Leprosy Mailing List – December 14th, 2011
From: J A Barreto, Bauru, SP, Brazil
Dear Dr Noto,
The last International Leprosy Congress, in Maceio’, Brazil, was an important moment to discuss the question of leprosy in America, as well as in the World. For WHO, nowadays, we are the last country where leprosy was not "eliminated", and though we all know that this is not true, Brazil became in a bad situation: are we so incompetent, more than all other countries, like Ethiopia, Sudan, etc?
The fact is only one, and WHO should change the way how this issue has being understood. Having an elimination target is good, and important, at least once the detection rate decreases when leprosy is not in focus, and not like what happened after 2005 in Brazil (The reporting was only on ¾ of the year). Nevertheless, to reach elimination, many efforts must be done, and the foolish strategy, which is in progress today, i.e., the making up of statistics, will have a high price.
Monitoring of “elimination”, as well as the quality of assistance, is also extremely important, and since 2005 nothing was done in Brazil about this. When I went to the state of Rio Grande do Sul, in 2003 and 2005, as monitor of Leprosy Elimination Monitoring, I observed that the goal of elimination, achieved in 1997 in that state, was only operational: an extremely centralized model of leprosy assistance, i.e., made by dermatologists in regional references, without evaluation of household contacts, associated with a high degree of stigma and prejudice. This led to the progressive decreasing from the detection rate due to gradual retirement of these professionals, whose were not substituted. Today, like the other 2 states that also achieved elimination (on paper), i.e., São Paulo and Santa Catarina, the rule is late diagnosis in referral centers, like the same problem reported by Dra. Nora Cardona Castro from Colombia.
I had published a paper about the leprosy cases diagnosed in our Institute from 2003 to 2007, with the profile of leprosy patients from the state of São Paulo. Almost two thirds had grade of disability higher than zero, and one third had grade 2; median time interval from the start of symptoms to diagnosis in a referral center was one year. Half of the patients came to our services without the suspicion of leprosy, i.e., among the other dermatologic diseases, since we have a Residence in Dermatology.
Today, like Dra. Nora, we are diagnosing 1 new case almost every day in our routine. During the last Skin Cancer Campaign in our city, fifteen days ago, 2 new cases were found, one of them was an advanced lepromatous case, with several lepromas. Finally, my opinion is that having an “elimination” target is important, but epidemiological vigilance must be kept, as well as monitoring the achievement, like what we are doing now.
Jaison A. Barreto
Instituto Lauro de Souza Lima
Bauru, SP, Brazil