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WHO Goodwill Ambassador's Newsletter For The Elimination Of Leprosy

AMBASSADOR’S JOURNAL: A Meeting with President Lula

The Goodwill Ambassador travels to Brazil to get the latest on leprosy control activities there, and to offer his encouragement and support.

BRAZIL (NOVEMBER 17-19)
In November I visited Brazil for a meeting with President Luiz Inacio Lula da Silva. I have been concerned about Brazil, where the leprosy prevalence rate remains quite high at 2.8 per 10,000 population. Along with Nepal, it is one of only two countries that have yet to advance beyond the WHO's interim goal of eliminating leprosy as a public health problem. Therefore, I wanted to learn more about the nation's current situation, and what can be done to help it pass the elimination milestone.

First I met with Dr. Maria Leide de Oliveira, coordinator of the National Program for Leprosy Control at the Ministry of Health. She reminded me that multidrug therapy was introduced to Brazil in 1986, and that the federal government has made leprosy a priority. She said that it is doing its utmost to achieve elimination.

However, she pointed out that Brazil is divided into 27 states and some 5,800 municipalities, and the high level of regional and local autonomy restricts the efficacy of central policy. Consequently, the strategy for leprosy is not being applied in a uniform way across the country.

As an example of the challenges the program faces, she mentioned that in 2007, 15,000 health centers nationwide (or just 34% of all health facilities existing) were diagnosing and treating leprosy. Ideally, that number should be 20,000 to 30,000, said Dr. Leide. Another problem stems from frequent changes in health personnel at the municipal level resulting from local elections, which disrupt relationship-building efforts between the federal and municipal authorities.

Brazil detected some 40,000 new cases of leprosy in 2007, of which 7.5% were children, and 6% presented grade 2 disability. The ministry has identified 1,173 municipalities, mainly in the Amazon region, that together form 10 leprosy hot spots. These clusters account for about 50 percent of new cases nationwide.

Dr. Leide stressed that one of the national program's priorities is to reduce the detection rate of new cases in children under 15. The goal is a 10% reduction by the year 2011. She said firmly that municipalities where child cases exist ought to be ashamed.

With President Lula (left) in Brasilia on November 18

Later the same day I met with President Lula. Also present were Minster of Health Jose Gomes Temporao, Special Secretary for Human Rights Paulo de Tarso Vannuchi, Health Surveillance Secretary Dr Gerson de Oliveira Penna, Dr. Leide, and representatives of MORHAN, the influential support group for people affected by leprosy. For the outcome of this meeting see my message on page one. What emerged was President Lula's keen commitment to solving the problem of leprosy in Brazil. He made it very clear to all present that he wants to see progress made on this issue.

During my stay in the capital, Brasilia, I also called on the offices of GAMAH, an NGO supporting women affected by leprosy, and met with Mrs. Marly Araujo, the organization's president. She is a nurse, and is herself a person affected by leprosy.

Following my time in the capital, I visited Sao Paolo, where I went to the Padre Bento Hospital and the Sao Francisco de Assis Home. The latter was built in 1973, on land donated by the city. It houses the former occupants of the leprosy isolation facility that was converted into the Padre Bento Hospital after the nation's policy of isolating people with the disease was scrapped in the 1960s. Of the 80 residents, 42 are affected by leprosy; the remainder are rent-paying senior citizens.

Brazil remains a concern, but I am hopeful that my visit has spurred political efforts to renew attention on the country's leprosy burden. I shall be following its progress closely.