History of Latin American Dermatology

ELBIO FLORES-CEVALLOS, LUIS FLORES-CEVALLOS, ZUÑO BURSTEINFigure 31. Rates ofprevalence anddetection of leprosyin Peru, 2000towards the elimination of leprosy, as part of its health objective for everyone in 2000.”In October 1988, the Rules and Procedures for the Control of Hanseniasis in Peruwere approved, of mandatory application in all the national territory in its technical, administrative,educational, social and investigational components. In 1992, the normativedocument was approved, entitled “Doctrines, Rules and Procedures for the Control andElimination of Leprosy in Peru.”In our country, there was, up to 2000, a technical and administrative structure withinthe Health Ministry called Office of the National Program for the Control of TransmissibleDiseases, which included the Tuberculosis and Leprosy Control Program, and whichcould count on the potential cooperation of an Advisory Committee formed by tropicalist,leprologist and dermatologist physicians.At present (2004), the administrative restructuring of the Health Ministry has eliminatedthe specific national disease-control programs, including that of Leprosy. In its stead,six administrative structures called Health Strategies have been set up in a General Officefor People’s Health, and one of them is in charge of Tuberculosis and Leprosy Control.Policy of the leprosy control program and future outlookThe framework of the doctrine adopted in 2000 by the National Leprosy Control Programin Peru 62 is based on the principle that “transmissible diseases, including leprosy,are linked to cultural, social and economic factors of complex solution,” and that “controlprograms are of national scope, permanent and continuous; they use appropriatetechnologies, they feed back and make their operation more efficient through monitoringand evaluation, and, in their current version, they have adopted the strategy of incorporatingand integrating their activities with the general health servcies, with theconsequent elimination, due to their inefficiency, of vertical programs with specializedexecution of their activities outside health services.”Within this framework, the current program considers that “the fight for the controlof leprosy is inscribed and articulated in the acknowledgement of the dignity of people,their universal rights and the search for liberation of their capabilities to attain full realization,”concluding that this new doctrine is based on a modern conception that “hasa bioethical sustentation in the development of the principles of equity, subsidiarity, universality,solidarity and autonomy, developed through the interaction of the medical, educationaland social fields.” The program is underpinned by the doctrine that it isfeasible to control and eliminate leprosy in Peru based on certain action principles.The WHO defines the elimination of leprosyas a health problem as a public prevalence rateof less than one case for every 10,000 inhabitants;however, this situation does not occur incertain identified and stratified regions of thecountry. This is why, in order to achieve thecontrol and elimination of this disease, it is necessaryto strengthen the development of a seriesof activities, based on the dissemination ofthe following principles: leprosy can be cured,the patient is to be treated at home and neitherisolation nor reclusion in leprosariums is required;leprosy that is diagnosed early does notnecessarily produce deformities or incapacities;once the polychemotherapy (PCT) isstarted, the leper does not infect others, and, if the patient does not receive treatment,he or she suffers deformities on hands and feet, which remain as sequels for the rest ofhis or her life, notwithstanding subsequent treatment.Departamentos Población Total de casos Tasa de prevalencia Casos nuevos Tasa de detecciónendémicos 1989 x 10.000 hab. x 10.000 hab.1. Loreto 889.471 83 0.9 29 0.32. Ucayali 424.410 60 1.4 14 0.33. Amazonas 143.981 0 0 0 04. Apurímac 243.852 1 0.04 0 05. Huánuco 776.727 2 0.02 0 06. San Martín 743.668 3 0.04 0 0Lima Norte(Hospital NacionalCayetano Heredia) - 15* - 0 0Lima Sur(Hospital de ApoyoMaría Auxiliadora) - 1* - - -Total de casos 3.218.109 165 0.5 43 0.1* Casos procedentes de las zonas endémicasFuente: Programa Nacional de Control de Enfermedades Transmisibles - Control de Lepra - MINSA350