Equipe de pesquisadores realiza roda de conversa com moradores do distrito de Corte de Pedra, em Presidente Tancredo Neves - BA / Foto: divulgação

In 2019, Bahia registered 1,292 cases of cutaneous leishmaniasis, an infectious, non-contagious disease that causes ulcers on the skin and mucous membranes. The numbers  divulgad the  the Secretary of State of Bahia Health ( Sesab ) can  be even more expressiv them  because of underreporting, which occur when it is not diagnosed the disease by official health agencies. Also according to  the survey , Valença is at the top  of the notifications : there were  at least  121  cases just last year. The situation in the municipality will now be monitored by the Eclipse project, a global study that aims to investigate the social impact of leishmaniasis in three countries. 

Led by parasitologist Helen  Price  and anthropologist Lisa  Dikomitis , from Keele University  , in the United Kingdom, the study will be conducted in Brazil by doctor Paulo Machado, coordinator of the Immunology Service (SIM) at Professor Edgard Santos University Hospital ( Hupes ) Federal da Bahia (UFBA), and Professor Leny Trad, coordinator of the Community, Family and Health Program (FA-SA) at the UFBA Institute of Collective Health. 

“Cutaneous (or cutaneous) leishmaniasis develops when a person is bitten by the Lutzomyia mosquito  , which contains Leishmania-type parasites. These microorganisms reach the blood vessels and form lesions on the skin that can grow in size ”, explains parasitologist Helen  Price. 

Researchers identify endemic areas in the region of Presidente Tancredo Neves – BA / Photo: disclosure

In addition to Brazil, the study will be carried out in Ethiopia and Sri Lanka, countries with a high incidence of the disease, but with different realities regarding the understanding and coping with cutaneous leishmaniasis. “In Ethiopia, for example, there is no official report on the disease. In Sri Lanka, the disease is more recent and the local population still does not have much knowledge on the subject ”, explains the parasitologist. 

She notes that the Brazilian population has more knowledge about cutaneous leishmaniasis, but that accessibility to treatment is still a problem to be overcome. “What is happening in one country can help those who work in the other, so that we can exchange experiences and establish collaborations”, he highlights.  

The project brings together researchers from different areas such as anthropology, medicine, parasitology, psychology, social sciences and the arts. For four years, the team plans to collect data, create intervention models and empower communities to deal with the effects of the social stigma caused by leishmaniasis.  

“Stigma is not just about scars, it involves other aspects. The project proposal is a biopsychosocial approach to health. That is why, in each country, it is important for the community to get involved and participate in the interventions ”, explains anthropologist Lisa  Dikomitis . 

Brazilian reference center 

Patients await care at the Leishmaniasis Reference Center Dr. Jackson Maurício Lopes Costa, located in the Corte de Pedra district, in Presidente Tancredo Neves – BA / Photo: disclosure

In Brazil, in addition to Valença, the project will also operate in Presidente Tancredo Neves and Teolândia, municipalities in Bahia with a significant history of cases. The contact of the researchers will be made with the collaboration of the municipal health secretariats and the Leishmaniasis Reference Center  Dr. Jackson Maurício Lopes Costa, located in the Corte de Pedra district, in Presidente Tancredo Neves, where most cases in the region are attended to. 

“In the last 30 years, the Immunology Service of  Hupes / UFBA has been developing important research projects at the Corte de Pedra health post, an area of ​​high  endemicity  for cutaneous leishmaniasis”, highlights doctor Paulo Machado. 

The Brazilian experience will now serve as the basis for the performance of the new study. “This is a disease linked to environmental factors, affecting a poor population in the rural area and bringing numerous challenges, such as the impossibility of prevention due to the absence of vaccines and other prophylactic means”, he observes.  

For the coordinator, the treatment based on injectable medications and that cause several toxic effects in patients is another obstacle for those living with the disease. “Unfortunately, cutaneous leishmaniasis is a neglected disease and health policies to deal with this endemic disease are far from meeting the minimum necessary,” he says. 

Recognizing the territory 

The British group’s first meeting with local researchers took place at the Federal University of Bahia last month. For a week, the team led by Helen  Price  and Lisa  Dikomitis  got to know UFBA units closely involved with the project.  

Parasitologist Helen Price (left) and anthropologist Lisa Dikomitis (right) present the Eclipse project at the UFBA Institute of Public Health

On the occasion, they presented the main proposals to members of the Collective Health Institute, the  Dean  of Research and Graduate Studies and the Immunology Service of the Professor Edgard Santos University Hospital ( Hupes / UFBA). “We had a particularly productive and strategic week to create the bases for the project at the university”, highlights Leny Trad, professor at ISC / UFBA and coordinator of Eclipse in Brazil. 

The team of researchers also visited the municipalities that are the focus of the project: Valença, Presidente Tancredo Neves and Teolândia. “We made an initial approach to the territories that will be the target of ethnography and especially rich contacts with some collaborators and key research informants”, explains the coordinator. 

In addition to conversation circles with members of the communities, the researchers also monitored the activities of the Leishmaniasis Reference Center Dr. Jackson Maurício Lopes Costa, in the municipality of Presidente Tancredo Neves, which provides specialized care for the disease for the population of that region. “Residents are very lucky to have that referral center, but we know that in other areas there is not even a supply of medicines,” observes anthropologist Lisa  Dikomitis  

For her, direct contact with communities is the main way to understand all the difficulties that the population is going through. “What we want is for all of our researchers to make the patients’ itinerary. What does it mean, for example, to travel 6 hours by bus to seek care? All researchers must take this same journey to discover how painful the treatment is ”, he suggests. 

Brazil was the first country visited by researchers at Keele University   to formalize the cooperation and multicentric research of the project. The Eclipse will last for four years and the expectation is to create committees and work groups in this period that can subsidize public policies to face the disease.  

Professor Leny Trad (ISC / UFBA) and doctor Paulo Machado, coordinators of the Eclipse project in Brazil

At UFBA, the project is supported by the  Dean  of Research and Graduate Studies, Advisory on International Affairs, Institute of Collective Health and Faculty of Medicine of Bahia ( Fameb ). 

“In addition to the impacts on the academic field, I highlight the potential for the health of the population, since Eclipse contemplates interventions aimed at overcoming the biopsychosocial challenges associated with leishmaniasis in local contexts, built together with key social actors”, concludes Trad. 

To find out more about the project, follow the Eclipse profile on Twitter: @ ECLIPSE_Keele