Leprosy Mailing List – February 22, 2014
Ref.: (LML) Hazards of setting targets to eliminate disease: lessons from the leprosy elimination campaign
From: Jaison Barreto, ILSL, Bauru, São Paulo, Brazil
Dear Pieter
In the past, I was strongly against the concept of leprosy elimination, once elimination is reached grants are reduced. However, today, after several years working in the field, I think that the idea to reach a target is hopeful. Every time we state a target, and, of course, when we work hard to reach it, more and more patients suffering from NTD are diagnosed and cured, diminishing the burden of the disease.
Will leprosy be, really, eliminated from the world easily? Personally, I do not think so, cause it is dependent on several factors, and among them, mainly ignorance and poverty, which are quite difficult to eliminate. But this does not mean that we shall give up to reach it.
Nobody can deny the importance of MDT implementation on the reduction of the burden of leprosy. Traveling in several other countries, I have noticed that the decentralized Brazilian system of notification/treatment/management is, although not perfect, much better than several other countries. I am also sure that we have so many cases diagnosed every year because we do not hide the statistics, our system of notification is robust and believable, and also because we work hard looking for early diagnosis. The efforts to look for leprosy among school children which we use to do in Brazil is one of the best examples, of how to create new methodologies, in order to make possible diagnosis in silent areas. Who is also doing this, in other countries were leprosy is said eliminated?
With the support of governmental institutions, like Instituto Lauro de Souza Lima, and NGOs like DAHW, we work together training health professionals in the field. Research projects on NTD have more and more funds. The most difficult problem to solve I have found is how to sensitize the physician who works in the field, and also the health managers in municipalities/states for the problem of leprosy. This is quite difficult, as well.
About drug resistance, I have seen, in the field or at the national reference I work, that this is quite uncommon, and most relapses are, in fact, under-treatment (borderline patients treated as having PB leprosy), or probable reinfection due to lack of evaluation of household contacts.
Regards
Jaison
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << editorlml@gmail.com
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