In her book A Place of Hope and Healing: The Karigiri Story, Usha Jesudasan describes how Dr Robert Cochrane, who was Principal of the Christian Medical College, at Vellore, began trials into the effectiveness of the raw parent of DDS as a curative drug for leprosy. She writes that “After many disappointing trials and much frustration he finally discovered that DDS would not kill the leprosy bacteria, but that in much smaller doses, it prevented the bacillus from multiplying.” (p. 2)
Dr Paul W Brand was also working in the Christian Medical College, Vellore. He had visited Chingleput leprosy Sanatorium and he became interested in the clawed hands of leprosy affected persons. He was amazed that with about ten million people in the world afflicted with leprosy, and about fifteen percent of them with deformed hands, no surgeon had thought of doing something for them. … Little was known about the pathology of leprosy in relation to deformity.
Under Dr Cochrane, Christian Medical College, Vellore had become a center for research into the development of the new sulphone drugs. North Arcot District was also a place with a high incidence of leprosy. Now it became a centre for research into hands and tissues as well. After his work as a surgeon was done for the day, Dr Brand looked into the problems of leprosy. He discovered that not all muscles were as paralysed as they seemed. With a small core of helpers he examined every patient he could get hold of. His team would test the level of the patient’s sensation with a pin or a feather. Then they would do further tests to discover which muscles were paralysed, which fingers were absorbed, which nerves thickened. All this was duly recorded and carefully studied.
Although his surveys did not show why deformity occurred, it did show that despite the paralysis there were good muscles to take the place of useless ones.
The pathologists working on biopsies of leprosy flesh discovered that the tissues of a finger which had shortened were very much like the tissues of a normal hand. They were subject to the same laws of healing as normal flesh. Armed with this knowledge, Dr Brand was ready for his first surgery on a deformed hand.
The first reconstructive surgery on a clawed hand was a success. More operations followed and for the first time those with terrible deformities had real hope of having their hands straightened and using them for normal activities. The operations though a success, brought other problems for which solutions seemed difficult at first. So many people with deformities came wanting surgery. The medical school had first claims to Dr Brand as surgeon and teacher. Beds for leprosy patients were hard to allocate as other patients objected to being beside them. Leprosy patients were also very poor and could not pay for their treatment. Normal patients who paid for their treatment would stop coming and the hospital could not afford to have the numbers drop. Not to be daunted by these obstacles, Dr Brand did reconstructive surgery when all his other duties were over.
It became increasingly clear that he needed a place where he could carry out research and teach others the techniques he was beginning to perfect.
Dr Cochrane had the vision of a small hospital near a bigger teaching one from which specialist staff from different departments would contribute … He strongly felt that the problems of leprosy would never be solved if there were studied only in isolation. Dr Brand supported this idea fully, as he too saw the growing need for full time research into leprosy. Dr Cochrane wanted to build his dream place just across the road from the Christian Medical College, but it was turned down by the local authorities. Nobody wanted to live near a leprosy hospital.
... After many inquiries, the Collector of North Arcot District offered a piece of land near Karigiri village, at the foot of a hill, far away from habitation. The land that was offered was an isolated stretch of wasteland that no one else wanted, three kilometers from the nearest travelable road. … Dr Cochrane, though disappointed that it was not closer to the Christian Medical College decided to accept the land and make his vision a reality. Part of the land was given as a gift by the Government; part of it was bought at a very nominal rate by The Mission to Lepers for leprosy research.
Thus was born the Schieffelin Leprosy Research Sanatorium at Karigiri.
In 1955, Schieffelin Leprosy Research Sanatorium, Karigiri consisted of a small hospital with seventeen beds, a research laboratory, a few staff houses and cottages for patients. The function of the institution was to observe study and investigate various types of leprosy, to treat medical and surgical complications and to train workers for full-time leprosy work.
The objectives of the Schieffelin Leprosy Research Sanatorium, Karigiri are expressed as follows:
· To serve in the spirit of Christ as an instrument of God in the healing of persons suffering from leprosy
· To demonstrate the most effective methods for control of leprosy, its management and the rehabilitation of leprosy patients
· To treat leprosy patients without distinction of caste, creed or colour
· To provide a center for the training of medical and paramedical personnel in all disciplines required for the management of leprosy
· To carry on research to further knowledge contributing to the ultimate solution of the leprosy problem
· To undertake such other activities in the interest of persons suffering from leprosy, as the Board of Governors may time to time determine
from A Place of Hope and Healing: The Karigiri Story, Usha Jesudasan
It was in the area of reconstructive surgery that Karigiri first made its mark. Dr Brand trained Dr Fritschi and Dr Sakunthala Karat. Both were creative surgeons willing to try out new procedures, always with the best interests of the patients in mind. Apart from surgery on hands and feet, reconstruction of eyebrows, noses and faces too were done.
... Preventive care of hands and feet became a priority. So the Physiotherapy and Occupational Therapy Departments too were kept busy. The preoperative and postoperative needs of patients had to be met; splints and plasters had to be applied. After surgery, there were exercises to make the fingers more supple and reeducation of using different muscles for different jobs. From the beginning, physiotherapists too were trained at Karigiri. Miss Beth Wilson, one of the early physiotherapists did much of the initial training for trainees from all over the world.
By 1977, the numbers for reconstructive surgery from the control area were on the declines, but patients from all over India still came to Karigiri to be operated on by Dr Fritschi.
Training other surgeons in surgery was one of the main reasons for Karigiri’s existence. In the 70s almost every reconstructive surgeon in leprosy in the world was trained at Karigiri.
In the 80s, the major responsibility of prevention of disabilities, the management of orthopaedic deformities and the management of pressure ulcers fell onto the Department of Surgery. Often the problem of leprosy was seen from the viewpoint of public health and statistics. The DISLEP project begun in 1989 recognised that the problem of leprosy was not just a public health one but involved the care of people who were ostracized, discriminated against and neglected in every way.
A new surgical ward improved facilities for patients.
The branch of surgery expanded to include the X-ray and Photography Departments. Apart from the normal x-rays, this department also prepares blue tone and colour slides and materials for presentation at various conferences.
Until this point, only patients who felt they needed surgery came to Karigiri. In the year 2000, the “camp approach” to identify and motivate patients to come forward for reconstructive surgery was tried out. What began in Gudiyatham Taluk as an experiment turned out so successful that the next year it extended to Vellore District, as well.
Prevention and Management of Impairments and Consequences (PAMIC), a hospital based, multidisciplinary approach to disability prevention in leprosy was also begun in 2000. problems relating to impairments are looked at from the point of view of the patient and a participatory approach including the family is adopted to address physical, psychosocial and economic needs.
As Karigiri expanded its services into the area of community health, the specific needs of the community too became obvious and had to be addressed. The Branch of Surgery further expanded into the area of General Surgery and ENT to accommodate community needs.
Entry updated February 2016