History of Latin American Dermatology

History of Dermatology in Peruof Health, was the only person who, with absolute responsibility, kept up a programbased on the projects, on his own ideas, and on his vast experience as clinical leprologistand epidemiologist.In 1980, Zuño Burstein published an essay on the “Breakdown of the Leprosy ControlProgram in Peru due to the Decentralization and Integration with the General HealthPrograms,” 59 providing a detailed analysis of the sanitary organization of leprosy control,and concluding that, in Peru, there was a serious breakdown of sanitary control actionscaused, to a great extent, by the inadequate, untimely and premature policy ofdecentralization and integration with general health programs, not suited to the nationalsituation. Moreover, he stressed that it was absolutely necessary to set up a well-articulatedand adequately financed Hansen’s Disease Control Program, since it was a healthproblem of significant seriousness in endemic zones, with national repercussions.In 1963, with the disappearance of the National Anti-Leprosy Service and its LeprosyDepartment, the specialized laboratory diagnoses, the preparation of lepromine, the fulfillmentof special investigations and the training of professional and technical staff became,in theory, tasks of the Leprosy and Medical Mycology Department, located in theorganizational structure of the National Institutes of Health, a decentralized dependencyof the Health Ministry. This Department was derived from the Central Leprosy Laboratory,which was part of the Leprology Section of the abolished Leprosy Department, acommand organization of the National Anti-Leprosy Service, at the level of the centralorganization of the Health Ministry. When the National Service and its Leprosy Departmentclosed down, the Laboratory was incorporated into the Public Health Institute, intheory keeping its function and structure, established since 1944. Based on this structure,the Health Ministry has, since 1975, had an agreement — repeatedly ratified —with the National Higher University of St. Mark, through its Daniel A. Carrión Institute ofTropical Medicine, in order to conduct joint research work, services to the communityand staff training, regarding hanseniasis and others ailements in the field of sanitarydermatology.In a communication published in 1972, under the title “Our Contribution to the Diagnosisof Leprosy in Peru,” 60 Burstein reported that, out of 2,366 biopsies sent, from 1944to 1971, for the diagnosis of leprosy to the Leprosy and Medical Mycology Department ofthe National Institute of Health under his management, 1,119 (47.3%) corresponded tolepromatose leprosy, 619 (26.2%) to undifferentiated leprosy, 233 (9.4%) to tuberculoidleprosy and 18 (0.8%) to dimorphic leprosy. Using the serial biopsies over time, thehystopathological changes of these patients were studied, and a correlation between theclinical diagnosis and the hystopathological verification was established. No later studiessimilar to this one have been conducted.In 1980 Dr. Samsaricq, head of the Leprosy Program of the World Health Organization(WHO), visited Peru and suggested the setting up of a permanent committee thatwould take care of the Hanseniasis Control Program, promoting, evaluating and recommendingnew actions, as well as the creation of a national scientific committee to promoteand evaluate research on the disease.Up to 1985, the Epidemiology Office, within its programmatic structure, consideredthe integrated control of tuberculosis and leprosy under the Technical Office for theCoordination of Special Programs, even though the WHO considered the control of thesediseases independently. For this reason, D.S. N° 017-87-SA was issued in 1987, approvingonly the Tuberculosis Control Program, thus disassociating it from that of Leprosy.In January 1988, the National Hanseniasis Control Program was approved as partof the special health programs, appointing Dr. Augusto Reátegui as its general director61 . Supreme Decree No. 003-88SA (January 22, 1988) established that “Peru,as a member of the World Health Organization, has adopted the commitment ofthe Fortieth World Health Meeting, of May, 15 1987, to organize active programs349