| A. Arrange for an experienced podoconiosis program shoemaker to provide training and begin shoemaking |
An experienced shoemaker traveled to the new program site to provide the training. |
Shoemaking was located on the treatment site and this brought meaning and commitment to the shoemakers' work. The use of shoes improves bandage use. Shoemaking built skills and provided income for the shoemakers. |
The shoemaking component took time to start. Shoemaking should have been organized earlier because of the difference shoes make in treatment progress. Socks should be distributed at the same time as shoes to prevent exposure to the soil and painful friction with wounds. |
| B. Begin weekly treatment meetings |
These meetings included patient registration, clinical staging, photo documentation, measurement of shoe size, health education, distribution of hygiene supplies, foot hygiene demonstration and practice, and psychological support. A subgroup of patients needed bandages, antibiotics for acute attacks, or wound care. Shoes were made and distributed based on need. Treatment meetings were held weekly in the beginning and subsequent frequency can be determined based on performance/needs. |
Patients paid subsidized fees for hygiene supplies (2 ETB = 0.12 USD) and shoes (10 ETB = 0.60USD) which increased patient ownership. Committed returning patients were asked to share their treatment experience and help other patients, which encouraged patient motivation and behavioral change. Patient progress and clinical staging was tracked through registers and photo documentation which promoted accurate case management and patient motivation. Patients reported validation and improved mental health from individual and group counseling and the private space of the treatment site. Program staff reported mental and spiritual growth/satisfaction from their participation in the program. Patients were asked “What is your contribution?” (i.e. mobilizing other patients, spreading education/awareness messages, etc.) which furthered ownership. |
Significantly more patients than anticipated arrived at the first treatment meeting creating a chaotic environment. It was more appropriate to focus the first meeting on registration and then assign patients into small groups (each approximately 30 patients) with each group meeting on a different day of the week. More patients than available resources approached the program creating a demand versus capacity challenge. A waiting list was created and those on the list were provided oral health education and then appointed to a date the next month to check availability. Hygiene education was addressed first, whereas it took time to start addressing acute attacks. Acute attacks must be dealt with immediately since they are painful and linked to disease progression. |
