A focus on the issues associated with implementing self-care as an intervention.

It is generally well understood that people with impaired nerve function are required to adapt to their disadvantage. Adaptation includes harnessing alternative resources to substitute for the loss of sensory, motor and autonomic modalities. It is also generally well understood that alternative resources include using other senses more acutely: sight substitutes for sensation as a warning of tissue fatigue, applications of water and oil substitute for loss of autonomic skin maintenance, and exercise substitutes for antagonistic muscle function that prevents contracture and deformity. For people affected by leprosy, essential actions taken to substitute for the loss of normal function fall in the domain of self-care. Self-care has been extensively promoted and is established as a key part of the mantra of POD for people affected by leprosy. Dr Paul Brand tirelessly sought to educate health workers and leprosy affected people alike to encourage self-care practice. Jean Watson presented practical guidelines that have been a standard text since they were first published 1986. Thousands of workers and perhaps hundreds of thousands of people have been made aware of the need to adopt self-care practices; yet hundreds of thousands of people have nonetheless neglected to apply the advice and have struggled through life with worsening disabilities. This paper therefore will not focus on methods of self-care, but will seek to open and begin to address the following questions: