No.66 Ambassador’s Message:Hidden Cases in Brazil and Indonesia

In December 2013 and January this year, I visited Brazil and Indonesia. Brazil sees over 30,000 new cases of leprosy annually and Indonesia around 20,000. In Brazil I traveled to the Amazon basin and in Indonesia to the eastern province of Papua. I toured health facilities and visited communities of people affected by the disease.

In both areas I met people with pronounced disabilities, a sign they were diagnosed late. I also encountered cases of transmission within families. In Brazil’s Para State I visited a family where all five members — the mother and father and their two daughters and son — have or once had leprosy. In Papua, I met a four-year-old girl patient.

In Brazil and Indonesia, multidrug therapy is dispensed at health centers. Patients must go there each month for their prescriptions. For many, this can mean long journeys that are costly and inconvenient. Consequently, quite a few never complete their treatment. Is it not possible to prescribe three or six months’ worth of MDT at a time, I wonder?

Both countries have made firm commitments to tackle leprosy, but because of the progress of decentralization, the central government’s commitment doesn’t necessarily filter down to the regions, where budgets and human resources for leprosy control are inadequate and local leaders may not be aware of the leprosy situation.

There must be many hidden cases in difficult-to-reach areas. We need to encourage community health workers, midwives, missionaries, teachers and especially people affected by leprosy to be on the look-out for new cases. Once confirmed, treatment must begin promptly.

Sustaining quality leprosy services requires this. Only this way can we observe the cardinal rule: early detection and prompt treatment. Decentralization notwithstanding, it is my strong wish to see central and local governments in Brazil and Indonesia join forces, raise the priority of leprosy and do their utmost to uncover new cases. I hope the WHO will hold urgent consultations with the governments concerned and find a way forward.

Yohei Sasakawa, WHO Goodwill Ambassador


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