Heal­ing the sole

Viet Nam News - - Front Page - by Hoàng Thuùy

Shoe­mak­ers in the cen­tral prov­ince of Bình Ñònh have crafted spe­cial shoes that pro­tect the feet of pa­tients suf­fer­ing from le­prosy, a project that was far from easy.

Suit­able footwear helps to pro­tect le­prosy pa­tients' be­numbed feet from in­jury.

With this in mind, shoe­mak­ers of the Quy Hoøa Na­tional Le­prosy Der­ma­tol­ogy Hos­pi­tal in the cen­tral coastal prov­ince of Bình Ñònh have braved the hard­ships when­ever they go deep into the for­est to ap­proach pa­tients and make footwear for them.

In most cases, it takes a day or two to com­plete a pair of shoes for a pa­tient. Once com­pleted, shoe­mak­ers de­liver the made-to-or­der footwear to pa­tients' homes free of charge.

Le­prosy is a slowly-pro­gress­ing bac­te­rial in­fec­tion that af­fects the pa­tient's skin, as well as the pe­riph­eral nerves of the hands and feet and the mu­cous mem­branes of the nose, throat and eyes. The de­struc­tion of nerve end­ings that fol­lows cause af­fected ar­eas to lose all kinds of sen­sa­tion.

"They tend to feel in­fe­rior to able-bod­ied peo­ple be­cause of the stigma of the dis­ease with which they're af­flicted," said Leâ Vieát Ñöùc, one of six shoe­mak­ers at the work­shop that the hos­pi­tal set up in late 1997.

Dr Nguyeãn Khaùnh Hoøa, head of the Health Plan­ning Di­vi­sion, said the hos­pi­tal has been treat­ing more than 4,000 pa­tients from 11 ci­ties and prov­inces of the South Cen­tral Coast and Cen­tral High­lands, and its shop has been pro­duc­ing 2,500 to 3,000 pairs of shoes ev­ery year.

"So many of them have their homes deep in the for­est to avoid com­mu­ni­cat­ing with nor­mal peo­ple. It is there­fore not sur­pris­ing that shoe­mak­ers are ex­pected to go there to make footwear for them," re­vealed Ñöùc, who be­gan work­ing at the work­shop when it be­came op­er­a­tional in 1998.

Ñöùc re­called fac­ing strong winds and rain while driv­ing his motorcycle to moun­tain vil­lages to ei­ther mea­sure pa­tients' feet or de­liver shoes for them. On sev­eral oc­ca­sions, he had punc­tures on the way and would have to walk all the way to vil­lagers' homes to have the tyres re­paired.

Once, while stop­ping by a vil­lage in the Cen­tral High­lands to ask res­i­dents for di­rec­tions to le­prosy pa­tients' homes, he ex­pe­ri­enced be­ing avoided by the vil­lagers, who all quickly ran away from him for fear of con­tract­ing the dis­ease.

Re­call­ing when the footwear shop was first es­tab­lished, Ñöùc said he and other shoe­mak­ers were wor­ried by pa­tients' ten­dency to re­ject shoes made for them, even if th­ese en­abled them to carry out daily tasks such as walk­ing and pro­tected them from se­ri­ous in­juries.

"The chal­lenges that we shoe­mak­ers faced in­cluded not only mak­ing shoes with painstak­ing ac­cu­racy but also ac­cept­ing the pa­tients’ re­jec­tion, though we had to ford springs and cross forests to come to their homes," he said.

Ñöùc cited the case of a man who had known him for 13 years but re­ceived footwear from him only re­cently. Le­prosy had eaten nearly all of his feet and caused a dras­tic de­cline in his health be­cause he had re­fused to prop­erly wear shoes suited to his con­di­tion.

"The pa­tient felt re­gret for not hav­ing fol­lowed my ad­vice. I could no longer help him," he re­called.

In another case, a pa­tient re­fused to wear shoes that Ñöùc had gifted him for fear that out­siders would find out he had le­prosy. But after some time and a se­ries of emo­tional con­ver­sa­tions about his con­di­tion, the pa­tient agreed to wear the spe­cialised shoes that Ñöùc would reg­u­larly give him twice a year.

All shoes are made to con­form to the shape of the pa­tients' feet, which be­come de­formed after the toes be­come mul­ti­lated and fall off. Be­cause of this, there are thou­sands of shoe de­signs for them, and none of them are alike.

"Each pa­tient has spe­cific in­juries, and it is the job of shoe­mak­ers to make pa­tients feel com­fort­able with their footwear," said Nguyeãn Vaên Taâm, the shop head.

Qual­ity shoes for le­prosy pa­tients con­sist of non-al­ler­gic ma­te­ri­als for their feet, as well as soft in­soles and hard un­der­soles. Also, soft ma­te­ri­als are used to cover the fore­foot to pre­vent in­juries.

Fe­male pa­tients' footwear are of­ten a bit stylised, but shoe­mak­ers fo­cus more on shap­ing the shoes to con­form to pa­tients' feet rather than fol­low­ing style pat­terns, Taâm said.

Be­cause shoes tai­lor-fit for pa­tients usu­ally dif­fer from one another in shape and size, it is easy for nor­mal peo­ple to see that the own­ers have de­formed feet or are lep­ers.

"I'm glad to see many of them ac­cept our footwear with joy," Ñöùc said.

Lack of fund­ing

Hoøa said the num­ber of shoes that the shop pro­duced var­ied each year, de­pend­ing on pa­tients' ac­tual de­mand. He com­pared the man­u­fac­ture of shoes to the pro­vi­sion of medicine for pa­tients.

Nguyeãn Thanh Taân, the hos­pi­tal di­rec­tor, said footwear for le­prosy pa­tients was es­sen­tial be­cause th­ese helped pa­tients move from one place to another and pro­vided re­lief from foot pain and swelling.

Since they no longer feel pain, pa­tients risk in­jur­ing their feet while step­ping on sharp ob­jects or heated sur­faces with­out notic­ing it. If they suf­fer from in­juries and fail to at­tend to them, they de­velop se­ri­ous in­fec­tions. The footwear pre­vents such in­juries and al­lows the feet to quickly re­cover from them, Taân said.

The hos­pi­tal con­tin­ues to make shoes for pa­tients, though Hand­i­cap In­ter­na­tional, the shop's main spon­sor and donor, had stopped fi­nanc­ing in 2005. The Nether­lands Le­prosy Re­lief has since taken over to help the hos­pi­tal sus-tain its shoe­mak­ing.

But Hoøa said the hos­pi­tal still needed about VNÑ500 mil-lion (US$24,000) each year to run the shop. He added that the hos­pi­tal had been re­ceiv­ing VNÑ200 mil­lion ($9,500) from the donor for the pur­chase of footwear ma­te­ri­als each year, but the fund was re­duced to VNÑ140 mil­lion ($6,700) this year.

"The cut­ting down of the fund and the hos­pi­tal's fi­nan­cially de­pen­dent sta­tus are chal­lenges to the hos­pi­tal in its ef­forts to pro­vide footwear to pa­tients free of charge," Hoøa said. "But it is im­pos­si­ble to stop mak­ing footwear for lep-rosy pa­tients."

Heart­felt em­pa­thy

Be­fore work­ing as a shoe­maker for le­prosy pa­tients, Ñöùc had wan­dered to var­i­ous parts of the coun­try to earn a liv­ing. He be­gan as a tai­lor be­fore turn­ing to fish­ing. Upon ar­riv­ing in Bình Ñònh, he be­gan his ap­pren­tice­ship as a shoe­maker.

It took him three months to fa­mil­iarise him­self with the ba­sic tech­niques of shoe­mak­ing. But Ñöùc only be­came a skilled shoe­maker and was able to pass on the craft to younger work­ers after work­ing in the shop for four years.

"Although most work­ers here are not me­thod­i­cally trained, they are quick to grasp the craft mainly be­cause they have learned it with their hearts and share a deep em­pa­thy with the pa­tients," Ñöùc said.

"We do not fear them. In­stead, we em­pathise with them and want to help them over­come the stigma of be­ing lep­rous and cure their ill­ness," he added.

"Many pa­tients are from eth­nic mi­nor­ity groups and are too poor to af­ford shoes from other shops. It is good for them to wear spe­cialised shoes to pro­tect them­selves and save their money for food," he noted.

Leâ Vaên Quyeàn, the son of a le­prosy pa­tient, has been mak­ing shoes for 10 years and knows how the dis­ease can bring phys­i­cal and men­tal pain to his fa­ther bet­ter than oth­ers.

He re­vealed that he would have re­fused to do the job if he didn't have any pas­sion for the craft and a great af­fec­tion for pa­tients.

"It re­quires us to be metic­u­lous and ded­i­cated to pa­tients when work­ing with them. It is not sel­dom that nor­mal peo­ple think we have le­prosy, and that may af­fect our loved ones as well," Quyeàn said.

In spite of dif­fi­cul­ties, he has be­come at­tached to his job and con­sid­ered the hos­pi­tal as his sec­ond home. Quyeàn's two sons are also work­ing there. One is a tech­ni­cian and the other is a cook.

Chal­leng­ing feat: Shoe­maker Nguyeãn Vaên Queá de­liv­ers spe­cialised shoes free of charge to a le­prosy pa­tient in Gia Lai Prov­ince’s Kon Thuïp Com­mune. VNA Photo Hoaøi Vaên

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