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

Challenging feat: Shoemaker Nguyen Van Que delivers specialised shoes free of charge to a leprosy patient in Gia Lai Province's Kon Thup Commune.

With this in mind, shoemakers of the Quy Hoa National Leprosy Dermatology Hospital in the central coastal province of Binh Dinh 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 Le Viet Duc, one of six shoemakers at the workshop that the hospital set up in late 1997.

Dr Nguyen Khanh Hoa, 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 Duc, who began working at the workshop when it became operational in 1998.

Duc 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, Duc 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.

Duc 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 Duc 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 Duc 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 Nguyen Van Tam, 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, Tam 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," Duc said.

Lack of funding

Hoa 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.

Nguyen Thanh Tan, 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, Tan 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 sustain its shoemaking.

But Hoa said the hospital still needed about VND500 million (US$24,000) each year to run the shop. He added that the hospital had been receiving VND200 million ($9,500) from the donor for the purchase of footwear materials each year, but the fund was reduced to VND140 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," Hoa said. "But it is impossible to stop making footwear for leprosy patients."

Heartfelt empathy

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

It took him three months to familiarise himself with the basic techniques of shoemaking. But Duc 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," Duc 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.

Le Van Quyen, 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," Quyen said.

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

VNS/VNN