Brazil is one of a handful of countries that have yet to achieve the WHO's goal of eliminating leprosy as a public health problem. However, under the personal direction of President Luiz Inacio Lula Da Silva, the government, the WHO and NGOs are actively working together to reach this milestone.

 On my most recent visit to Brazil in June, the prevalence rate stood at 1.48 and I was told there were some 18,000 registered cases. A measure of progress is that in just two years, the reported number of new cases has dropped by 24.27%, down from 49,300 in 2004 to 38,400 in 2005. According to the federal government, Brazil will reach the elimination goal at the national level by the end of the current fiscal year or at the beginning of the next.

 The first stop on my journey was Rio de Janeiro, where I visited the Hospital Frei Antonio, the oldest leprosy facility in Brazil. It was originally a monastery founded by the Jesuits in 1752 and was active as a leprosy hospital up until 20 years ago. Today only four elderly residents remain. One of them entered the hospital as a girl of seven and has lived there more than 80 years. When she was admitted, her father planted a sapling in the hospital grounds. Today it has grown into a large tree, and she told me that looking at it is a daily pleasure.

 Next I visited the Tavares de Macedo colony in the suburbs of Rio, which was established by the federal government in the 1930s. About 250 people affected by leprosy live here. However, the non-leprosy affected population is much larger, attracted by subsidized rents and utilities.

 Most of the arrangements for my visit to Brazil were made by MORHAN, a grassroots movement headquartered in Rio for the reintegration of people affected by leprosy. MORHAN has six regional coordinators and 100 centers across 24 of Brazil's 27 states, and works closely with the Brazil government. It sits on the 48-member National Health Council. Half of the council's members are drawn from civic society, and it plays a key role in shaping the federal government's health policies.

 One of MORHAN's major initiatives is a tollfree telephone counseling service called Telehansen. For the past two years, The Nippon Foundation has supported its activities. Staffed by volunteers, including people affected by leprosy, the 12 phone lines Telehansen operates receive an average of 7,000 calls a year related to leprosy. Subjects range from medical questions to queries about human rights and social issues.

　

　

　

　

 From Rio de Janeiro I traveled to the capital, Brasilia. Among those I met were Brazil's health minister, Dr. Jose Agenor Alvares da Silva, Dr. Rosa Castalia, in charge of the leprosy control program, Rogerio Sotille, head of the special secretariat for human rights, and Senator Tiao Viana, vice president of Brazil's Senate.

 Between them they assured me that the elimination goal would be achieved and that human rights questions were being addressed. Concerning the rehabilitation of people affected by leprosy, the federal government has admitted that the past policy of isolating them was a mistake, and is now working to provide appropriate social support, possibly by offering benefits in the form a pension. This would certainly be a remarkable development if it happened.

 Next, I traveled 2,300 kilometers northeast of Brasilia to the town of Fortaleza in Ceara State. There I paid a courtesy call on Dr. Jurandir Frutuoso, the state health secretary. At present, the state PR is 1.76, and Ceara is increasing the number of health personnel as it makes steady progress toward the elimination goal. Dr. Frutuoso also gave me some insights into political measures being taken for the social rehabilitation of persons affected by leprosy, as well as their integration into general society.

 In some countries, the thinking is to close down colonies and have people affected by leprosy find a way to live in the community at large so as to hasten their social reintegration. In Brazil, the government believes it better to encourage family members to go and live in the colonies and achieve social integration that way. It is a very interesting approach.

 I visited two colonies that day ― Antonio Diogo in Redencao, and Antonio Justa in Maracanau. At the latter, I spoke with 66-year-old Raimundo Martins de Souza (“Severo”), MORHAN's coordinator in Maracanau. Severo recalled in blunt terms what life had been like in the past, when nuns had been in charge of the colony and ran it on very strict lines. No one was allowed to go out after 10 p.m. regardless of the reason, and they would be attacked by dogs or thrown in the colony jail if they did. The colony was dubbed “the town of the dead” and it was surrounded by barbed wire to prevent escapes. Severo told me that when he entered the colony he was stripped of his citizenship and the word “leper” was inscribed on his identity card.

 On leaving Fortaleza, I next headed for Manaus, the capital of Amazonas State. It was in Manaus that I met Dr. Maria da Graca Souza Cunha, head of the Alfredo da Matta Foundation (FUAM), which is making an outstanding contribution to leprosy control in the state, especially in remote, highly endemic areas. She and her staff arranged for me to visit the Paricatuba health center in Iranduba, a jungle town of about 800 people reached by boat along the Rio Negro, a tributary of the Amazon.

 I was pleased to find a good supply of MDT at the health center, despite Iranduba's isolated location. I was also fascinated to explore the ruins of a leprosy sanatorium. A vast stone complex originally built for immigrant workers, it later became a school, and then a prison, before being turned into a leprosy sanatorium in 1929.

 The next day, I went to visit a leprosy-affected family living on the banks of the Rio Negro. To reach them, I traveled by boat for about two hours, passing by isolated dwellings en route.

 Antonio Motelo and Dona Maria live together with their son and his family, and make a comfortable living by manufacturing wooden skewers use for cooking fish and meat. Talking with them, I was surprised to learn how deeprooted the problem of discrimination was.

 Antonio was the first to develop leprosy. A paramedic would visit regularly to bring MDT. Next, Dona Maria came down with the disease. Because she didn't want it to be known locally that she had leprosy, she went to a hospital in Manaus to have the diagnosis confirmed and receive her supply of drugs. Then their daughter contracted the disease. Apparently she too hid the fact and went to Manaus. Even in such a remote location, it seems, people feel it necessary to conceal the disease from others.

 I left Brazil confident that the federal government is making strenuous efforts to eliminate leprosy, deliver treatment to all who need it and root out discrimination and prejudice. In addition, it is receiving invaluable support from dedicated organizations such as MORHAN and FUAM. I intend to remain in close contact and do all I can to assist in this progress.