What can we do Dr Noto?

Leprosy Mailing List – December 19^th, 2011

Ref.:    What can we do Dr Noto?
From: S. Noto, Genoa, Italy

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Dear Dr Nora Cardona Castro,

Thank you very much for your message in LML dated Dec. 8th, 2011 about ”Why Brazil is doing this?” and for sharing important information about the leprosy situation in Bolivia.  At the end of your message you kindly asked:- << ”What can we do Dr Noto?” >>.

I think we should carry out anti-leprosy activities using the proper tools.  If we use the proper tools we can only do better.  But probably your important question is too big for me and others have to answer.  I can try to understand who is advising Brazil in doing the right thing with the wrong tools and why?  After this, one may discuss with these persons and get explanations on why it should be “elimination” instead of “control”? Why registered point prevalence rate instead of incidence related indicators? And what will change after we reach the 1 in 10,000 benchmark?

The more I think about the National Congress of the Brasilian Society of Hansenology and the Regional Congress of the International Leprosy Association held in Maceio’, Brazil, from the 23 to 26 November 2011,the more hypotheses I get.  The congress days were excellent.  I met many friends and colleagues all discussing about leprosy, its complexity, its sequelae and how to address the many unresolved questions.  None, among the great number of health workers present was talking about the so called “elimination strategy”, with two exceptions.   Just at the welcome session two speakers, mentioned this strategy.  Might it be (hypothesis) that somebody from Brazil or from outside is advising the use of this strategy against the opinion of most people working in this field?

If that were that case it is a nightmare, we are back to square one.  There has been no learning from the past.  Should wait we again for somebody like Dr Sansarricq who honestly reported:  << “ … Noteworthy, too, is that the elimination initiative was recommended by the WHO Executive Board and the World Health Assembly without a WHO Expert Committee meeting, Study Group, or other preparatory step.  It may have been felt that a technical meeting was likely to express some reservations about the elimination concept …” > >?

Not to mention about who is going to organize the next International Leprosy Congress about a disease that was already eliminated in the year 2000, then with a final push it was eliminated again in the year 2005, then the same disease went into the post elimination era [incredible, the post-elimination era!] and, then Brazil starts all over again and, then India pays money to “volunteer” health workers per each leprosy patient detected.

It is not a matter of words, it is a matter of tools or weapons in the armamentarium against leprosy, we should use the right ones.  It is like we were using the wrong drugs and giving away MDT.  If instead, we use the right tools we can only do better.

Best regards,

S. Noto