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Dear Sir:
In more than 30 years of Leishmania research in Três Braços and later in Corte de Pedra in Brazil, many beliefs regarding tegumentary leishmaniasis and many researchers have come and gone. Constant has been the presence of Lago (Ednaldo Lago de Lima). When Phillip Marsden, Aye Barreto, and Cesar Cuba Cuba founded the field site of Três Braços in southern Bahia, Brazil in the early 1970s, Lago was completing technical training in Chagas disease control. When offered a chance with the Leishmania group he quickly adapted to the work. Since Lago started, mucosal leishmaniasis caused by Leishmania braziliensis has been found to account for 3% of the total leishmaniasis cases and not 30%, a new field site was built in Corte de Pedra, a network for leishmaniasis treatment in the area has developed, the immunologic response and novel immunologic therapies have been investigated, and Phillip Marsden has died. Integral to these developments and many of the more than 100 publications that have come out of the field sites from teams based in Brasilia and Salvador has been Lago. Phillip Marsden, Edgar Carvalho, Jackson Costa, Vanize Macedo, Steve Reed, Tom Jones, and Warren Johnson among others have spent formative time at these sites with Lago.
On a typical day, Lago can be found stopping in the health post in the morning to administer intravenous doses of antimony and driving to the regional center for public health to check on Leishmania reporting. In the afternoon, he dissects Triatomids for Trypanosoma cruzi surveillance, gives talks on the diagnosis and management of leishmaniasis at other health posts, and visits patients far removed on dirt roads. It is a unique experience to drive with Lago through villages and along rural roads with no names. While shifting in and out of four-wheel drive to make it past the mud, he is simultaneously chatting and honking at acquaintances. Topics of conversation revolve around the price of cacau, banana, or cloves and inevitably, Lago’s passion, leishmaniasis. Beyond his experience in the region, Lago knows how to talk with people, from illiterate farmers who have never left the region to illiterate foreign researchers who typically stumble through broken Portuguese-Spanish.
When we arrive at a one-room house hours from paved roads, the family is usually standing outside to see the individual who can afford a truck. Skepticism is the rule with few greetings as even Brazilians from the city are typically seen as foreign. Then Lago appears smiling. Soon we are being invited in, not only examine the Leishmania ulcer but to partake of juice or coffee. On many studies in the area, follow-up rates for this disease that affects the rural poor have been more than 90%. This is because of Lago, his communication with patients, and his efforts to track down those who do not return.
In most articles with Phillip Marsden he is listed as a contributing author, which at times has been questioned because of his limited training as a technician. However, in planning epidemiologic and clinical studies his input is essential. He has a clear understanding of the epidemiology of leishmaniasis (and even argues convincingly against the importance of some published observations). His clinical acumen is sharp, being based on the thousands of patients he has seen. And, he knows the population and gives critical input on what is asking too much or too little of them.
As many with talent in rural Brazil, he once entered politics. After one term as vice-mayor and mayor for a short period of time he resigned, disillusioned by the reality of the job. At that time he received a personal letter from Phillip Marsden that supported him through this transition, that concluded, "Lago, you do not need to be involved in politics to show your humanity, that is clearly evident in your daily life." Lago has been essential in improving the management of tegumentary leishmaniasis in the area and is the real infrastructure that has caused his village to become a name known among international researchers. Through his genuine dedication to improving the lives of those in his community he sets an example for those of us working in the area.
Although personally exceptional, we realize that it is the exception not to find dedicated locals of talent as the base of successful field sites. In recognizing one, we hope to acknowledge the critical role of local workers who often do not appear as authors but at times enact the greatest change in their communities.
Received December 16, 2006. Accepted for publication December 19, 2006.
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