Nepal

Leprosy

Trust

Annual Report 2006-07

2

Contents Executive Summary......................................................................................................................................... 4

NLT Nepal ....................................................................................................................................................... 5

Leprosy Diagnosis and Treatment ................................................................................................................... 6

Prevention of Disability ................................................................................................................................... 8

Rehabilitation ................................................................................................................................................. 9

Social Support ............................................................................................................................................... 11

Financial summary ........................................................................................................................................ 11

NLT UK .......................................................................................................................................................... 12

NLT Ireland .................................................................................................................................................... 13

Appendix ....................................................................................................................................................... 15

Acknowledgments ........................................................................................................................................ 17

Contact Information ..................................................................................................................................... 18

Note The information in this report is based on the Nepal Fiscal Year 2062/63 which was from mid-July 2006 to

mid-July 2007.

Self Care in the Community

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Opening remarks from the Chairman

It is 35 years since Nepal Leprosy Trust began its work on behalf of people affected by leprosy. NLT was

founded by Winifred Eileen Lodge (known to all in Nepal as Eileen Didi – ‘older sister’). On December 9th

2007 all the Non-Government Organisations working in the field of leprosy in Nepal held an event to

celebrate the life and work of Eileen. The event was attended by many dignitaries including

representatives from the Government of Nepal and the World Health Organisation as well as many friends

and colleagues who have worked with Eileen. In the speeches and presentations given by the honoured

guests we were reminded of all that Eileen has achieved in her time in Nepal. At the beginning she was

with the International Nepal Fellowship, then with Nepal Leprosy Trust and latterly with the Nepal Leprosy

Fellowship. As one of the guests put it, Eileen has achieved what most people could only hope to fulfil in

three life times.

These occasions are a timely reminder of all that has been achieved so far in the field of leprosy. In all

areas of Nepal the number of people affected by leprosy is falling. Lalgadh Leprosy Services Centre (LLSC)

has supported the Government in bringing about a dramatic fall in the number of people affected by

leprosy in that area (Janakpur Zone). Such an event also serves to remind us that there is still much to do.

In this report you will read that there are still many new cases of leprosy being diagnosed at LLSC. Despite

all the progress made there are still many people who will live the rest of their lives with the disability and

deformity caused by leprosy. Nepal Leprosy Trust is committed to helping these people, providing the

care and support that they need.

I would like to take this opportunity of congratulating the staff working at the LLSC for achieving so much

in the past year despite the continued political unrest, frequent strikes and disturbances in the Terai area.

This has been an historic year for NLT, representing a new era as our new Agreement came into effect.

Since the end of the old Agreement in November 2006, NLT’s work in Nepal is now run under a tripartite

agreement between NLT Nepal (as the local implementing agency), NLT UK (as the main funding provider)

and the Government of Nepal. I would like to thank the staff in the Kathmandu office for their work

producing the new agreement. Over the last year we have been working on the transfer of ‘ownership’ of

the organisation from NLT UK to NLT Nepal. A lot of progress has been made and I would like to thank my

fellow Management Committee members for all their efforts.

Mr Mukta Singh Rana, one of the management committee members sadly passed away on December 25th

2006. He served NLT as a management committee member from the beginning and he will be greatly

missed.

Mr Nar Bahadur Bhattrai

Chairman, NLT Nepal

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Executive Summary The continuing political unrest in the country (frequent strikes, markets closed and demonstrations) has

affected all of NLT’s work in Kathmandu and Lalgadh, both directly and indirectly. We have managed to

continue our programmes as normal in Kathmandu. In contrast the political situation in the Terai region

has severely limited the field programmes at Lalgadh.

NLT Kathmandu is working towards self-sustainability. Its main source of income is from the income

generation programmes which covered 61% of its total income. NLT’s export company (Lydia Trading) was

thus able to donate substantial amounts from its profits to NLT’s social welfare activities, to serve elderly

people, widows, heart patients and other disabled people. The NLT Kathmandu Chief Executive

participated in the IFAT Asia Regional Conference in Bangkok, visited Italy and the Netherlands as part of a

EU collaboration programme. He also participated in the biannual conference in Balkenburge and ECATA

workshop in Belgium to promote products from the NLT’s income generation programmes.

At the Lalgadh Leprosy Services Centre, it has been a busy year with more patients seen in the outpatients

department than ever before. The hospital is seeing fewer patients with leprosy as the overall number of

patients on treatment in the surrounding districts continues to fall. NLT has made every effort to support

the Government of Nepal’s Leprosy Control Programme by diagnosing and starting treatment for 1017

new patients in the last year. After the initiation of multidrug therapy (MDT) almost all patients were

transferred for further management to the health post and centre nearest to their homes. We were able

to detect this large number of new cases through our Out Patient Department where we saw 39,364

patients of all types, many from well beyond our four Districts.

This year we worked on the Tripartite Project Agreement between NLT UK, NLT Nepal and the

Government of Nepal through the Social Welfare Council. We signed a new five-year Project Agreement in

June 18, 2007. The new Agreement allows for the integration of NLT’s activities in Kathmandu and at LLSC

as one Nepali organization (NLT Nepal), working under the NLT Management Committee.

We would like to pay tribute to and thank our prayer partners; our valued customers who helped us in

buying substantial quantities of NLT products; all of the donors who have generously supported NLT this

year; the Management Committee members for their guidance; local authorities; the Fair Trade Group

Nepal - who are committed to building up the capacities of its members; the Social Welfare Council; staff

members - for their open interaction, hard work in the spirit and values of the organization; and many

others who have supported us in our activities. All of their contributions helped to make our programmes

successful. Without the moral input, financial support and encouragement of all these partners it is not

possible for NLT to operate. We look forward to your continued support, trust, interest and cooperation in

the coming years.

Kamal Shrestha

Chief Executive NLT Kathmandu

Dambar Ale

Acting Programme Director Lalgadh Leprosy Services Centre

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NLT Nepal Nepal Leprosy Trust (NLT) operates from two centres – the administration, craft workshops and the socio-

economic programmes in Kathmandu, and the clinical, rehabilitation and socio-economic programmes at

the Lalgadh Leprosy Services Centre. In January 2005 NLT produced a 5 year plan that sets out how we

intend to fulfil the Vision and Mission of the organisation for the period 2005 to 2009. The focus for the 5

year plan is the Stigma Elimination Programme (STEP) concentrating primarily on leprosy as one of the

main causes of stigma in an area with the highest incidence of leprosy in the country. The 5 year Plan

takes into account the fact that we are working in an environment of uncertainty and change. The

insurgency that has destabilised the nation since the mid 1990s continues to disrupt communications and

field work as well as divert resources from Government programmes in which NLT participates. In

practice, NLT’s ability to function in this environment varies according to the local security and political

situation.

Another important factor we have taken account of is the anticipation that in the foreseeable future

leprosy will be eliminated as a major public health concern. The prevalence of leprosy worldwide has

reduced by more than 90% since multi-drug therapy was introduced in 1985. Since then more than 15

million people with leprosy have been diagnosed and cured. Out of 122 countries having a prevalence of

more than 1 case per 10,000 in 1985, 118 countries have already achieved this leprosy elimination target

at the national level. Nepal is the only country in Asia and only one of four countries in the world that has

yet to achieve the WHO elimination target. However, prevalence rates vary widely in the different regions

of the country. The programmes at LLSC operate mainly in 4 districts of the Central Development Region of

Nepal, namely Dhanusha, Mahottari, Sarlahi and Sindhuli. The first three districts have the highest

prevalence rates for leprosy among all the districts in Nepal (Figure 1Error! Reference source not found.).

NLT is committed to supporting the Government of Nepal’s efforts in achieving the global vision of a world

without leprosy. Whilst this will, we hope, become a reality in the coming years, the damage done to the

lives, bodies and circumstances of those already affected by the disease will continue for the rest of their

lives. NLT will continue to expand its work to reduce the discrimination against people affected by leprosy

through the Stigma Elimination Programme (STEP).

Figure 1. Prevalence rate of leprosy in Nepal by District

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Leprosy Diagnosis and Treatment Lalgadh Leprosy Services Centre has been running for 16 years supporting the Government’s Health

Service to achieve the WHO goals of the elimination of leprosy, the prevention of the disabilities and

deformities caused by leprosy, and reducing the stigma and discrimination against people affected by

leprosy.

Out-patients

Figure 2 shows the trend in the number of patients seen in the out-patients department (OPD) at LLSC. In

2006/07 a total of 39,364 patients attended the OPD. This is higher than previous years, with an

underlying trend showing an average annual increase in attendance of 8% over the past 10 years. Out of

the total number of attendances, 6750 (21%) were patients with leprosy. The underlying trend is for fewer

out-patient attendances by patients with leprosy. The reason for this reduction is the policy of transferring

patients to the care of government health posts once a patient is diagnosed with leprosy.

Figure 2 Trend in the number of patients attending outpatients at LLSC

Among the 32,614 general patients attending out-patients in 2006/07, 26,962 patients (83%) had skin

problems. This is an essential component of the work of LLSC, representing one of the most effective ways

of finding new cases of leprosy. LLSC provides services primarily for people affected by leprosy but, being

a Community Health Centre, it cannot ignore the increasing demand for general health care services.

Therefore LLSC has the challenge of managing an increasing number of patients with health problems

other than leprosy.

Figure 3 shows the trend in the number and characteristics of the new leprosy patients diagnosed at LLSC.

In 2006/07, 1017 new patients were diagnosed, slightly up on the previous year. Out of all the new

patients diagnosed, 5% had a significant degree of disability (WHO Grade 2 or more) at the time of

diagnosis, slightly less than the national figure of 5.6%. In the last two years we have seen a slight increase

in the proportion of new patients presenting with Grade 2 or more disabilities. This suggests that we need

to increase our efforts at raising awareness of leprosy in the community and encouraging patients to seek

help earlier before the disabilities occur.

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Figure 3 Trend in the number of new leprosy patients diagnosed at LLSC

Among the new patients diagnosed, 51% were type MB (multibacillary), the most infectious type of

leprosy and one of the key indicators for leprosy control. This is an increase on the figure for the previous

year. The underlying trend shows a gradual fall in this figure, so this rise, although slight, is of concern.

The national figure was 55%.

Of the 1017 new patients diagnosed at LLSC, 139 came from India. All patients diagnosed at LLSC are

provided with one month of medicines. They are given health education advising them that if they develop

any reaction to treatment then they should see a doctor immediately. The patients are then referred to

the nearest health post for completion of treatment and follow up.

In-patients The hospital admitted a total of 512 patients in the last year, slightly down on previous years with a bed

occupancy of 89%. Most of the patients were admitted for complications due to leprosy. There were 66

patients admitted with general (non-leprosy) problems -13% of all admissions, a slight reduction of the

proportion of admissions from last year. Although patients are encouraged, educated and counselled to

take care of themselves in their own community, due to many reasons some develop complications and

need special medical intervention. As a result many patients are admitted to LLSC’s special care unit where

they are provided with physical, mental, emotional and spiritual care as well as medical care. Patients are

provided with counselling, occupational therapy, literacy classes, recreational facilities and health

education according to their needs and interest while they stay at the Centre.

This year saw the beginning of reconstructive surgery being carried out by one of NLT’s resident doctors –

Dr Krishna Lama. Following training in India, Dr Lama has carried out reconstructive procedures for 24

people to prevent further deformities and to re-construct the body part which had been deformed due to

leprosy.

Community Awareness The Training and IEC unit has been conducting training for Basic Health Staff (BHS) at different levels

working with the Government of Nepal. Last year we provided training for:

BHS with Refresher Comprehensive Leprosy Training,

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BHS from different regions with Strengthening Training at the request of the Leprosy Control Division,

Occupational Therapy training to LLSC staff.

Orientation in leprosy was given to faith healers, community club members, persons affected by leprosy and facilitators of different Self Help Groups.

Due to the political problems in the Terrai we were unable to run as many street drama shows as we

would like. The ethnic tensions in the Terrai meant that some of the existing drama teams were restricted

in the areas where they could perform. For example we ran 32 shows of street drama in Sarlahi district

including shows done in schools as this district is in the hills and therefore mostly free of the ethnic tension

seen in the Terrai.

Prevention of Disability Self Care Training Centre In the Self Care Training Centre (SCTC) at LLSC patients learn how to care for themselves and practise how

to protect their hands, feet and eyes in a home-like environment. This year 317 trainees were enrolled for

Self Care Training courses at the centre, out of which 96% successfully accomplished the 2 weeks’ training.

The remaining 13 trainees will complete their training in the coming year. When they arrived for training,

almost all the patients had skin cracks, or small wounds with hard and rough skin due to the nerve damage

to their hands and feet. After training the patients understood the importance of taking great care with

the skin on their hands and feet.

Since it began the SCTC has trained 1458 leprosy-affected people in self care education. They are given

training about leprosy and self care practices, enabling them to protect their eyes, hands and feet at the

earliest stage. As well as Self Care training, the centre also provides literacy classes to those enrolled as

trainees. As a result, 60 % of last year’s illiterate trainees were able to sign their names at departure and

were encouraged to continue their studies at home.

Self Care in the Community Patients with leprosy are encouraged to practice self care in their homes. We have encouraged patients

living in the same village to form a group to support and motivate each other. These Self Care Cells have

at least 6 members. The Cells meet once a week to discuss ideas about self care and come up with

solutions regarding their self care practices, disease and problems. There are currently 18 Self Care Cells

with an additional 4 about to be established in the near future. In December 2007 there were 114

members in the Self Care Cells. All of the group members are people affected by leprosy

Self Help Groups go a stage further. Once a Self Care Cell is well established, staff from LLSC encourage

the members to develop into a Self Help Group and start community development activities such as micro-

credit schemes and income generation projects, while continuing to support one another with self care.

(See the section on Self Help Groups on page 11). These group members also act as advisors for anyone

who suspects that they may have leprosy and refer them to their nearest health post. Out of many cases

they have suspected and referred, 36 people have been confirmed as having leprosy.

Prevention of Disability (POD) Clinics in Government Health Posts LLSC is committed to supporting the Government’s efforts to integrate leprosy control activities into the

general health service. NLT provides training and support to health workers through POD clinics run in

government health posts. The main activities consist of improving the skills of community based health

personnel in various technical aspects with regard to leprosy. During the year this field work has been

hampered by political interruptions. Currently there are 7 POD support clinics in different Health Posts in 3

districts. Each clinic runs once a month, while one takes place twice a month due to patient numbers. A

total of 289 patients attended the POD clinics in the last year.

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Rehabilitation Income Generation - Kathmandu Many people who have the capacity to work cannot find employment due to their disability and

discrimination. Our programmes support clients economically, socially and psychologically by offering job

opportunities, fair and advantageous wages. We produce high quality handicraft items and then export

them or sell them locally. This is the most important source of income for NLT Kathmandu, covering 68% of

total turnover in this financial year. However, NLT is a service-oriented rather than profit-oriented

organization. Under this programme, NLT runs a Leather Goods Workshop, Batik, Felt and Fabric

Industries.

Leather Goods Workshop NLT produces various kinds of leather products. The leather workshop has provided skilled jobs to leprosy

affected and other marginalized people since its establishment in 1978. 16 workers from different

backgrounds were busy throughout the year in producing a range of leather bags, purses, wallets,

shopping bags, mobile phone cases etc. The workshop has gained a good reputation for producing high

quality products, which are suitable for supply to foreign markets. In this year we sold leather goods worth

R4,566,736 (US $ 70,258) to local and foreign markets.

Nepali Batiks Batik technique was introduced by German and Swiss missionaries, who were working with the Sunuwar

ethnic group of people. Their vision was to improve the livelihood of this tribe through from batik

handicrafts. In 1988 this project was handed over to NLT and currently 16 families have benefited from

this. In 2006/07 they produced a variety of batiks (cards, wall hangings, mini cards, book marks) resulting

in a total income of R806,364 (US $ 12,406).

Felt Industry NLT’s Felt Industry was busy throughout the year. The producers are from low-income families and quickly

learnt to produce good quality products. This relatively new industry is producing an increasing amount of

products each year. It involves hard work, using water, soap and wool, but the stunning designs of felt

bags, balls, shoes, mats, tea cosy, hats, purse, Christmas decorations etc. are attractive to European

customers. In the last year the sales were Rs. 690,163 (US $ 10,618).

Fabric Industry This Industry gives work to low income ladies. It produces fabric goods like denim bags, aprons, tea cosies,

Christmas decorations etc. This year it produced denim bags and Christmas decorations for UK and

Swedish customers and sales were Rs. 25,994 (US $ 400) which was significantly less than we expected.

Lydia Trading Lydia Trading Pvt. Ltd. is the export company of NLT. Lydia Trading supplied NLT’s products to the UK, USA,

Germany, Ireland, Sweden, Canada, Holland and a few other countries, to the value of Rs. 7,837,382 (US $

120,575). From its profits Lydia Trading was able to donate a substantial amount of money to the social

programmes of NLT.

IFAT (The International Fair Trade Association) Membership: NLT is one of the executive members of Fair Trade Group Nepal, a member of Asia Fair Trade Forum. In

March 2007 the IFAT Secretariat awarded its membership to NLT as it adheres to the strict fair trade code

of practices (commitment to Fair Trade, Transparency, Ethical Issues, Working Conditions, Equal

Employment Opportunities, Concern for People, and Concern for the Environment). IFAT is the global

umbrella organization for fair trade producers, groups and organizations. Its main aim is to support

producers by practicing fair trade business. This improves the livelihoods of disadvantaged people in

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developing countries by linking and strengthening organizations that offer just alternatives to unfair trade

structures and practices.

We are grateful to all our valued customers for their regular orders and encouragement: IM-Soir (Sweden),

Ten Thousand Villages (USA & Canada), TLM Trading Ltd (UK), Tear Craft (UK), Jubilee Traders (USA), NLT

(UK), Chotanagpur (Germany), and Ms Anita Van Hoeve (Holland).

Vocational Training We started a new Capacity Building Program

in Kathmandu in March 2007. In the early

part of the programme we developed

policies and criteria for selecting clients. Our

primary clients are people affected by

leprosy and immediate dependent members

of their families. Our program also reaches

out to those people who are marginalized

from society through their physical, ethnic,

cultural or economic circumstances.

During 2006/07 we supported people who

took part in training. This included sewing

and tailoring, felt making, batik making, basic computing and driving. At the same time we ran 4 Adult

Literacy classes in 4 places, in co-ordination with various organizations like the Women’s Skill Development

Resource Centre, Mahila Bishwashi Sangh, HOPAD and NLT itself. More than 8 clients took literacy classes

in each centre. The main objective of the 6 month program is to help women who never had the

opportunity to go to school so that they are capable of reading and writing simple sentences.

At LLSC in 2006/07 we were able to include 818 more people to the rehabilitation programme. When

added to the previous year a total of 1104 people are benefiting from this programme with an additional

72 clients have received vocational training in Kathmandu during the year.

Micro-credit Kathmandu This is a relatively new programme for Kathmandu. Working with colleagues from LLSC we have developed

procedures, the micro credit loan strategy, client inclusion criteria and the necessary documentation. After

carrying out client assessment, home visits and analysing the client proposals for using a loan, we have a

small committee which decides on whether a loan should be granted.

In 2006/07 we gave loans to 10 people ranging from a loan of R12,000 for someone to make and sell

candles to a loan of R5,000 for someone to set up a small tea shop. We encouraged all clients to refund

their loan as soon as possible, although the deadline is one and a half years. Clients are expected to make

monthly loan repayments. Currently 8 clients are making regular loan repayments. The rest of the clients

will start paying once their new businesses are profitable. We make regular visits to the clients to evaluate

their projects. Most of the clients have started to earn regularly and are slowly becoming self-dependent.

LLSC In 2006/07, 57 people were able to receive a micro credit loan for small scale businesses, such as tea

shops, vegetable shops and animal husbandry. For these businesses clients have used their loan to buy

oxen, goats, pigs, cows, buffalo and ducks. As all of our clients are from rural areas, these loans has proven

to be very successful—29 people have already started to sell the milk they get from the cows and buffalo

and are very enthusiastic about their new work. With the selling of the milk they are earning around R4600

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per month, from which they are refunding R1100 to the Financial and Business Committee of the

respective Self Help Group.

Social Support Kathmandu NLT in Kathmandu supported 92 needy people in the last year. The beneficiaries obtain essential

assistance from four projects under NLT’s Social Support Programme:

Half-way House The house is located in a peaceful location and is for poor widows, the sick, leprosy patients and elderly

women. It provides a safe shelter to those people who do not have anyone to care for them.

Financial Assistance Scheme NLT provides a small level of financial support to the most vulnerable, disabled and other helpless people

to help them pay for rent, food and medicines. Most of the recipients are very old, physically disabled and

sick people who cannot work. In the last year NLT helped 37 such people.

Lydia Children’s Fund (LCF) NLT also provides monthly educational support up to higher secondary level to orphans, children from

leprosy-affected families and poor students. We supported 30 students in the last year. More than 70% of

the students obtained very good results. We try to give priority to gifted and attentive students who are

from low-income families.

Self Help Groups We have set up Self Help Groups in the villages

around Lalgadh where a Self Care Cell has been

running successfully for a year or more. Last year we

were able to include 818 more people in new Self

Help Group to bring the total number of

people/families to benefit from this programme to

1104. In December 2007 there were 31 Self Help

Groups with 12 new groups started in 2007, 9 groups

started the previous year and 10 groups that have

been running longer and are now registered as a

local NGO. The total membership of all the Self Help

Groups is 1081 people. Of these, 70% are people

affected by leprosy, 12% are people with disabilities and 18% are other marginalised people. A total of 93

members of the SHGs have benefited from the Income Generation programme. Of these, 26 members are

already achieving a profit and have started to refund the loans that they have taken from their respective

Group. Among the families of SHG members, 125 children are enrolled in education classes. Among the

members of the SHGs, 84% are people affected by leprosy, 5% have disabilities and 11% are marginalized

people. There is also a Self Help Group made up of employees in the NLT leather workshop in Kathmandu.

Financial summary This has been another challenging financial year for NLT but we are very thankful for our generous

supporters and donors and praise God for the resources given to support the work in Nepal. The

Kathmandu programmes showed a healthy surplus of R690,704 at the end of the year. LLSC finished the

year with a deficit of R2,123,384 (Table 8). One of our main tasks for the coming year is to make LLSC

more self-sufficient through increasing its income from medical services and local sources and by reducing

costs.

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NLT UK

At the end of June, we welcomed many friends and supporters to Richmond to celebrate 35 years

of NLT’s work in Nepal. Our invitation included many of those whom the UK office has sent out

for short term to work in Nepal, so it was an interesting reunion for those able to come. As well

as time to chat, eat some lovely Nepali food and a birthday cake, brief talks were given about “the

early days” and describing how NLT has changed over 35 years and how Lalgadh Hospital

developed from a dream to reality in the early 1990s. It was a day of reminiscing and

thankfulness as we looked back, but it was also a time to realise that we can look forward to the

future with confidence, knowing that God is faithful and will continue to lead all those involved in

the work.

The day reminded us just how many people have contributed to NLT’s work in Nepal over the

years—so many people with different skills and personalities. At times there have been several

expatriate families all serving in Nepal at the same time, some for up to eight years. At other

times, because of visa problems, health problems, or for no obvious reason, there have been no

expatriates at all.

Having had no expatriates in Nepal for some time (with the exception of Vicky Elliot whose term

as a podiatrist finished at the end of 2006), it came as something of a surprise to find that three

appropriately skilled people, with a lot of Nepal experience, all wanted to serve in Nepal

commencing in late 2007.

Dr. Graeme Clugston, who has expertise in health and nutrition and his wife Meena are now

based at Lalgadh, where they are having valuable input in many aspects of the work there.

Dr. Mike Lavender, who has been a UK Trustee for many years, has now returned to Nepal

with his wife Sue. They had previously worked in Nepal with Save the Children and

International Nepal Fellowship (INF), and with Mike’s experience in the NHS in

Northumberland he will be a great help as he works alongside Kamal in Kathmandu.

Richard Odell, who has helped NLT for several years as an adviser, has also gone back to

Nepal with his wife Joyce, to live there. They will mostly be working with INF, but one-fifth

of Richard’s time is devoted to NLT, particularly focused on helping staff involved with

finances in Kathmandu and Lalgadh.

We are delighted that Peter Short from Northumberland has joined the Trustees, which has

coincided with Dr. Mike Lavender stepping down when he returned to Nepal. Peter is planning to

take people to visit Nepal, as well as to speak about NLT’s work in his local area. Marion

Cochrane also stepped down recently, after many years of faithful service, and we acknowledge

her many contributions over the years.

The Trustees and Office team

NLT UK

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NLT Ireland STEP As you will know from our 2005/06 Annual Report, we were pleased to receive funding from Irish Aid for

the Community Based Empowerment and Rehabilitation (CBER) component of NLT’s Stigma Elimination

Programme (STEP) activities for 2006/07. The programme has been very successful and an application for

a further 2 years has been submitted to Irish Aid.

Nepal Visit March 2007 A group from NLT Ireland visited Nepal in March to see the impact of the STEP activities in rural

communities in south-east Nepal. During this trip interviews were carried out with patients, members of

staff and members of self help groups to gain a broad understanding of all aspects of the work on the

ground. Children involved with self help groups, either directly or through their families, were also

interviewed, providing material for lessons conducted by NLT volunteers in Irish schools (See below -

Schools Programme). These interviews and observations have both informed and inspired us and laid the

foundation for much of NLT Ireland’s subsequent work during the year.

Irish Aid Funding for NLT Ireland Currently in Ireland there has been a resurgence of interest in development issues, encouraged by the Irish

Government through Irish Aid.

NLT Ireland has been grateful to receive funding from Irish Aid not only for STEP in Nepal, but also for the

development of NLT Ireland itself and for a Schools Programme in conjunction with Irish Aid’s

Development Education grant scheme.

Website With support from Irish Aid, NLT Ireland launched its new website in December 2007, which informs

people about the work of NLT in Nepal and how they can become involved. Some of the personal stories of

those impacted by the activities of NLT can be found on the website.

Schools Programme In conjunction with Irish Aid’s Development Education grant scheme, a presentation for use in National

Schools about stigma and the impact of stigma on the lives of those affected by leprosy in Nepal has been

developed. The project runs for one year from September 2007. To date (January 2008) 11 schools have

been visited in the Kildare and Westmeath areas.

ElectricAid ESB NLT Ireland is also grateful to have received funding from ElectricAid for work with NLT’s Counselling,

Health Education and Helpless Client Programme.

Himalayan Handicrafts It has been a year of review as how best to market and sell NLT’s handmade craft products in Ireland. The

Crafts Council of Ireland (in conjunction with the Westmeath County Enterprise Board) kindly permitted

NLT to participate in a programme they were running for Irish craft producers on selling and marketing

craft in Ireland. Participation in the programme has assisted in the process of drawing up a plan for the

expansion of the sales and marketing of our craft products. Himalayan Handicraft products continue to be

sold at Craft Fair events and at private home parties.

Fundraising events Once again a number of energetic ladies took part in the Flora Women’s Mini Marathon in June on behalf

of NLT. Their enthusiasm and energy are an encouragement to many!

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A fundraising BBQ held in Gillian’s garden in August was very well attended, with a lovely atmosphere. The

whole event was made possible by the hard work of many and donations given by local companies in the

area.

Personnel The past year has been one of change in NLT Ireland. We were very sorry to say goodbye to two of our

longstanding Directors during the year, Liz Browne and Laura Ryan. Liz and Laura have shown much

dedication and commitment over several years, helping in the various activities of NLT Ireland. They will be

greatly missed and we thank them for all they have contributed to the work of NLT.

Gillian McCutcheon stepped down as General Manager in October to pursue further study. Her role in

developing NLT Ireland has been very significant. Happily Gillian has joined the team of Directors and thus

her work with NLT Ireland continues.

Emma Lynch joined the NLT Ireland team in September as Coordinator. Having served as a volunteer with

NLT in Nepal for a number of years, she is delighted to be a part of the team.

Finally Finally we are very grateful to all the individuals, groups, churches, schools, trusts, donor agencies and

other partners who have given their time, financial support and prayer support to help NLT in the fight

against leprosy and its stigma in Nepal. Your support makes the work of NLT possible. Thank you all very

much.

Emma Lynch Coordinator Nepal Leprosy Trust, Ireland

15

Appendix

Table 1 Number of people attending outpatients at LLSC

Nepal Fiscal Year 2054/55

2055/56

2056/57

2057/58

2058/59

2059/60

2060/61

2061/62

2062/63

2063/64

1999/98

1998/99

1999/00

2000/01

2001/02

2002/03

2003/04

2004/05

2005/06

2006/07

Leprosy visits 11780 12743 13283 13386 10261 9292 8883 8582 7625 6750

General visits 8845 10850 11281 15412 19722 21427 24747 28655 30277 32614

Total visits 20625 23593 24564 28798 29983 30719 33630 37237 37902 39364

Table 2 Number and characteristics of new leprosy patients diagnosed at LLSC

Nepal Fiscal Year 2054/55

2055/56

2056/57

2057/58

2058/59

2059/60

2060/61

2061/62

2062/63

2063/64

1999/98

1998/99

1999/00

2000/01

2001/02

2002/03

2003/04

2004/05

2005/06

2006/07

Total New Cases 1485 1256 1597 1570 1012 1311 1149 1146 945 1017

% MB 60% 55% 55% 55% 52% 51% 45% 48% 47% 51%

% WHO Grade 2 4.0% 8.0% 8.0% 3.9% 4.8% 7.9% 7.8% 5.7% 2.0% 5.0%

Table 3 Inpatient admissions at LLSC – Reasons for admission

Nepal Fiscal Year 2061/62 2062/63 2063/64

2004/05 2005/06 2006/07

Ulcer 284 299 286

Reaction 77 49 58

DDS Allergy 12 7 13

Neuritis 4 11 12

Major Surgery 22 28 24

Septic Surgery 338 258 208

Other 96 83 66

Total Admissions 523 532 512

Table 4 Activity in different hospital departments at LLSC in 2063/64 (2006/07)

Department No. of patients visit Total

Leprosy General

Laboratory Unit 3,821 13,468 17,289

Physiotherapy Unit 9,230 539 9,769

X-ray Unit 111 1,835 1,946

Wound Care Unit 1,660 996 2,656

Eye Clinic 648 497 1,145

Footwear Unit 2,428 113 2,541

16

Table 5 Training and orientation

Nepal Fiscal Year 2061/62 2062/63 2063/64

2004/05 2005/06 2006/07

Government Health workers 159 276 37

Community influential people 859 580 49

People affected by leprosy 138 95 71

Self Care in training centre 363 366 304

Self Care in the community 105 114 190

Table 6 Community based rehabilitation and empowerment

Nepal Fiscal Year 2061/62 2062/63 2063/64

2004/05 2005/06 2006/07

Total number of members in community groups 260 872 318

People affected by leprosy 176 262 267

People with disability 39 36 16

Marginalised people 45 39 35

Table 7 Community awareness

Nepal Fiscal Year 2061/2062 2062/063 2063/064

2004/05 2005/06 2006/07

Total number of street drama shows 496 Nil 897

Total number of the audience 66133 Nil 12800

Table 8 Income and expenditure for NLT

LLSC

Kathmandu Income NRp %

Income NRp %

NLT UK 39,895,784 70%

Grants 2,852,735 29%

Medical Services 9,784,037 17%

Sales 6,089,257 61%

Local income 7,517,893 13%

Local Income (including a donation from Lydia Trading) 974,133 10%

Total income 57,197,714 100%

Total income 9,916,125 100%

Expenses

Expenses

Purchases 3,431,145 6%

Costs of goods sold 5,026,373 54%

Staff costs 25,429,078 43%

Staff costs 2,411,040 26%

Project costs 22,617,557 38%

Social support 761,630 8%

Overhead costs 7,843,318 13%

Vocational training & Micro-credit 89,739 1%

Total expenditure 59,321,098 100%

Overheads 936,639 10%

Deficit for the year -2,123,384

Total expenditure 9,225,421 100%

Surplus for the year 690,704

17

Acknowledgments NLT wishes to express its gratitude to the many individuals and partner organizations that generously

supported its work during July 2005-06. Without this support NLT could not carry out so many activities

and continue to help so many people in Nepal.

Organisations providing technical support

Central Regional Director for Health and all the team at Harihar Bhawan

Chief District Officer, Dhanusha

Dhanusha – District Development Committee Chairman

DHOs and DPHOs of Dhanusha, Mahottari, Sindhuli, Sarlahi districts

The Chief and staff of the Leprosy Control Division, Department of Health Services

IDEA Nepal and CBR Network

International Nepal Fellowship (INF)

Lahan and Janakpur Eye Hospitals

Leprosy Mission Nepal/TLM (Anandaban Leprosy Hospital)

Patan Hospital

Ministry of Health and Department of Health Services, Government of Nepal

Ministry of Women, Children & Social Welfare, Government of Nepal

Home Ministry and Immigration Department, Government of Nepal

Social Welfare Council

Association for International Non-Government Organisations (AIN)

Fair Trade Group Nepal

Nepal Leprosy Fellowship

Nepal Leprosy Relief Association (NELRA)

Netherlands Leprosy Relief Association (NLR/NSL)

Network of Leprosy NGOs, Nepal (NLN)

United Mission to Nepal

WHO Consultants Main Donor Partners

American Leprosy Missions (ALM)

Fontilles

IM Soir/Save the Children (Sweden)

Irish Aid (Government of Rep. Ireland)

Kadoorie Charitable Foundation

LEPRA (British Leprosy Relief Association)

Sasakawa Memorial Health Foundation

The Leprosy Mission International (TLMI) Other Grants and donations We are also grateful to the many other grant-making trusts, small organisations, churches, companies and

individuals who gave generously towards the work of NLT during July 2006-07, either regularly or by

making one-off gifts. Every such gift is important in enabling NLT to fulfil its objectiv

Contact Information Kathmandu UK Kamal Shrestha Mike Houghton Chief Executive General Manager Nepal Leprosy Trust Nepal Leprosy Trust P. O. Box 96 10A The Vineyard Kathmandu Richmond, Surrey Nepal TW10 6AQ, England Tel: +977 1 5521622/5523322 Tel: +44 20 83329023/ 89401200 Fax: +977 1 5523322 Fax: +44 20 89482703 Email: nlt@mail.com.np Email: info@nlt.org.uk Website: www.nepalleprosytrust.org Website: www.NLT.org.uk

Lalgadh Leprosy Services Centre Ireland Damber Ale Ms Emma Lynch Acting Programme Director Nepal Leprosy Trust Ireland Lalgadh Leprosy Services Centre Calm Waters, Russelstown Dhanusha, Janakpur Mullingar, Co. Weastmeath, Ireland Tel: +977 41 620182/ 521125/ 560005 Tel: +353 (0)44 9335707 Email: lalgadh@mail.com.np Email: emma@nlt.ie Website: www.nepalleprosytrust.ie

NLT Governance NLT Nepal – Management Committee Chairman Mr. Nar Bahadur Bhattrai

Vice Chairman Dr. Rajendra Kumar Rongong Treasurer Mr. Bir Bahadur Khawas Secretary Ms. Seeta Gurung Member Mr. Mukta Singh Rana (died December 2007) Member Mr. Radheshyam Shrestha Member Mrs. Droupadi Rokaya Member Mr. Krishna Man Shakya Member Ms. Mana Kumari Rupacha NLT UK – Trustees/Directors Secretary/Treasurer Mr. James Lowther Member Dr. Mike Lavender (until September 2007) Member Mrs. Sue Wells Member Mrs. Marion Cochrane (until October 2006) Member Mr. Ron Roberts Member Mr. Richard Sykes Member Dr. E. Jordon

NLT Ireland – Trustees/Directors Mr. Gary Hill Ms. Tricia Linehan Ms. Gillian McCutcheon Dr. Steven Thomas Ms. Debbie Thomas