Linda Lehman, MPH, Technical Director of Programs, American Leprosy Missions discusses how ALM addresses the problems of neglected tropical diseases through strengthening health systems and community outreach.

1. Integrating Care Across Neglected Tropical
Diseases and Chronic Health Conditions
Linda Faye Lehman, OTR/L MPH C.Ped
Senior Advisor for Morbidity Management and Disability Prevention
Jim Oehrig
Vice President of Integral Mission

2. Deuteronomy 6:5 “Love the Lord your God with all
your heart, with all our soul, with all your mind and
with all your strength.”
Leviticus 19:18 “Love your neighbor as yourself.”
Two Greatest Commandments at the
heart of our lives and work
Matthew 22.36-40

3. …American Leprosy Missions works to answer these
questions constantly:
1. Are we made of people who desire to love the
Lord their God?
2. Are we supporting people as they pursue
working out the first commandment in their
lives?
3. Are we loving our neighbor around the world
and those with whom we work?
4. Are we working to ensure that when people ask
“Why? and Who?” a response is available?

4. Burden of Neglected Tropical Diseases
• 1.4 billion of world’s poorest suffer from NTDs,
including 500 million children
• Many NTDs can cause disability
http://www.who.int/neglected_diseases/EB_resolution_2013/en/
http://www.who.int/neglected_diseases NTD_RoadMap_2012_Fullversion.pdf
CDC, 2011

5. Detection & Disease Specific
Treatment of NTDs
Disease Management, Disability
& Inclusion (DMDI)✚
Disease Burden

6. • Identify common
complications early
• Take appropriate actions to
prevent or minimize the
complication
• Know when and where to
refer
• Know how to monitor if it is
better, worse or the same
• Involve the person affected,
their family and community www.leprosy.org/ten-steps

7. Managing Cross-cutting
Issues
Leprosy
BuruliUlcer
Yaws
Leishmaniasis
Lymphatic
Filariasis
Podoconiosis
Trachoma
STH
Eye / Vision X X X
Sensory Loss X X
Muscle Weakness X X
Movement Limitations X X X X X X X
Dry Skin & Nails X X X X X X
Wounds X X X X X X X
Scars X X X X X
Edema X X X X
Footwear X X X X X

8. Managing Cross-cutting
Issues
Leprosy
BuruliUlcer
Yaws
Leishmaniasis
Lymphatic
Filariasis
Podoconiosis
Trachoma
STH
Self-care X X X X X X X X
Psycho-social support &
counseling (depression)
X X X X X X X X
Participation Restrictions X X X X X X X X
Stigma reduction / Advocacy X X X X X X X X
Education X X X X X X X X
Nutrition X X X X X X X X
Livelihood X X X X X X X X
WASH (Water & Sanitation) X X X X X X X X

9. Develop Self-efficacy(Bandura, 1977)
Belief I can achieve an intended result
“I can Do and We can Do”
Developed by:
• Performing a task successfully
• Witnessing other people successfully completing a task
• Seeing people similar to oneself
Training by “team” improves communication and
collaboration between health workers at all levels.
Follow-up and mentoring: Continue learning through “On
the Job Training” during monitoring activities.
Bandura, A. (1994). Self-efficacy. In V. S. Ramachaudran (Ed.), Encyclopedia of human behavior (Vol. 4, pp.
71-81). New York: Academic Press. (Reprinted in H. Friedman [Ed.], Encyclopedia of mental health. San
Diego: Academic Press, 1998). https://www.uky.edu/~eushe2/Bandura/BanEncy.html

10. Utilization of Ten Steps
Health System
Strengthening
• CBPHC
• Acute & Hospital
Care
• Chronic Conditions
• Integrated NTD
Program
• Referral Services
• Traditional Healers
School & Educational
Curriculums
• School Health
• Medical and Nursing
• Community Health
• Rehabilitation
specialist
Community Focus
• Community-directed
interventions
• Community-based
inclusive
development
• Community-based
Rehabilitation
• Community-based
self-care and self-
help groups

11. Proposed Joint Indicators for
WASH & NTD’s
• Toilet is accessible and safe for people with
physical impairments, women.
• Improved on site water source with universal
design
• Water is consistently available in sufficient
quantities to do activities of daily living and
self-care

12. Thank you
Linda Lehman llehman@leprosy.org
Disease detection, Disease management, Self-care, Disability
Prevention and Inclusion
“I can do it, We can do it!”
www.leprosy.org/ten-steps