Monday, March 15, 2010

Fight for Elimination and Equality: Leprosy in Brazil

by Alex Moorhead

edited by Alexandru Cristea

One of the oldest diseases known to man, also cited multiple times in the bible, is still affecting people today. The biggest shock of all is that the infection is curable. Leprosy is still widespread in 17 developing countries. They make up 94% of the world’s leprosy cases, according to studies by The Nippon Foundation. The foundation researches the disease expansively to reach its goal of eliminating leprosy.

The World Health Organization (WHO) made a target to eliminate leprosy, also known as Hansen disease, as a public health problem. Less than one in 10,000 people in the world have it. The results of its attempt showed there are only two countries that do not meet those standards: Brazil and Timor Leste.

According to a WHO 2009 Report, the prevalence of leprosy in the 121 countries that responded was 213,036, that’s around 30,000 fewer cases detected from the previous year. Brazil detected 38,914 in 2008. The only country with a higher number is India.

When asked why Brazil has such a high percentage of people affected by leprosy, immunologist Samira Buhrbr at the World Health Organization in Brazil said “we would also like to know the answer.”

She added that the number of people with leprosy started many years ago and back then people were not given medical attention, so there is still contamination causing the infection in Brazil.

The WHO, “is working very hard to decrease the number, but it’s not that easy,” Buhrbr indicated.

The main strategy of controlling leprosy is detecting new cases early and then promptly providing treatment with multidrug therapy (MDT). MDT is provided free of cost to leprosy patients in endemic countries. But if so, then why does leprosy still exist?

Buhrbr says their strategy to reduce the disease is examining all contacts, people living with patients or former patients. Leprosy is a stigmatized disease and that, “makes it difficult to make them come to the health center. They usually want to hide their leprosy from society,” Buhrbr said.

She also indicated that people avoid going to the doctor because they do not want to find out if they have it. Leprosy is a deforming disease and this is why it carries a stigma, but this is not the only reason why some are ashamed to admit they are affected by it.

“Many people still believe that God gives leprosy. It’s difficult to eliminate a stigma that has been spoken about throughout history,” Buhrbr said. She added that, because leprosy is referenced in stories from the Bible, people see the disease connected with religion.

There are many programs, documents, and organizations dedicated to fighting for the rights of those who have leprosy. Victims are usually ostracized from their community because of their deformed appearance.

The 5th Global Appeal to End Stigma and Discrimination against People Affected by Leprosy was passed in January this year. The Nippon Foundation sponsored the appeal in hopes that it will create social integration while stopping discrimination against people with leprosy. The first sentence in the 2010 Global Appeal expresses the victims’ outlook. “People affected by leprosy often say that dealing with society's attitudes toward the disease is harder than dealing with the disease itself.”

In an attempt to ease the pain of dealing with society’s attitudes, a nonprofit organization called The Movement for the Reintegration of People Affected by Leprosy (MORHAN) was created to advocate for the social rights of leprosy patients by trying to get rid of the disease and the stigma. MORHAN provides services in approximately 100 communities in Brazil.

On MORHAN’s website there is a description of the organization’s project called “Partnership Program for Diagnosis and Treatment of Leprosy.” They partnered with the National Council of Municipal Health and built the Carreta Health Center that has five offices in the states of Maranhao, Para, Tocantins, and Piauí, which are the most widespread, in order to reach their goal of eliminating leprosy this year.

The center is serving the poorest populations by providing both consultation and early treatment when they find positive cases. MORHAN’s written mission is that everyone will learn how to identify the disease and will know where the health centers are in their cities.

The most affected population is the poor region in northeastern Brazil. Buhbrb compares catching a cold with how leprosy is contracted.

“It’s easy to imagine getting a cold; your immune system goes down and you become more susceptible to other infections.”

Brazilians living in the northeastern region are likely to get leprosy because their immune systems remain low and because of their lack of food and unhygienic lifestyle.

“That’s why they’re more vulnerable to get infections,” Buhrbr said.

With all these efforts in place to abolish the disease and rehabilitate those who are affected, there has been progress. The Ministry of Health provides the latest information on the improvements saying the number of new cases of leprosy has dropped by 30% in the last five years. The preliminary data the Ministry has gathered states that in 2009, 16 out of 100,000 inhabitants will be detected to have leprosy, compared to about 20 in 2008.

Coordinator of the National Leprosy Control Program,Maria Aparecida de Faria Grossi explained the reduction.

"We have intensified partnerships and actions of communication and education, to keep the diagnosis of existing cases. It is important that all people with red or white patches or areas dormant in the body to seek health services," she said.

Caring for leprosy has been added to the primary healthcare services of the Unified Health Systems.

“The fact that we have most of the treatment of leprosy in the primary care level of the Unified Health System shows that the network has been organized to facilitate patient access to services. However, there is much to be done in order to improve care. The goal is early detection, to provide timely treatment and stop the chain of transmission of the disease, with emphasis on surveillance of the contacts. Thus, prevent disabilities, encouraging self-care, " Grossi added.

Photos courtesy of and

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