Meanings and senses of Hansen's disease for health workers from a Vygotskian perspective: a qualitative study

Background: Hansen's disease is an infectious disease with a slow and chronic evolution that can manifest itself through skin lesions, with changes in thermal, painful and tactile sensitivity, and also affect peripheral nerves, causing significant physical disabilities. This study aimed to analyze the meanings and senses for health workers from outpatient services who provide care to people diagnosed with Hansen's disease.

Methods: This is an exploratory qualitative study that used the Vygotskian theoretical-methodological framework based on the dimension of historical-dialectic materialism that bases its procedures on the use of meaning cores. The study was carried out in Ribeirão Preto, in the inland state of São Paulo, Brazil. In total, 13 health professionals participated in the study, including two nurses, three physicians, five nursing assistants, a physiotherapist and two social workers.

Results: To understand the meanings and senses of Hansen's disease, we take three cores of meaning as a basis: (1) personal, professional and social aspects of health workers and Hansen's disease, the health workers report that their view of what Hansen's disease was based on the understanding that it was an infectious disease that caused deformities, known as "leprosy", and that those affected needed to be isolated; (2) Hansen's disease - neglected, invisible and unknown, the invisibility of Hansen's disease continues to haunt those affected by it, and diagnosis is still late, referring to the marks carried in the history of Hansen's disease that remain today; and (3) challenges and potential in the world of work in the Hansen's disease reference services, the dichotomies, challenges and potential of working with those affected by Hansen's disease are linked to the creation of bonds, love for the profession, religious beliefs and problems related to the lack of resources for the rehabilitation of those affected.

Conclusions: The re-elaboration of meaning can occur when professionals are inserted in the world of work. The socially produced senses and meanings surrounding leprosy are related to its invisibility and late diagnosis. Changing the meanings and senses requires mediation and the use of critical active methodologies in health education, with investments from training bodies, social movements and health services.