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HOPE CLUBS: A NEW STRATEGY FOR MORBIDITY CONTROL PROGRAMMES IN AREAS n ambitious goal -- the global elimination within the community. For example, in Recife, A of lymphatic filariasis as a public health where recent droughts have decreased access to problem -- was announced by the World Health clean water, patient-initiated community mobilization has resulted in establishment of principal strategy recommended by WHO for community “foot-washing centers” where interrupting parasite transmission is annual patients can gather and practice regular, daily mass treatment with either diethylcarbamazine albendazole. The effectiveness of these drug Clubs in filariasis-endemic areas include combinations against intestinal helminths passivity and hopelessness resulting from long- should enhance community acceptance of mass standing beliefs that no effective treatment treatment for filariasis, but their lack of efficacy exists; lack of access to clean water; lack of in reversing the chronic sequelae of filarial effective advocacy; and, to date, limited involvement of potential donors, including non- urogenital disease (e.g., hydrocele), and hidden religious groups, and manufacturers of medical supplies and skin care products (e.g., anti- fungal creams). Increased involvement of such in the early 1900s and more recent data from groups is needed to catalyze and solidify the animal models suggested a role for bacterial growing network of organizations concerned infections in the progression of lymphedema, community as a result of physical, social, and with the “morbidity control pillar” of the global during the past two decades these observations psychological barriers. This social isolation, program to eliminate lymphatic filariasis as a when added to the belief that progression of the research, which hypothesized that disease disease is inevitable, leads to dependency, passivity, and hopelessness. Our experience promotion as the process of enabling people to responses to Wuchereria bancrofti or Brugia suggests that these tendencies can be reversed, increase control over, and improve their health. malayi infection. Observations that lymphedema and the sustainability of treatment ensured, by In Recife, Hope Clubs have acted as powerful and elephantiasis generally worsened with time, the creation of Hope Clubs, in which patients agents of health promotion for people with coupled with our lack of knowledge about how support each other and prepare themselves once lymphedema. Challenges remain to replicate to reverse these immunologic processes, led to a again for full participation as human beings and Hope Clubs in other filariasis-endemic areas sense of hopelessness among both physicians and to harness their positive energy for the goal and patients regarding treatment of lymphedema of interrupting transmission of lymphatic in filariasis-endemic areas. Recently, however, innovative approach that was launched seven filariasis. For example, Hope Club members data from several sites in India, Brasil, Ghana, years ago in Recife, Brasil, at the Aggeu can be strong advocates of mass distribution of and Haiti have shown that recurrent bacterial infections of the affected limbs are strongly Currently the program is supported by the international network of Hope Clubs -- by Federal University of Pernambuco and the patients and for patients -- could contribute lymphedema and elephantiasis. Prevention of Amaury Coutinho Non-Governmental significantly to the growing consortium of these infections provides new hope for halting, Organization, created in December 1997. The public and private organizations committed to or even reversing, progression of the disease. aim of Hope Clubs is to equip lymphedema the elimination of lymphatic filariasis as a patients with the skills, motivation, and major component of the global programme to enthusiasm to sustain effective, low-cost, and eliminate lymphatic filariasis, it must be convenient self-care for their lymphedema and Gerusa Dreyer 1 e David Addiss 2
feasible at the community level, i.e., as a public to amplify these activities throughout filariasis- 1NEPAF, Hospital das Clínicas da UFPE e health measure. The treatment must be simple, so patients can do it themselves, inexpensive, 2Division of Parasitic Disease, National Center sustainable, and reproducible throughout the encouraged to accept responsibility for the filariasis-endemic world. During the past 10 success or failure of their own treatment and to years, such a treatment regimen has been make the best use of their own resources developed in Recife, Brasil. Based on hygiene, (physical, emotional, social, and strategy for lymphatic filariasis endemic areas. skin care, simple exercises, and elevation of the Transactions of the Royal Society of Tropical Medicine and Hygiene- Bulletin of Tropical replicated in Haiti and is strikingly similar to benefits to patients and their communities, as Medicine and International Health, 8(1):8(8 those developed independently in Allepey, has been observed in Recife. Patients with India and Tanzania. These principles have lymphedema come to realize that they are not been summarized in a 16-page booklet, New alone; that they have access to simple, effective *Available in English, free of charge, from the Hope for People with Lymphedema*. This measures to prevent acute bacterial infections booklet is available in English, free of charge, and relieve suffering; that they can regain their Prevention, Mailstop F – 22, Atlanta, GA from the US Centers for Disease Control and potential for productive work; that, as human 30341 – 3724, USA. It is being translated into beings, they have certain rights deserving of Portuguese, Arabic, Spanish and French. The Portuguese, Arabic, Spanish, and French. The recognition and respect; that, as social booklet is also available on the WHO filariasis booklet is also available on the WHO filariasis creatures, they and their family members can work together to help each other and to solve cooperation; and, that through such action, they can produce sustainable, positive changes

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