Leprosy Mailing List – November 5th, 2007
Ref.: A Note of
Warning from Brazil
From: Poorman E.,
Boston, MA, USA
Dear Salvatore,
In response to Dr. Das’
note (LML October 23rd, 2007) regarding the leprosy
situation in Brazil, I would like to say that in my short time in
Brazil I find it very likely that there is an active transmission
situation of leprosy (though I have done no systematic research on
this).
However I would caution against a strong
reaction to this. There
is very low compliance to drug therapy in Brazil because of the
secondary effects involved in the drugs, and the lack of preparation
on the parts of Doctors and the health system generally to deal with
these effects.
Bauru is a very unusual and
wonderful center in Brazil (and indeed in the world); most places of
treatment have no integrated services.
I believe that the result of pushing drugs more aggressively
(as suggested by Dr Das) would be more drug reactions which doctors
would be unprepared to treat, and patients would find much worse than
the disease itself. These
patients would discourage others from taking the medication, as I have
seen time and time again.
In short, I think top-down approaches as
regards leprosy control in Brazil have failed and will continue to
fail as long as the primary concern is controlling the spread of the
disease and not the symptoms of the patient.
Sincerely,
Elisabeth
Elisabeth Poorman
Study Coordinator
HMS-DSM
643 Huntington Ave
Boston, MA 02115
USA
