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WHO Goodwill Ambassador's Newsletter For The Elimination Of Leprosy

INTERVIEW: ‘Nobody Believed Her’

In Brazil’s Mato Grosso state, people suffer because doctors don’t recognize leprosy.

How is the situation in your state?

Yesterday, I saw five cases of leprosy. Four people were already disabled by the time they came to me, including a child of seven who had lost some fingers and had a claw hand. There was a 40-year-old woman who had been looking for a diagnosis for three years. She knew that she had leprosy, but nobody believed her. She also had ulcers.

What’s the problem?

Communities have access to doctors, but unfortunately many doctors don’t recognize the disease because they don’t know enough about leprosy. Leprosy is fundamentally a disease of the peripheral nerves with skin manifestations, but not always. You have to learn to examine the peripheral nerves, to examine the sensitivity. It’s easy to diagnose someone with a skin patch; it’s much harder without a patch when you have to look at nerve involvement.

Were you familiar with leprosy as a child?

No, only after I entered medical school. I did my residency at the Instituto Lauro de Souza Lima (a specialist dermatology and leprosy center in Sao Paulo) and saw leprosy patients many times. I wrote my doctoral thesis on leprosy.

What drew you to specialize in the disease?

The disability that it leaves behind; the after-effects.

Are your fellow health professionals interested in leprosy?

No, because it is not a specialty that makes money for them as consultants. It is not profitable for doctors.

If you had to persuade them, what would you say?

You have the power to change the course of someone’s life, especially a child, when you make a diagnosis. If you don’t act at this moment, that child will have complications that will affect the rest of his or her life. As a doctor, you can make a difference.

What needs to happen now?

We need to train doctors and healthcare staff at the very local levels — the basic health units, the primary health care units — to identify and treat leprosy patients. That way, you cover most of the cases. Difficult cases can be referred to referral centers. If you train doctors at the periphery of the health structure, you will reach most of the population and then you will improve the diagnosis and treatment.

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PROFILE: Dr. Luciana Neder

Dr. Luciana Neder is a doctor specializing in leprosy at Hospital Universitario Julio Muller in Mato Grosso, Brazil. The state has the highest case detection rate of leprosy in the country.