A Multidimensional Welfare Status of Leprosy Patients Living in a Suburban Area

Leprosy has a high incidence of physical complications that will impact directly the physiological, economic, and social status of patients. Indonesia has a high burden of the disease, and several leprosy settlements are still spread in the country. Neglasari Village, Sitanala, Tangerang serves as one of the places of residence of people who have had leprosy. A health service initiative known as ASEAN Journal of Community Engagement ISSN: 2581-0030 / E-ISSN: 2580-9563 https://scholarhub.ui.ac.id/ajce Page: 71-104 How to cite the article (APA version): Irawati, Y., Menaldi, S. L S, W., Harini, M., Wahyuni, L. K., Alwin, W., Dwiranti, A., ... Lestari, Y. N. (2021 A Multidimensional Welfare Status of Leprosy Patients Living in a Suburban Area. ASEAN Journal of Community Engagement, 5(1), 71-104. https://doi.org/10.7454/ajce/v5i1.1088 72 Identifikasi Tanda-Tanda Mata, Ekstremitas, dan Kulit pada Kusta (KATAMATAKU) was launched as a collaboration of health services among multi-departments (ophthalmology, dermatovenereology, and medical rehabilitation). Sitanala has a relatively high incidence of people who have had leprosy with disabilities of the hand, foot, and eye. As a continuation of this health service and combined with the efforts to improve the welfare of leprosy patients, in November 2019, a multidisciplinary program titled KATAMATAKU Universitas Indonesia, was conducted. This program aimed to determine the demographic data regarding the health, psychological, social, and economic status of the leprosy population at Sitanala The project consisted of a collaborative anti-stigma program by the Faculty of Psychology, Public Health, Social and Political Sciences, Cultural Sciences, Administrative Sciences, and Vocational Educational Program; thematic health program, which supports the improvement of physical abilities and empowerment of former leprosy patients, by the Faculty of Medicine, Dentistry, Nursing, and Pharmacy; thematic economics program, which aims to increase the economic capacity of the leprosy community, by the Faculty of Economics and Business, Mathematics and Natural Sciences, and Engineering. This program enabled the construction of a multidimensional management model, in which every aspect plays important roles to improve the patients’ quality of life.


Introduction
Leprosy is a chronic and progressive infectious disease caused by the infection with Mycobacterium leprae. The disease is still found in developing countries given the limitations of the provided adequate services in the fields of health, education, and socioeconomic welfare in society. Southeast Asia has the highest number of new leprosy cases, and Indonesia is the third highest country in the world with leprosy, after India and Brazil (Hogeweg, 2010;WHO, 2018). The leprosy prevalence rate in Indonesia was 0.72 per 10,000 populations in 2018. The number of leprosy cases was 19,033 cases, which is the largest value of prevalence per 10,000 populations (Kemenkes, 2017). The number of new leprosy cases found was 14,397 cases. Leprosy patients usually live together and called their area a settlement, with the stigma from general communities restricting them to live among a common crowd (Kemenkes, 2018). Sitanala is one of such settlements and is located within the area of Sitanala Hospital in Tangerang, Banten, which is the border of rural and urban areas near Jakarta, the capital city of Indonesia.
Community engagement refers to the process of working collaboratively with and through groups of people affiliated by geographic proximity, special interest, or similar situation to address issues affecting their wellbeing (CDCP, 1997). This activity can be held by organized groups, institutions, or individuals involved in health promotion, policy making, and research. The collaboration is interdisciplinary, including the fields of healthcare, psychology, sociology, economic, social work, political science, and other discipline that contribute to community development. To carry out a successful collaboration with community, the provider needs to understand the point of view of the "insiders" and observe the community culture and behavior that shaped the community's belief about their health condition. An essential point of community engagement is helping the community to discover the root cause of population's problems, search for solutions, develop ideas, contribute to decision making, share responsibility, and build the community (CTSA, 2011).
The high incidence data of leprosy in Indonesia encouraged Identifikasi Tanda-Tanda Mata, Ekstremitas, dan Kulit pada Kusta Universitas Indonesia (KATAMATAKU UI) to conduct a health service program for leprosy patients. Leprosy is not only related to health problems but also affects other aspects of life, such as economy, psychology, social, culture, and others. In this program, KATAMATAKU UI combined forces from multiple faculties and departments to overcome the several aspect problems of leprosy patients.
KATAMATAKU UI was sub-clustered into three thematic teams. The anti-stigma thematic This study aimed to determine the demographic data regarding the health, psychological, social, and economic status of the leprosy population at Sitanala. By obtaining these data, appropriate studies and interventions can be carried out to reduce the level of disability, prevent further disability, eradicate leprosy, and end stigma. Furthermore, the social and economic welfare of the citizens can be improved. This research is limited to several samples and data analysis. This research intended to perform the holistic management of each aspect, which will altogether overcome the problems in leprosy society. On a large scale, this work will optimize the quality of life of leprosy patients and community empowerment.

Methods
The "KATAMATAKU UI" multidisciplinary service program was conducted by a team consisting of several experts and held at the leprosy settlement village in Tangerang City in November 2019. All the members coordinated and collaborated as a multidisciplinary team to create a holistic solution to achieve public welfare.
The program started with the preparation by each expert, followed by the coordination of the whole master plan with the local government and hospital near the Sitanala settlement.
Routine meetings and approaches to the residents were carried out, starting from the local government. The multidisciplinary team met with the board of Sitanala Hospital to discuss and match the programs' proposal to community needs ( Figure 1). The anti-stigma thematic team started the program one and half weeks before the collaboration program by collecting the database of every resident in RT 01 RW 13 Sitanala settlement village. The databases contain personal and demographical information from the village officers, followed by the door-to-door survey to match the database with real data. The data consisted of personal, health, and demographical information. A baseline survey was conducted to assess the latest condition in the study site before the intervention. This survey aimed to explore the various views of the population toward the knowledge, attitudes, and practice on leprosy and its impacts, such as on the quality of life and stigmatization. https://doi.org/10.7454/ajce/v5i1.1088 75 Figure 1. Flowchart of the Program for Sitanala Resident Furthermore, the health thematic team focused on leprosy patients, especially those with impairment of the eye, skin, the extremities, oral and dental, and psychological health. The team targeted residents based on the data collected by the anti-stigma thematic team. The data were developed as a full database of the whole health status of the community. Then, the patients were treated by the multidisciplinary team to achieve their optimal welfare status by increasing their ability to perform their social, economic, and cultural roles in the community.
The examination program was held at Sitanala Hospital Sports Hall and the settlement area, which is around 100 m from the sports hall. The participants were all residents of RT 01 RW 13 Sitanala settlement village. A total of 304 subjects were included. Upon arrival, the participants must approach the registration table to match their data with the database, and they were given different forms based on their leprosy status.
A red form was given to leprosy and ex leprosy patients; a yellow form was given to the family member who lived at the same house with the leprosy and ex leprosy patients, and a green form was given to family members who have no leprosy patients living in the same house. The participants brought their forms to the first session, which was an interview regarding their real personal data and involved the acquisition of verbal and written informed Ophthalmology examinations were performed to detect eye abnormalities in residents of the leprosy settlement (leprosy and non-leprosy). A total of 18 ophthalmologists, 13 general practitioners, and 4 refractionists were involved in this examination. The eye examinations included uncorrected and best-corrected visual acuity, intraocular pressure measurement, and anterior segment examination. Posterior segment examination was mandated if visual acuity was not concordant with the anterior segment examination, using indirect funduscopy with 90D lenses and/or binocular indirect ophthalmoscope. Ocular abnormalities were documented in the eye examination section of the form. The dermatovenereology examination started with the investigation of rifampicin administration as chemoprophylaxis for household contacts, the Dermatology Life Quality Index, and examination.
The questionnaire was administered and followed up with an in-depth interview (Romero, 2012). The study about the quality of life of leprosy patients is still ongoing; in collaboration with the Faculty of Pharmacy, patients who do not live in the same residential area and administrating medical prevention were compared with those who live in the same residential area as a leprosy patient (Girdhar, 2016). Simultaneously, an examination of nail abnormalities was conducted, along with clinical and dermoscopic observations followed by a physical examination of the upper and lower extremities, including the range of motion and manual muscle test (MMT) by an occupational therapist (Kaur et al., 2003). The products and activities of daily living and leisure were identified. Each muscle group was tested bilaterally during MMT. The occupational therapists commonly used a goniometer, which is an instrument that measures the angle of a joint, to measure the range of motion. The deformity and functional level of the joint were documented after conducting these assessments. The oral medicine team from the Faculty of Dentistry examined the status of oral and dental health as an integrated part of the clinical examination of patients with leprosy in this health service. Furthermore, the dentist team provided information and educated people with leprosy. The appropriate treatment of dental infections can reduce recurrence in leprosy patients (Pallagatti et.al, 2012).
Using the rehabilitation principle of participation limitation, the medical rehabilitation team designed art activities for leprosy villagers in Sitanala. Art activity was selected because it is one of strategies for yielding new insights into and acceptance toward leprosy patients (Hasnain, 2020;Reis, 2017). Social acceptance is also related to the stigma attached to https://doi.org/10.7454/ajce/v5i1.1088 77 leprosy survivors and their children. Through focus group discussions, the social and cultural team attempted to identify the experiences and strategies for facing stigma among young peoples.
To achieve optimal results, the Department of Psychology developed an assessment of intervention and examination by Hopkins Symptoms Check List-25 (HSCL-25), which is a measurement tool that can screen a person's psychological distress levels (Hutahaean & Sumampouw, 2018;Hutapea & Mashoedi, 2019;Turnip & Hauff, 2007). The focus of the review was on the team's findings regarding the level of psychological distress of Sitanala villagers as baseline data to determine interventions which would then be arranged as a further step. In the next step, our team conducted a lesson to remove the social stigma to improve the quality of life of people with leprosy.
The community welfare was achieved by increasing the economic and social life of the leprosy community. This goal was manifested by a continuous program for cultivation in the area, including hydroponics and organic waste management. These programs were selected to support people with leprosy and their relatives with practical and valuable activities. Twenty individuals (10 males and 10 females) with leprosy in Sitanala joined the program. The program was divided into the 1) introduction of hydroponic and organic composting through interactive presentation and examples; 2) hands-on hydroponic and waste processing; 3) program evaluation.
The nutrient film technique (NFT) in hydroponics was applied in this program, along with the installation of solar panels as the power source to run this system. The waste management was carried out using the composting method. Five large composters (150 L) were distributed to the people in Sitanala to be used for the collective organic waste processing. In addition, 80 small waste cabinets (9 L) were distributed to help the people in waste collection from individual houses. The evaluation of the program was carried out using a questionnaire to obtain the respondent's opinions about the program.

Results and discussion
The total number of RT 01/RW 13 Karangsari is 965 people, with 937 joining the door-todoor surveys and 200 being affected by leprosy. However, several of the population members were unavailable at home during the survey or refused to be interviewed. In addition to leprosy survivors and their families, several Sitanala Hospital medical staffs also live in the region. The characteristic population is normal, almost half of the population (46%) is in productive age (16-55 years), and about one-third (30%) is under 16 years. Most of the https://doi.org/10.7454/ajce/v5i1.1088 78 population members have social insurance (87%), and a higher number is observed among the people affected by leprosy (94%). Table 1 shows the characteristics of people affected by leprosy in the study. The level of jobless people with leprosy is higher compared with the general population.
This situation is common among people with leprosy; it is related to a low education achievement, exclusion, low self-esteem, stigmatization, and discrimination (van Brakel, 2018). Losing an opportunity or job will devastate the family's social-economic status in the long term because they cannot contribute to the family welfare, especially for the productive age parents. This condition will raise other problems, such as spoiling the family bond, neglected child education, and affecting the food security for the family member, which https://doi.org/10.7454/ajce/v5i1.1088 80 probably can jeopardize the family health condition (Pescarini, 2018). Several leprosy people will use a shortcut to become beggars for life; others feel comfortable with this job and have become vulnerable to social problems in the community (Kaur et al., 2003). As found in India, begging for life has created the community's cultural view that leprosy patients must be a beggar, or being a beggar is the last choice for leprosy. However, if the person with leprosy do not finish the treatment, then they become a carrier of the disease (Krishnamurty, 1990;Rao, 2000).
Late adulthood presented the highest percentage in leprosy population. Nevertheless, a leprosy case was still observed at the age <5 years old (2%, 3/200). This finding will be a great concern for the health program to give optimal medication for adult patients. Thus, early identification and treatment will prevent the spread to children. Moreover, the database about education prompted the program to give a simple and applicable approach. Thus, the patients can understand the approach well and apply it in their daily life.

Eye health status
The eye examination applied to all participants included leprosy patients along with their family with or without leprosy signs and diagnosis. Examination started with anamnesis of the patients about their eye health and symptoms. Visual acuity was classified based on World Health Organization (WHO): Vision Impairment Classification, with mild or no visual impairment of the visual acuity ≥ 6/18, moderate visual impairment of the visual acuity < 6/18 to ≥ 6/60, severe visual impairment of the visual acuity <6/60 to ≥ 3/60, and blindness of the visual acuity < 3/60 to no light perception (WHO,2018). Table 2 shows the patient database. The impairment of visual acuity was correlated to the condition of the anterior and posterior segments of the eye. A total of 304 subjects participated, but the posterior segment examination was performed on 106 patients who were suspected to have posterior segment abnormalities based on the visual acuity and anterior segment examination  Table 3, the result of anterior eye health examination for 304 Sitanala's population was 34.2% with normal eyes, and the highest abnormality was cataract, followed by pterygium, lagophthalmos, and dermatochalasis. The abnormalities found are preventable and treatable, thus preventing visual impairment and blindness. Nevertheless, the patients needed an optimal vision. This program was followed by the treatment related to the patients' eye abnormality, ranging from giving them spectacles to improving visual acuity to elective surgeries, such as cataract, lagophthalmos, and pterygium removal, which was held one month after the screening examination. Several patients refused to have surgery. Surgical charity should be carried out periodically to overcome patients' eye disorders. As presented in Table 4, the posterior eye health examination showed that most of the population has normal fundus (91%), and the other majority abnormalities found were glaucomatous and myopic crescent pupils. Both can be treated optimally with the right medication and routine follow-ups by the ophthalmologist.
The surgeries were performed for five lagophthalmos patients with techniques of gold weight implant or modified tarsorrhaphy with the condition. One and seven days after operation, one patient had a minimal lagophthalmos with a size of 0.5 cm, and others had optimal improvement of the lagophthalmos condition. Pterygium removal was conducted for five patients with technique of pterygiumplasty and optimal graft condition on the first and seventh day after operation has been reached.
Furthermore, cataract surgery was performed for 10 patients with the technique of phacoemulsification, extracapsular cataract extraction, or intracapsular cataract extraction, following the cataract condition of each patient considering the benefits and risks individually (Olson, 2017

Type of leprosy
Unknown --

Skin health status
Participants who followed the comprehensive anti-stigma, economic, and health program comprised 304 people with 117 people diagnosed with leprosy. The mean age of leprosy patients was 51.2 ± 10.5 years with male and female proportion of 54.7% and 45.3% respectively (Table 5). Approximately 41% of patients were treated for leprosy for a duration of 2-5 years, whereas 32.5% was undetermined due to recall bias. All participants had completed their leprosy treatment regime.
Nail changes were observed through clinical examination and dermoscopy in 80 participants. Both fingernail and toenail abnormalities were found in all 80 participants (100%). More than one nail abnormalities can be found in a patient. Twenty types of nail abnormalities were assessed in this study. However, we presented the three most frequent nail changes found with the following proportions, as summarized in Table 6.  (2013) found 10 old leprosy cases that had nail changes in the hands and/or feet.
Nail involvement can be found in three out of four leprosy patients. The factors associated with nail changes in leprosy are neuropathy, repeated trauma, vascular impairment, repeated infections, or adverse effects from the drugs used in leprosy treatment, such as clofazimine or dapsone (Ramos, Reyes, & Belinchón, 2013). Nail abnormalities in leprosy are usually secondary to distal resorption of the phalanges (Romero, Rincón, & Rabell, 2012).
Furthermore, Kaur et al. (2003) reported longitudinal melanonychia to be the most frequently found fingernail changes in PB and MB types. This result is similar to our findings, of which longitudinal melanonychia was one of the most frequently found fingernail changes in the participants. In contrast to this study, the participants were not divided based on their leprosy type; all were released from treatment years ago, and thus, diagnosis based purely on recall memory is unreliable. Any nail changes may be caused by diseases directly affecting the nail unit or as a part of a systemic disease (Romero, Rincón, & Rabell, 2012). Nail changes are not specific to leprosy and can be found in other peripheral neuropathies, such as diabetes mellitus (Ramos, Reyes, & Belinchón, 2013). Still, observation of these changes is vital for reevaluating the consequences elicited by leprosy, which consist of patient's physical, psychological, and social wellbeing.

Extremity abnormalities
Disabilities in leprosy are classified as grade 0 for no anesthesia and no visible deformity, grade 1 for anesthesia present but with no visible deformity, and grade 2 for visible deformity or damage. This WHO disability grading is commonly used in to evaluate the physical condition of leprosy. Disabilities often result in more defects than physical dysfunction and include activity limitations, stigma, discrimination, and social participation restrictions (Kemenkes, 2012;WHO, 2018). Overall, 124 patients with a leprosy-related disability were identified, but 7 participants did not follow the procedure completely. Seven people dropped out because of missing value. Thus, the final data for 117 people were obtained. Exactly 17.9% of the patients had a grade 2 degree of impairment of scars of healed ulcers, decreased sensation, and muscle weakness but showed no joint contracture (Table 7). The degree of physical impairment is related to social problems and stigma ( Figure 2).
According to WHO, disability is an umbrella term covering impairments, activity limitations, and participation restrictions. Examples of how to describe disabilities in leprosy patients and survivors are given in this paper. Impairment is a problem in a body function or structure. Hand deformity is an example of a body structure problem in leprosy patients. The deformity is primarily due to peripheral nerve lesion, mostly in ulnar and median nerve, From the previous description, leprosy is prone to cause impairment, activity limitation, and participation restriction. The participants were referred to medical rehabilitation if they showed activity limitation and participation restriction. From the description, impairment leads to activity and participation limitation, but in real life situations, the case may be different. The impairment of organs will affect their function (Gopa, 2016), but the impairment is not correlated with activity limitation and participation restriction which may be due to compensation mechanisms or other factors (Reis, 2017). However, such information presents hope in managing leprosy disability.
Using the rehabilitation principle of participation limitation, the medical rehabilitation team designed art activities for leprosy villagers in Sitanala. Art activities were selected because they are one of the strategies used to yield new insights and acceptance by doing art activity (Hasnain, 2020;Reis, 2017). Thus, we asked the participants to create a painting with their impaired hand. Several refused because of their lack of confidence. Then, it was proven oppositely, given that most of participants can paint, even for those with severe deformity ( Figure 3). We hope that this kind of activity will develop into larger projects, such as sports,  In addition, we can implement actions, such as medical rehabilitation and administration of orthoses and prostheses, to increase the mobility and productivity of the patient.
Promotional activities were carried out in the form of leprosy seminar to leprosy patients and their families to prevent further disability in the patient's extremities and eyes. completely independent, 12 (16.2%) were partially dependent, and 9 (12.2%) were completely dependent on others for brushing their dentures.
The inability to maintain oral health and hygiene in leprosy patients is mostly related to physical deformities, especially in the fingers and hands (Ferreira et al, 2018). Matos et al.
(2018) research in India stated that the oral health status of leprosy patients was poor and required treatment. This result may be due to peripheral neuropathy and hand deformities that impede oral hygiene (Matos et al., 2018). Abnormalities in the oral cavity of leprosy patients in hard and soft tissues can be specific or unrelated manifestations of the leprosy they suffer from. However, they can also be related to the inability of patients to maintain oral hygiene due to defects in innervation or physical disability that inhibits activity.

Psychological aspects
The sample was randomized from 304 patients, and 107 selected patients who were diagnosed with leprosy or family members of leprosy patients were included for psychological examination. The physical disabilities of the patients affected their psychological health. We observed that 62.5% of the patients experienced a significant distress, whereas a value as large as 37.5% was observed in the family group. Females experienced higher psychological distress than males. This result is in line with that of previous studies (Dijkstra, Brakel, & Elteren, 2017;Islam, 2019;Zhang et.al., 2018). Meanwhile, the psychological distress rate was lower in participants who had family support. From the findings in this data processing, several things can be discussed and serve as the basis for the preparation of interventions in the second phase of activities. Data showing that family groups experience more https://doi.org/10.7454/ajce/v5i1.1088 89 psychological distress than the patients can be an indication that their family may be experiencing burnout in carrying out the role of a support.
The family probably experiences burnout, which is widely known as "caregiver burnout" (Scharlach et al., 2016), that results from the inability of the patient to carry out their physical activities. This situation has also forced several patients not to send their children to school to help at home. Their children eventually had to earn money to meet the family's economic needs, such as by selling goods at the road crossings, serving as a garbage transporter, or busking. The pressing economic issues reinforce the pressure from the family because of the oppressed needs. However, on the patient's side, family support is their strength. Table 8 shows that the majority of participants in this study were females (91, 59%), and in Table 9, the average HSCL-25 score of participants was below the cut-off value of 1.52, with a minimum value of 0.96 and a maximum of 3.12. A total of 40 participants (26%) had levels of psychological distress above the cut-off. As many as 25 participants (62.5%) who have psychological distress were residents who suffered from leprosy, whereas as many as 15 participants (37.5%) were family sufferers. The families of patients showed a slightly higher average level of psychological distress compared with the patients themselves. Still, a statistical analysis was performed to determine significant differences between the two groups (t-test). The results showed no significant difference in psychological distress (t = 0.55, p > 0.05). In addition, people with leprosy who feel unsupported by anyone present the highest level of psychological distress compared with those who feel the support of their family and/or neighbors. Still, the results showed significant differences in the psychological distress among the three groups (F = 2.19, p> 0.05).

Social and cultural aspects
Based on the qualitative data, the leprosy survivors were ex-patients of Sitanala Hospital and came from different regions of Indonesia. Around the early 80s, they obtained permission to stay in the hospital housing complex, and to date, more than three generations are living in the housing complex. As leprosy survivors, their access to economic resources are limited.
Therefore, several of them are begging until now. Interestingly, their children as the second generation and grandchild as the third generation are healthy. The second generations are more educated, who are graduated from a vocational school. Nevertheless, access to the labor market is limited when a leprosy child is stigmatized in social relations.
A case involved a girl who failed to marry when her leprosy family background was revealed. In dealing with social stigma, young men are indifferent, in contrast to the group of https://doi.org/10.7454/ajce/v5i1.1088 91 young women. However, both groups hope that their children (the third generation) will no longer live with the stigma.
Social cohesion is weak, particularly among leprosy survivors, as proven by the former head of the neighbourhood association. He stated that such condition may be due to his busy working life. Moreover, given their physical condition, the survivors are reluctant to participate or join in social and religious activities. The condition is also reflected by their children. Young people claim that they only gather on the Indonesian Independence Day and or Islamic holidays. From the sociological aspect, the social capital of the Sitanala community is weak and needs more efforts to build togetherness in the community.

Agro-economic aspects
The health status affects the person's quality of life. As an effort to increase the economic capacity of the leprosy community in Sitanala, our team conducted a series of programs to cultivate their area through hydroponics and the management of their organic waste. The program consisted of the installation of the NFT hydroponic system along with solar panels, the introduction of hydroponic and household waste processing through interactive training and examples, and hands-on follow-up with the assistance of hydroponic and waste processing. Hydroponics refers to the process of growing plants without soil but in water enriched with nutrients and oxygen.
According to the interview, most of the participants had experience in small farming on lands, and several of them are land laborers. However, none of them had prior knowledge about hydroponics. In this program, they were taught how to grow vegetables, such as water spinach, lettuce, etc., using the hydroponics by NFT, which is a hydroponic technique wherein a shallow stream of water containing all the dissolved nutrients required for plant growth is recirculated past the roots of plants in a channel. The nutrients are mixed accordingly in a primary reservoir from which they flow through the system, continuously feeding the plants (Mohammed & Sookoo, 2016). This method is advantageous in terms of the effective use of limited areas. In addition, by using this method, more people will be involved in the program. The system was installed using solar power. Thus, the people in Sitanala are not required to provide electricity for this hydroponic system. The participants were enthusiastic to learn and cultivate vegetables using hydroponics. Figure  The second program, i.e., organic waste processing, was carried out using the composting method. Waste is one of the problem sources for various fields, including health and the environment (Alam & Ahmade, 2013;Chadar & Chadar, 2017). To date, the wastes produced daily by the people in Sitanala are commonly thrown away directly. These wastes can be converted into various useful products and give a high economic value if marketed (Amasuomo & Baird, 2016). In this program, the waste cabinet and composters were provided by the team for the participants. The people collected household organic wastes in the cabinet, and the wastes were further compiled in the composters for the composting process. The composter has a small cap at the bottom to receive the liquid fertilizer (leachate) resulting from the composting process, in addition to the solid fertilizer. The production of liquid fertilizer from organic waste processing is beneficial as nutrients for hydroponics.
Thus, these programs (hydroponic and organic waste processing) are practical, valuable, and has potential to be carried out by people with leprosy in Sitanala in a sustainable manner.
The evaluation of the program was carried out using a questionnaire to obtain the respondents' opinions about the program. In the preliminary step, the organic fertilizer, vegetables, and composter produced from their activities are only used for themselves, but they have the potential to be marketed in the near future. The outcomes of the program are defined as the community's motivation to broaden their knowledge of hydroponics and waste processing and their willingness to continue hydroponics and waste processing after the program is over. Three months following the first program, the team visited Sitanala to monitor the progress and discuss the challenges faced by the people. A group of 10 people was defined to organize this agro-economy program. On the second occasion, the team also https://doi.org/10.7454/ajce/v5i1.1088 93 trained the young men (aged 20-35 years old) in Sitanala to create a composter on their own. This step increased the skills of the people with leprosy in Sitanala and added promising value to increase their input once the products are marketed.
At the end of the program, the participants were motivated to continue hydroponics and organic waste processing on their own. Furthermore, according to this program, the implementation of collaboration between different faculties is important to the success of the program, which can be duplicated in other areas as a model of community empowerment.
The data from the multicenter fulfilled each other, and the demographics showed each datum based on their domicile status, which is very useful in categorizing the health status of families, including the status of patients, close contact relatives, or a healthy population.

Conclusion
As part of the whole program, a collaboration of faculties in Universitas Indonesia that joined together as KATAMATAKU can comprehensively improve the quality of life of the people with leprosy in Sitanala from every aspect including health, social, and economy. A model for the leprosy program with multidimensional collaboration is highly effective on physical

Declaration of Conflicting Interest
There is no conflicting of interest for this manuscript.