The World Day to Combat and Prevent Leprosy is always celebrated on the last Sunday of January. This year, the date falls on the 30th and the campaign theme is “We need to talk about leprosy”. The date is a symbol of Purple January and aims to draw people’s attention to the disease, which has treatment and cure. Prejudice is still one of the great challenges in the fight against leprosy.
Leprosy is an infectious disease caused by the bacterium Mycobacterium Leprae, also known as Hansen’s bacillus (named after Gerhard Hansen, the Norwegian physician and bacteriologist who discovered the disease in 1873). The bacillus reproduces slowly and the average period of incubation and appearance of signs of the disease is approximately five years, according to information from the Pan American Health Organization (PAHO).
The initial symptoms are spots on the skin, resulting in lesions and loss of sensation in the affected area. Muscle weakness and tingling sensations in the hands and feet may also occur. When cases are not treated at the onset of signs, the disease can cause progressive and permanent sequelae, including deformities and mutilations, reduced limb mobility and even blindness.
For Artur Custódio, National coordinator of the Movement for the Reintegration of People Affected by Leprosy (Morhan), the challenges in combating the disease are many. “We have problems with the early diagnosis of leprosy, that is, health professionals are not able to identify the disease at the beginning. Another serious problem, which occurred in the previous year, was the lack of medication. We need to have these medicines manufactured in the country so as not to be vulnerable to any external problem. We also need to have research for new drugs for leprosy, as well as for new tests for early diagnosis. We also have the problem of the sequelae of the disease. So we need a rehabilitation system that accepts people, that does not have prejudice, that can fulfill the role of rehabilitating those who are left with some sequelae of leprosy. And finally, we have to face the stigma of the disease. Stigma is underestimated, it is there, it is structural and generates a series of problems, including from an institutional point of view”.
According to the Brazilian Society of Dermatology (SBD), about 30,000 new cases of the disease are detected every year in Brazil. Worldwide, about 210,000 new cases are reported annually, of which 15,000 are children. According to PAHO, leprosy is found in 127 countries, with 80% of cases in India, Brazil and Indonesia (2018 data).
Sandra Durães, coordinator of the Department of Leprosy at SBD, leprosy is classified among the so-called neglected diseases, which affect populations with a low Human Development Index (HDI). “Brazil, despite being among the great world economies, has great social inequality. On the outskirts of their metropolises there are large pockets of poverty”, he explains.
She also points out that the majority of the population is resistant to leprosy, but there is a small percentage of people who are susceptible to the disease. “In these people, the disease varies a lot depending on the resistance they present to the disease. We have two basic types of patients, those with excellent resistance and with few skin lesions, few peripheral nerves affected and low bacillary load. On the other hand, we have patients who have a large bacillary load, a large number of skin lesions and a large number of affected peripheral nerves. The treatment of these patients is different. Those with few lesions are treated with antibiotics for six months. Patients with a high bacillary load undergo treatment for 12 months. The treatment is done at the health center where the patient, once a month, takes a medication, and the other medications are taken at home”.
Leprosy is transmitted through the air, especially in situations of close contact. The majority of the population has natural defenses against the bacteria, but about 10% of the population do not have these protective mechanisms and can become ill.
As soon as antibiotic treatment is started, the disease is no longer transmissible, so it is important to diagnose it at the beginning of the signs. However, antibiotic treatment does not reverse neural damage and sequelae caused by late diagnosis. If there is a positive result, people who have intense contact with the infected person should also seek the health system.
The World Health Organization (WHO) strategy, entitled Towards Zero Leprosy, focuses on reducing new case detection, physical disabilities (especially among children), and stigma and discrimination. Until the 1970s, in Brazil, carriers of the disease were excluded from social life and taken to confinement in colonies.
“In the past, we had a policy of segregation, hygienist, cleaning of the Brazilian State, in which the sanitary police came, captured the person and took them to an isolation colony. This practice, despite the discovery of a cure in the 1940s, officially persisted in Brazil until 1976 and, in practice, we had episodes until 1986. Law 11,520/2007, which established compensation, for the crime of State, to those people who were segregated. And we fight to have the recognition of the children who were taken from their parents at the time of segregation. There is a bill in this sense, which unfortunately was removed from the agenda in the last vote of the year. So it is important that he returns to the agenda at the Constitution, Justice and Citizenship Committee (CCJ) and leaves the CCJ of the Chamber and goes to the Senate”, explains Custódio.
Also according to the National coordinator of Morhan, “Brazil is one of the countries that ended all discriminatory laws in the 1990s, and that advanced towards the creation of reparations”.
“Brazil has already compensated around 10,000 people to date,” he added.
For Sandra Durães, enlightening the population is essential, “so that they are aware, know the signs and symptoms of the disease, can seek medical assistance as early as possible and so that the diagnosis and treatment are early, thus avoiding neurological damage. and patient disability. And, also, to contribute to the reduction of the stigma that exists in relation to the disease, which is infectious and potentially curable”.
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