Lesiones cutáneas hipopigmentadas en un inmigrante de raza negra / Cutaneous hypopigmented lesions in a black inmigrant

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Disease in Africa: a medical perspective from the 1950s.

So much attention is focused on the current HIV/AIDS epidemic in Africa that there is a tendency to overlook the grievous burden of disease from which the peoples of that Continent have suffered for centuries. This paper, based on letters sent in 1953/54 by a young doctor in Sierra Leone to his parents in Scotland, together with extracts from Makeni Hospital records of the same period, provides a factual account of front-line medicine in West Africa half a century ago.

The cost of tuberculosis to patients in Sierra Leone's war zone.

OBJECTIVE: To evaluate how the extreme poverty of the patients and the poor salaries of the staff combined to increase the cost of treatment to patients within the subsidised national tuberculosis programme in Sierra Leone. DESIGN/SETTING: From September to December of 1994, semi-structured interviews were conducted with 72 patients and 17 staff of the National Leprosy and Tuberculosis Control Programme of Sierra Leone, a screening and treatment programme funded by international donors. RESULTS: Although some extra costs were indeed incurred within the subsidized national tuberculosis treatment programme, they were much lower than those incurred during the pre-programme period when the patients sought intermittent help from a wide range of traditional and biomedical sources within the plural healing continuum. The national politico-economic crisis, and the consequent poverty of most patients, impeded compliance with and sustainability of treatment, even within the formal subsidised treatment programme. CONCLUSIONS: More money was spent by patients on treatment in the months/years preceding entry into the national tuberculosis programme. Many factors retarded entry, including poor communications, misinformation, malpractice by health professionals, and displacement resulting from chronic internal warfare. The war intensified all factors that predispose to tuberculosis and retarded access to treatment. Supra-programme cost, or 'corruption,' was minimal due to the poverty of health professionals, with a few salient exceptions.

Leprosy among the Limba: illness and healing in the context of world view.

The study analyzes the traditional beliefs and practices concerning leprosy of the Limba people of Sierra Leone. It shows that this dialectally diverse ethnic group has two views of leprosy and its cause, and two varieties of stigma associated with the disease. The Limba have abandoned their traditional treatments for leprosy in response to an effective leprosy control programme, but retained their traditional world view, including its definition of illness, which holds a person seriously ill only when he has severe pain or disability. Thus, they seek treatment from the programme, but often at a relatively advanced stage of the disease. The study shows that the Limba have reinterpreted the notion of 'germs' as introduced by medical workers, and that leprosy control workers have their own misunderstandings of Limba beliefs and practices. The study points the way to improved communication between leprosy workers and Limba patients by focusing on the points at which their views differ, and by identifying concepts within Limba world view that can be adapted by leprosy workers to help convey their message. The study emphasizes the importance of world view as a key to understanding patient attitudes and behaviour in developing countries, and to making valid cross-cultural comparisons, but notes that it can take years for an investigator to understand the world view of a particular culture. It argues that in short-term research projects there is an advantage to working with an anthropologist who has in-depth knowledge of the culture, but who may not be a specialist in medical anthropology.

[Skin diseases in Sierra Leone]. / Hautkrankheiten in Sierra Leone.

Today there is no Third World country in Africa that offers sufficient basic services for skin diseases. This paper describes the distribution and clinical aspects of skin diseases in school children, soldiers, the city population and villagers of Sierra Leone. Poverty-linked types of dermatosis play a major role throughout the country. The high prevalence rates and clinical degree make skin diseases a severe public health problem in Sierra Leone.