If we assume that the main problem to promote collaboration between health workers and patients is a matter of communication, let us consider that nature is wise and that the one that could better master the skills of communication is the health worker that lives in the same country, or in the same city, or in the same village and that have a cultural background similar to the patient. An abridged version of this idea can be found in an statement made by Dr. Colin McDougall related to a meeting on teaching/learning materials for leprosy：
I have noted, with some concern, that many people accept/assume... that books, booklets, etc. ... should be developed in the U.K. or perhaps in Europe and send out... I have considerable reservations. ... some of the material is inappropriate, too complicated or too long, or simply too difficult for people with limited education. . .
Concluding, we may say that, although MDT has effectively contributed to a variety of improvements in the control of leprosy, nerve damage is still a continuing threat to managers of control programs and a challenge to health personnel and researchers. The best approach to prevent nerve damage, and thus prevent disabilities, is still early detection and adequate treatment. However, it is clear that a group of persons will need some sort of actions to prevent disabilities and to prevent its worsening. In this regard, program managers and all health personnel should be aware for the needs to implement POD activities in their control programs.
REFERENCES
VIRMOND,M. Hansen's disease as a low prevalence disease. Hans.Int, 20 (2) , 1995.
YUASA,Y. MDT for all - target oriented leprosy control program in the 1990s - Int.J.Lepr.
59(4) , 1990.
World Health Organization. Action Programme for the Elimination of Leprosy. Status Report 1996. WHO/LEP/96.5
M. Virmond, Lauro de Souza Lima, Bauru, BRAZIL
