Leprosy Mailing List – October 3, 2024
Ref.: (LML) Our new doctors have no clue about leprosy': experts skeptical of India's target to eliminate the disease by 2027
From: Claudio Salgado, Belém, Brazil
Dear Pieter,
Regarding The Guardian's report on the lack of diagnosis that we have been discussing for a long time (1–3), I would like to inform LML colleagues that we are now forming new hansenologists in Brazil, something that hasn't happened for over 40 years.
The Brazilian Society of Hansenology (SBH), together with the Public Health School of Mato Grosso (one of the most endemic states in Brazil) and the State Health Department of Mato Grosso, have established an agreement to form between 50 and 60 new hansenologists from 2023 to 2025. The course is performed in 12 months, and to enroll in the course, doctors must already have some other registered specialty, like dermatology or infectious disease, for example.
In 2023, we formed the first 18 doctors in a highly practical course, where the student doctors were taken to examine individuals alongside the professors, all of whom hold PhDs and are members of SBH. These examinations were conducted in referral centers, basic health units, institutions such as penitentiaries, and in the homes of families affected by leprosy.
The initial results are very encouraging. In 2023, Mato Grosso was the first Brazilian state to return to pre-pandemic levels of new cases from 2019, and it currently ranks first in new leprosy case detection in Brazil. This year, 2024, the second cohort will complete their training, adding 19 more leprologists spread across Mato Grosso, a state with a land area comparable to that of Germany. We have made efforts to avoid concentrating these new specialists in the capital, which naturally happens due to a shortage of various resources. Moreover, in 2024, it seems likely that there will be a significant increase in case numbers, perhaps even doubling again, as it did from 2022 to 2023.
To work alongside these new leprologists, the Public Health School and the State Health Department of Mato Grosso decided to open a course to specialize other health professionals, which will further strengthen the system.
Along with the new diagnoses, problems such as lack of care pathways and substitute antibiotics for patients with intolerance to MDT or drug resistance have begun to arise. Recently, a public hearing was held by the Regional Medical Council (CRM) of Mato Grosso to evaluate possible solutions in light of the shortage of substitute medications. The results also appear promising, and a document is expected to be released soon by the CRM of Mato Grosso with the outcomes and recommendations from the hearing, which had central participation from SBH, with the Public Health School of Mato Grosso, the State Health Department of Mato Grosso, the Ministry of Health, the Public Prosecutor's Office of MT, the State Court of Accounts of MT, which is also expected to hold another meeting in November, and social movements such as the Movement for the Reintegration of Persons Affected by Leprosy (MORHAN) and the National Movement of Neglected Diseases.
How are diagnoses, or the lack thereof, in the world of leprosy that was "eliminated" since the year 2000? Is everything okay? Do the hansenologist/leprologist colleagues here at LML think everything is fine, or do we need to form new hansenologists for this transmissible, chronic, slow-progressing disease that rarely kills but leaves people with disabilities and pain for the rest of their lives?
Claudio Salgado
Claudio Guedes Salgado, MD, PhD
Full Professor
Institute of Biological Sciences
Pará Federal University
Former President of Brazilian Society of Hansenology (SBH), 2018-2023
International relations advisor for the SBH
References
1. Barreto JG, Guimaraes Lde S, Leao MR, Ferreira D V, Lima RA, Salgado CG. Anti-PGL-I seroepidemiology in leprosy cases: household contacts and school children from a hyperendemic municipality of the Brazilian Amazon. Lepr Rev. 2012/03/24. 2011;82(4):358–70.
2. Salgado CG, Barreto JG, da Silva MB, Frade MAC, Spencer JS. What do we actually know about leprosy worldwide? Lancet Infect Dis [Internet]. 2016 Jul 1 [cited 2016 Jul 21];16(7):778. Available from: http://www.thelancet.com/article/S1473309916300901/fulltext
3. Salgado CG, Barreto JG, Silva MB da, Goulart IMB, Barreto JA, Junior NF de M, et al. Are leprosy case numbers reliable? Lancet Infect Dis [Internet]. 2018 Feb 1 [cited 2018 Jan 25];18(2):135–7. Available from: http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(18)30012-4/fulltext#.WmqVq2P8oBM.mendeley
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