LEPROSY AND PRIMARY CARE: EDUCATIONAL AND HEALTHCARE CHALLENGES FROM THE PERSPECTIVE OF MEDICAL RESIDENTS

Abstract

Primary care is the privileged care level for measures to control leprosy, a neglected and stigmatized infectious disease that has not been controlled as a public health problem in Brazil yet. Aiming to describe the perception of leprosy by primary care physicians, we conducted a focus group with seven Family Medicine residents in the municipality of Betim, Minas Gerais. Results: Content analysis pointed to the subcategories of “knowledge sources”, “primary health care” and “health education”. Undergraduate medical training about leprosy was shown to be predominantly theoretical with few cases, and continuous education in the Local Department of Health is insufficient. In the assistance category, it was pointed out that a high level of suspicion is needed to clinically evaluate patients for leprosy. Primary healthcare was recognized as the correct treatment setting for these patients despite the excessive demands and the inadequate infrastructure of the services; the obligatory reference to specialized services creates separation, expands the stigma and complicates horizontal monitoring of the patients with this disease. In educational practices, the dissociation between the disease and severity, attributed to the change of nomenclature, is clear. Concerning communication, popular language should be used by the mass media; stigma is a crosscutting theme. Conclusion: The three categories of analysis, knowledge (absent), assistance (insufficient) and health education (for suspicion), together explain the difficulties of care. A medical degree is insufficient, relies on theoretical content with few cases, and generates the perception of a rare disease in the purview of the specialist. Educational activities must correlate the symptom of the “skin patch” to disease severity, and demand effective primary healthcare to serve these people satisfactorily.