and female wards. Every patient in the ward has at least one extremity if not all four with major deformities and amputations. They are wrapped in bandages and on rounds the nurses remove countless layers of gauze, allowing the surgeon to review and make assessments and plans for treatment. One lady in the ward had the classic "lion features" With her permission I took her photo and it is above. I don't have a great photo of her full body, but basically the disease has caused her so much numbness in her hands that her fingers are completely worn off on both hands and her legs are covered in non healing ulcers and amputated to the ankle. NOTE: THE FOLLOWING DESCRIPTION IS SUPER DISTURBING AND NOT FOR THE WEAK STOMACH....The most horrifying wound we saw during rounds was a man who only yesterday presented to Karigiri. On the anterior portion of his left ankle he had a 15-20cm gaping lesion with deep creveces of necrotic tissue which seemed to me to be moving. On closer inspection his wound was crawling with at least 100 tiny white maggots eating the dead tissue. After puking up everything I've eaten since January I got my wits about me and learned from the surgeon that most patients come to Karigiri with maggots in the wounds, but this is actually a blessing as they remove the dead tissue and keep the wound clean. Yeah maybe so. But it's still disgusting. After the marathon surgery rounds we were invited to go to the operating room to watch the debridement of several cases of osteomylitis. Turns out they've got the same sexy scrub suits and communal flipflops as Vellore CMC. So that was awesome. And we took a pic. Tomorrow we head out to the mobile clinics to see leprosy patients in the villages. Should be totally amazing and I will post again with our adventures.