The Centenary of the Leprosy Relief Association (Lepra)-a moment for celebration and reflection†.

The year 2024 is the Centenary of the foundation of the Leprosy Relief Association (Lepra), formerly the British Empire Leprosy Relief Association (BELRA). The name of the organization changed to the LEProsy Relief Association (LEPRA) in 1976 but has been known as Lepra since 2008. Over the years it has worked closely with members and office holders of the Royal Society of Tropical Medicine and Hygiene. Its work has encompassed activities from the earliest initiatives to ensure appropriate living conditions for those with the disease to the development of leprosy chemotherapy. However, this has now evolved into a strong partnership between the UK- and India-based Lepra hubs, which are carrying out research and public health initiatives ranging from elimination of prejudice against those with leprosy to adopting the recently launched WHO programme for skin NTDs to facilitate integrated control and management regimens. The fight against leprosy has always been a partnership between a wide variety of disease-specific NGOs, health-care workers and international health agencies. The story of Lepra illustrates the central role of these partnerships and national as well as international collaboration.

Socio-historical representations of a disease: a study of posters from campaigns against Hansen's disease during the second half of the twentieth century. / Representações sócio-históricas de uma doença: um estudo sobre cartazes de campanhas para o combate à hanseníase na segunda metade do século XX.

This article analyzes the use of iconographic sources in the context of educational campaigns to combat Hansen's disease from a socio-historical perspective at four points in time: the 1950s, 1960s, 1980s, and 1990s. Four posters are analyzed to identify the elements (textual, visual or graphic) used to develop discourse on this disease and those it affected and transformations and permanences in this discourse, as well as to verify how they became part of a narrative of institutional memory linked to public health in the state of São Paulo. These were produced by various public health institutions and are part of the Health Campaign Poster Collection held by the Emílio Ribas Public Health Museum.

Este artigo analisa o uso de fontes iconográficas no contexto das campanhas educativas para o combate à hanseníase numa perspectiva sócio-histórica em quatro momentos: décadas de 1950, 1960, 1980 e 1990. São analisados quatro cartazes para identificar os elementos (textuais, visuais ou gráficos) utilizados para elaborar um discurso sobre a doença e os doentes; suas transformações discursivas e permanências, além de verificar como se tornaram parte de uma narrativa de memória institucional ligada à saúde pública paulista. As fontes estudadas fazem parte da coleção Cartazes de Campanhas de Saúde, cujos itens foram produzidos por diversas instituições ligadas à saúde pública e integram o acervo do Museu de Saúde Pública Emílio Ribas.

[Sergio Arouca, institution builder and democratic innovator]. / Sergio Arouca, construtor de instituições e inovador democrático.

The article discusses the trajectory of Sergio Arouca (1941-2003), observing his performance as a public health activist via and within institutions. The analysis of episodes reveals a fertile combination between Arouca's surprising ability to think in a non-standard way, his charisma, and the presence of people who shared the same values. In some situations, this combination generated democratizing innovations. Examples include the Paulínia project in the 1970s, in which Arouca with his team invited the population to participate in the management of health services; the opening of the 8th National Health Conference to the participation of civil society; the installation of democratic management in the Oswaldo Cruz Foundation (Fiocruz) and the creation of the Participative Management Department of the Ministry of Health during the first Lula administration.

O artigo aborda a trajetória de Sergio Arouca (1941-2003), observando sua atuação enquanto militante de saúde coletiva por meio das e nas instituições. A análise de episódios mostra uma combinação fértil entre as oportunidades institucionais e políticas a surpreendente capacidade de Arouca de pensar fora do padrão, seu carisma e a presença de pessoas que compartilhavam os mesmos valores. Em algumas situações, essa combinação gerou inovações democratizantes. Os exemplos incluem o projeto de Paulínia nos anos 1970, no qual Arouca com sua equipe convidaram a população para participar da gestão de serviços de saúde; a abertura da a 8a Conferência Nacional de Saúde à participação da sociedade civil; a instalação da gestão democrática na Fundação Oswaldo Cruz (Fiocruz) e idealização da Secretaria de Gestão Participativa do Ministério da Saúde no primeiro governo Lula.

Sergio Arouca, construtor de instituições e inovador democrático / Sergio Arouca, institution builder and democratic innovator

Resumo O artigo aborda a trajetória de Sergio Arouca (1941-2003), observando sua atuação enquanto militante de saúde coletiva por meio das e nas instituições. A análise de episódios mostra uma combinação fértil entre as oportunidades institucionais e políticas a surpreendente capacidade de Arouca de pensar fora do padrão, seu carisma e a presença de pessoas que compartilhavam os mesmos valores. Em algumas situações, essa combinação gerou inovações democratizantes. Os exemplos incluem o projeto de Paulínia nos anos 1970, no qual Arouca com sua equipe convidaram a população para participar da gestão de serviços de saúde; a abertura da a 8a Conferência Nacional de Saúde à participação da sociedade civil; a instalação da gestão democrática na Fundação Oswaldo Cruz (Fiocruz) e idealização da Secretaria de Gestão Participativa do Ministério da Saúde no primeiro governo Lula.

Abstract The article discusses the trajectory of Sergio Arouca (1941-2003), observing his performance as a public health activist via and within institutions. The analysis of episodes reveals a fertile combination between Arouca's surprising ability to think in a non-standard way, his charisma, and the presence of people who shared the same values. In some situations, this combination generated democratizing innovations. Examples include the Paulínia project in the 1970s, in which Arouca with his team invited the population to participate in the management of health services; the opening of the 8th National Health Conference to the participation of civil society; the installation of democratic management in the Oswaldo Cruz Foundation (Fiocruz) and the creation of the Participative Management Department of the Ministry of Health during the first Lula administration.

[The leprosy "drama": Governador Valadares, public health policies, and their territorial implications in the 1980s]. / O "drama" da hanseníase: Governador Valadares, as políticas públicas de saúde e suas implicações territoriais na década de 1980.

The incidence of leprosy in Governador Valadares, Brazil, in the 1980s spurred this town to pioneer the introduction of polychemotherapy. The aim of this research was to understand how the different actors involved in this context interacted, especially the employees and patients at the Special Public Health Service. To identify the territories that these interactions inevitably constituted, a variety of theoretical instruments were used, including dramatism (Burke) and performance (Turner). By taking a theatrical metaphor, we sought to find out the dynamics by which the different actors took the stage and established their most significant relationships in a dynamic process of constituted and reconstituted territories.

[City-laboratory: Campinas and yellow fever at the dawn of the Republican era]. / Cidade-laboratório: Campinas e a febre amarela na aurora republicana.

In the late nineteenth century, there were yellow fever epidemics in Campinas. Considered a seaside disease, the fever startled lay people and physicians. The scientific debate about the etiology of the disease left the domain of magazines and medical correspondence to orient political and sanitary actions. In order to combat the disease, the city began to resemble a laboratory and experienced its "era of sanitation and demolition," with victories over the ailment and inconvenience to the public. The State Sanitary Commission led by Emilio Ribas, aware of Finlay's Culicidae theory, rehearsed in Campinas what would happen with Oswaldo Cruz and Pereira Passos in Rio de Janeiro. The novelty of combating mosquitoes coexisted with age-old practices dear to miasmatic theory, such as disinfection.

Rodolfo dos Santos Mascarenhas: a pioneer of health history.

Studies on the work of Mascarenhas analyze his contribution to the history of health in Sao Paulo and the aspects of his work which place him in what is entitled the second generation of health workers of São Paulo state - being the first generation the one led by Emílio Ribas. This article recaptures these points and highlights his last works on preventive and community medicine. We argue that the conception of public health consolidated during his education was essential for his interest in the new model of medicine that was starting to spread in the country.

Cidade-laboratório: Campinas e a febre amarela na aurora republicana / City-laboratory: Campinas and yellow fever at the dawn of the Republican era

No final do século XIX ocorreram epidemias de febre amarela em Campinas. Considerada doença litorânea, a febre assustou leigos e médicos. O debate científico sobre a etiologia da doença deixou revistas e correspondências médicas para orientar ações políticas e sanitárias. Visando combater a enfermidade, a cidade ganhou contornos de laboratório e vivenciou sua "era do saneamento e das demolições", com vitórias sobre o achaque e transtornos à população. A Comissão Sanitária Estadual comandada por Emílio Ribas, ciente da teoria culicidiana de Finlay, ensaiou em Campinas o que ocorreria no Rio de Janeiro de Oswaldo Cruz e Pereira Passos. A novidade do combate aos mosquitos conviveu com antigas práticas caras à teoria miasmática, como as desinfecções.

In the late nineteenth century, there were yellow fever epidemics in Campinas. Considered a seaside disease, the fever startled lay people and physicians. The scientific debate about the etiology of the disease left the domain of magazines and medical correspondence to orient political and sanitary actions. In order to combat the disease, the city began to resemble a laboratory and experienced its "era of sanitation and demolition," with victories over the ailment and inconvenience to the public. The State Sanitary Commission led by Emilio Ribas, aware of Finlay's Culicidae theory, rehearsed in Campinas what would happen with Oswaldo Cruz and Pereira Passos in Rio de Janeiro. The novelty of combating mosquitoes coexisted with age-old practices dear to miasmatic theory, such as disinfection.

Rodolfo dos Santos Mascarenhas: a pioneer of health history / Rodolfo dos Santos Mascarenhas: pioneiro da história da saúde

Studies on the work of Mascarenhas analyze his contribution to the history of health in Sao Paulo and the aspects of his work which place him in what is entitled the second generation of health workers of São Paulo state - being the first generation the one led by Emílio Ribas. This article recaptures these points and highlights his last works on preventive and community medicine. We argue that the conception of public health consolidated during his education was essential for his interest in the new model of medicine that was starting to spread in the country.

Os estudos que comentam a obra de Mascarenhas analisam sua contribuição à história da saúde em São Paulo e os aspectos de seu trabalho que o enquadram no que se convencionou chamar de segunda geração de sanitaristas paulistas - a primeira seria liderada por Emílio Ribas. Esse artigo retoma esses pontos e destaca seus trabalhos mais recentes, relacionados à medicina preventiva e comunitária. Argumentamos que a concepção de saúde pública consolidada em sua formação foi central para seu interesse no novo modelo de medicina que começava a se difundir no país.

[Joining WHO of Republic of Korea and the projects in the 1950s].

The Republic of Korea(ROK) and the World Health Organization(WHO) have done many projects successfully from 1949, in which the government of First Republic joined the WHO. However the relation between the ROK and the WHO have not been studied very much so far. The main purpose of this research, which could be done by the support of WHO, is connected with three questions. First research point would be "how could the ROK joined WHO in 1949 and what's the meaning of it? And the what's the difference in the process for the WHO between the ROK of 1949 and the DPRK(Democratic People's Republic of Korea) of 1973?" The first president of the ROK, Rhee Syngman, who had received his Ph. D.(about international politics) from Princeton University in 1910, was strongly interested in joining international institutes like UN, WHO. The ROK that could join WHO on 17 August 1949, with the approval of Assembly on 25 May 1949, was one of the founder members of the Western Pacific Region. By joining WHO, the ROK could get chance to increase the level of public health and its administration in 1950's. But the DPRK manage to became a member of WHO on 19 May 1973 and joined the South-East Asia Region. The joining of DPRK was influenced by the easing of the cold war after the Nixon Doctrine and the joining of the China(People's Republic of China). Second research point would be "What kind of roll did the WHO take in the First Republic?" Yet the public health administration of the First Republic that had been made in the period of US army military government was been strongly influenced by USA, the roll of WHO was also important in the 1950's. Last research point would be "What kind of the projects did the ROK and the WHO take part in during the period of he First Republic? How could evaluate the results?" The ROK and the WHO handled the projects including health services, communicable disease prevention and control, control of noncommunicable diseases, and protection of health. Specially for the efforts to prevent communicable disease, the WHO focused on leprosy, malaria, measles, smallpox, tuberculosis in 1950's. The First Republic could overcome the bad health condition after the Korea War successfully, supported by WHO.

Lepra, medicina e políticas de saúde no Brasil (1894-1934) / História e Saúde / Leprosy, medicine and health policies in Brazil (1894-1934)

Aborda a trajetória da lepra no Brasil não como um acontecimento meramente médico-biológico, mas, sobretudo, como um aspecto da vida política e social. A autora não estudou a lepra medieval, assentada sobre princípios ético-religiosos e ligada à ideia de pecado e punição; tampouco se debruçou sobre a hanseníase, nome contemporâneo com o qual a lepra foi rebatizada para distinguir-se da outra e livrar-se do seu estigma. A pesquisa se concentra no período entre o fim do século XIX e as primeiras décadas do XX, quando houve um crescimento das pesquisas sobre a lepra e a interação entre a conjuntura internacional e a realidade sanitária brasileira produziu uma trajetória singular para a doença no país. A autora divide essa trajetória em três momentos. No primeiro, na década de 1910, a doença ainda não era considerada prioridade no âmbito federal e seu controle ficava a cargo dos estados, notadamente com o auxílio de instituições filantrópicas. Depois, nos anos 1920, a lepra se tornou um problema sanitário nacional e, para centralizar o combate à doença, estabeleceu-se a Inspetoria de Profilaxia da Lepra e das Doenças Venéreas, não sem crises e tensões. As ações da inspetoria não se resumiam à segregação dos leprosos em sanatórios e alguns as consideravam demasiadamente liberais. Assim, no terceiro momento, que corresponde à década de 1930, foi extinta a inspetoria e desarticulada sua política de enfrentamento da lepra: reforçou-se o isolamento compulsório e inúmeros leprosários foram construídos. (AU)

Escravos no purgatório: o leprosário do Tucunduba (Pará, século XIX) / Slaves in purgatory: the Tucunduba Leprosarium (Pará, nineteenth century)

Analisa a experiência dos escravos recolhidos ao leprosário do Tucunduba, em Belém, no Pará, ao longo do século XIX. Libertos depois de exibir no corpo as marcas da lepra, esperava-se deles submissão à política de segregação que pretendia afastá-los do contato com o restante da população. A documentação produzida pela Santa Casa de Misericórdia do Pará e autoridades políticas da província revela as estratégias desenvolvidas pelos escravos no enfrentamento dessa política, utilizando-se da predominância numérica no leprosário para criar uma rede de solidariedade que lhes permitisse recriar a vida e se contrapor ao tipo de nação sonhada pelas teorias higienistas da época.

The article analyzes the experience of the slaves interned at the Tucunduba Leprosarium in Belém, state of Pará during the nineteenth century. The slaves were freed once they showed the marks of their leprosy, and expectations were that they would submit to the segregation policy meant to keep them from contact with the rest of the population. The documentation produced by Santa Casa de Misericórdia hospital in Pará and by the province's political authorities reveals the strategies the slaves devised in response to this policy; they used their numerical predominance at the leprosarium to create a network of solidarity that allowed them to recreate their lives and stand in opposition to the type of nation that the era's hygienist theories envisioned.

Privação e padecimento: uma compreensão existencial do ser frente à Hanseníase / Deprivation and suffering: an existential understanding of the Being front the leprosy

Este estudo teve como objetivo compreender a experiência de privação e padecimento em pessoas que vivenciaram o processo de isolamento compulsório po rhanseníase. Na perspectiva da Pesquisa Qualitativa e da Fenomenologia Existencial foram realizadas entrevistas narrativas com 06 pessoas, de ambos os sexos, que vivenciaram o processo de asilamento em um hospital colônia no estado de Minas Gerais. O discurso dos entrevistados revela que a hanseníase levou a uma ruptura no projeto existencial dos sujeitos, restringindo a liberdade do Dasein e substituindo o seu mundo próprio e familiar por outro marcado pela dor, privação e sofrimento. O estigma da doença dificultou a reinserção social,de modo que mesmo após a desinstitucionalização os entrevistados permaneceram na colônia. Apesar do sofrimento, os participantes construíram novas formas de enfrentamento e ainda novos significados à existência e ao padecimento.

This study aimed to understand the experience of deprivation and suffering of people who experienced the process of compulsory isolation of leprosy. In the view of the Qualitative Research and the Existential Phenomenology, narrative interviews were conducted with 06 people of both sexes who experienced the process of institutionalization in a colony hospital in the state of Minas Gerais. The speech of the respondents reveals that leprosy led to a rupture in the existential project of the subjects, restricting the freedom of Dasein and substituting their own world and family by other marked by pain, deprivation and suffering. The stigma of the disease prevented social reintegration, so that, even after deinstitutionalization, respondents remained in the colony. Despite the suffering, the participants constructed new ways of coping and even new meaning to the existence and suffering