Leprosy in Nepal

Life drawing, still life and life class are all fairly mundane terms I thought only applied to nude figures and fruit bowls in an art studio. However, in November I stood and drew in the corner of a plastic surgeon’s theatre in Lalgadh hospital, near Janatpur in Nepal. The theatre was set up to operate on the paralysed hands of leprosy patients. ‘Life’ drawing became very appropriate very quickly.

There were over 200,000 reported new cases of leprosy in the world in 2016. However like many low infectious diseases that predominantly affect those in poverty - leprosy is alive and well. The sad irony is that this disease is difficult to contract and is relatively straightforward to treat. Many patients present late, when irreversible paralysis sets in. Although drug treatment can make them non-nfective, the paralysis requires surgery to correct.

Each year the Bristol based charity Working Hands run by Hand Surgeon Donald Sammut work for two weeks, pro bono, operating on the backlog of patients in Lalgadh, training staff and providing hundreds of kilos of medical equipment and consumables. The work is highly skilled but in many cases the objective is simple: to generate enough movement and power in a hand for the patient to go back to work, or to eat, or to look after themselves in a society where stigma is attached to those with the disease. Most of these patients are illiterate farmers whose only means of support depends on how much they can dig, or carry.

As I was drawing Raj, a 60 year old man having an opponensplasty (an operation to restore strength and movement to a paralysed thumb) it occurred to me that there have been many crossovers between surgery and art. Leonardo da Vinci and Henry Tonks were two of them; both using drawing as a way of comprehending the human body.

It is extraordinary to observe two pairs of hands try and repair the ability of one. Watching Donald Sammut I could see why often surgeons make great artists. The value of being bold, with highly tuned hand eye coordination; an obsessive understanding of what looks beautiful and a consideration for symmetry were all tips from the drawing books. But it doesn’t end there. It turns out surgery is also under great time constraint, these procedures are all done under local anesthetic, including the amputations, with a tourniquet to stem blood flow. The shorter the tourniquet time the less damage to the tissue.

If you wanted more evidence of this then you need look no further than Donald, who before each surgery draws the patients hand in its entirety for several minutes; scar tissue shown with cross hatching, deformity by weight of line, ‘cut’ lines with dotted lines. He says “Those few minutes of examining and drawing the hand are invaluable. While drawing, one is obliged to examine every millimeter, the texture and suppleness of the tissues one is about to rearrange. And it also gives one a few moments to plan the surgery, running it through one's head like choreography steps.

Drawing is the beginning of a very basic trust and a life changing procedure.

Behind The Scenes