FIGURE 8. Training the next generation of healthcare workers in Brazil and Panama to recognize signs and symptoms of leprosy.

Scenes from an expedition in Brazil to a fishing village where local healthcare workers were trained to recognize the signs of leprosy. (A) Fishing villages are often accessible only by boat and comprise (B) poor homes in close proximity to frequently flooded river habitats. For this particular trip, (C) a team of leprosy experts and specialists are led by community health agents to the homes of suspected cases. (D) Suspected cases are either examined at their home or (E) in a clinical setting. (F-G) A point-of-care tool being used to improve leprosy diagnosis (Semmes-Weinstein monofilament), seen here being applied to suspected patches of M. leprae infected skin on the (F) cheek and (G) foot. As originally reported in 2021, a Semmes-Weinstein monofilament kit comprises six different monofilaments from the thinnest one, light green (0.07 gm force, like the feeling of a mosquito landing on your skin) to the thickest, pink (>300 gm, the thickness of a pencil lead). The graded force of the six colored monofilaments are used to progressively determine loss of sensation in skin lesions or on the hands or feet by touching the monofilament tip to the skin surface and asking the person if they feel it. If they don’t feel the thickest pink one, then there is total loss of sensation in the skin lesion. Photos courtesy of John Spencer and Carlos Franco-Paredes.