Knocking on Doors: An Interview with PIH’s Director in Peru

Dr. Leonid Lecca, 38, has worked for Socios En Salud, Partners In Health’s sister organization in Peru, since 2006. Last year, he was named executive director. We caught up with him by phone to talk about SES’s work on their 18^th anniversary, which they’re celebrating this week.

Where are you from?

I am Peruvian, from Lima. My family is from the north of the country, but my parents married and moved to Lima, where my dad found work. I studied medicine at Cayetano Heredia University here in Lima. In addition, I have two master’s degrees—one in health management and another in clinical epidemiology. Since I was a medical student, I’ve been very interested in public health and research, above all tuberculosis. It’s a disease that’s very common in our hospitals and clinics. I had the opportunity to get involved in research at the university and later at the Peruvian National Institute of Health.

How did you get involved with Socios En Salud?

I was first exposed to SES in the early 2000s, when they were getting off the ground with the project to expand access to treatment for multidrug-resistant TB (MDR-TB), funded by the Gates Foundation. I met the team from Harvard, PIH, and SES when I was the human protection administrator at the Peruvian National Institute of Health.

The approach was to knock on the doors of these people who—despite all their limitations—wanted to be cured.

When I saw the work of SES, I was impressed by the way staff tackled cases and how they approached people who were suffering from tuberculosis. SES works in the places no one else goes; they help in the farthest hillsides. The model of finding people in their communities impressed me, and I realized that patients aren’t only in hospitals or health centers. The approach was to knock on the doors of these people who—despite all their limitations—wanted to be cured.

I helped in the TB lab at the NIH in Lima, and through that work I was able to present reports to the World Congress on TB that was in Montreal in 2002. We submitted six abstracts, and all were accepted. Thanks to this, SES invited me and a group from the lab to participate in this congress. That’s when I entered the world that PIH occupied. I met more PIH colleagues, and I saw the work they were doing. It was a really strong group. In 2006, SES contacted me to see if I was available to work with them on the EPI project, a massive research study to understand how TB and MDR-TB spread from one person to another, which we’re just completing this year.

That’s where my story with SES begins.

How did you feel about all this revolutionary MDR-TB work unfolding?

The MDR-TB epidemic in Peru was, and continues to be, a difficult situation. What SES built with the state was really impressive. They managed to save many lives, and I think it was an opportunity for the same health professionals to see that it was possible to implement a program despite the limitations that existed.

As a doctor, I feel fulfilled because every day we are doing projects that save lives, the lives of the most vulnerable people. If SES hadn’t been there, those patients probably would have never received medical attention. It was always the poorest, the most forgotten, the most vulnerable. To this day, when I go to a health center and I see the work of SES, the patients we’ve supported, or how the team knows the whole life story of a patient—it impresses me.

The opportunity we have to help support the Ministry of Health is invaluable. There are more problems than we as an institution can address because we have limited resources, so it’s also important that we support the state to help ensure their resources are used in the best possible way.

So we should strengthen our alliances: that’s why we call ourselves 'partners in health.'

As a Peruvian, it’s a privilege to be part of the TB program we have in this country, which is one of the strongest in the region. We’ve struggled to define health as something more than what pertains to the Ministry of Health—it’s also about education, jobs, and better living conditions. Little by little we’ve understood—and we’ve continued to help others understand— that control of TB is not only a matter of taking pills.

What challenges do you face as the executive director?

It’s a huge responsibility to assume the leadership of a great organization that’s widely recognized for its work in Peru. While it’s true there are a lot of public health problems, the strength and commitment of SES is to work on these issues of tuberculosis, HIV, and community health. We still have a lot to do with these issues, but we’re committed to the community and the Ministry of Health, which is why we support local, national, and international efforts, public or private, of people or institutions that want to be part of finding solutions. So we should strengthen our alliances: that’s why we call ourselves “partners in health.” Our principal partners are the communities and the Peruvian government.

You’ve been executive director of SES for about a year now. What are your major initiatives at this point?

In the last year a lot has happened, and I’ve come a long way in understanding our position and in managing SES. We’re trying to focus on accompanying the public sector with greater emphasis on the most pressing problems. In the past, for example, we’ve provided treatment for MDR-TB, and we’ve accomplished a lot. Now the Peruvian Ministry of Health provides this care, and we’re working in a different role.

Now we provide social support to MDR-TB patients with the most limitations—those, for example, who have defaulted from treatment, are alcoholics, drug addicts, or very poor. We’re also focused on providing support for patients with extensively drug-resistant tuberculosis, which is often their last chance for getting better and surviving this disease. Other vulnerable populations we’re serving are MDR-TB patients in prison and children with tuberculosis, for whom diagnosis and treatment is more difficult.

Besides TB, what other programs are you working on?

Dr. Lecca walks with Nancy Rumaldo, child development program coordinator, between home visits in the community of Fray Martin. (Photo by Socios En Salud)

After this year, we’ll be focusing on several initiatives, just one of which is TB. The second is HIV. We want to continue applying our community-based model to people living with HIV who are poor, improving the management of co-infection of TB/HIV, and caring for children with HIV. We’re focusing on vulnerable populations with HIV—children and adolescents, sex workers, transsexuals, and poor and marginalized people. We want to show that to reach such marginalized groups, you have to go looking for the patients in the communities where they live, in the hillsides. They’re not the people you have in your registers at the health clinics. It’s an issue of access—not necessarily because of socioeconomic problems, but other barriers such as stigma.

Another area of focus will be on maternal and child health. We’re applying the community-based model to improving early childhood development among poor children. We have initiatives in Lima and in the south of the country to increase the capacity of the public sector by improving training and infrastructure, including community work, to provide comprehensive care. We’re thinking about how we could help alleviate maternal mortality, too. Teen pregnancy is a particular challenge here, often affecting poor, vulnerable people. We have trained health workers in maternal care to go into communities and refer pregnant women to health clinics.

We’re also putting together a complete package of primary care in Lima. We want to make sure that programs for key health problems, such as HIV, TB, maternal health, and child health, work well in Carabayllo, the marginalized district to the north of Lima where we’ve always worked. This includes work we’re just starting on noncommunicable diseases, such as diabetes and hypertension.

I have a lot more gray hairs now than I did a year ago, but that’s part of the job.

And last, we’ve just started working to establish mental health services as part of the primary care delivered through public facilities. Right now, if someone has a mental health problem they have to go to the hospital, and there are very few who actually go. We have to equip the local health workers and community health workers to treat it and help manage cases. This is something we’re excited to start. We think it’s going to work very well.

A big part of your work also involves research. What’s happening in that arena?

We’re working right now in two areas: one, improving infrastructure and the capacity to establish ourselves as a center of global health research with our colleagues at Harvard University and other institutions. The other is to develop a critical mass of professionals interested in conducting research on local health issues in Peru. For example, we just issued a call for young professionals who are interested in research. We will recruit and train them so they join our group and can help us do our research, but also so they can learn and form more of a workforce of researchers with the capacity to do research that helps us resolve local problems. I’m talking with various local educational institutes, such as universities, to see how we can help them improve or generate better capacity for research.

That’s a lot to figure out.

It’s a puzzle, but it’s a good thing. We’re trying to prioritize which issues to work on, all with the aim of elevating the health of Peruvians. Some things could change, because we’re always attentive to the feedback of the Ministry of Health and the needs of our patients.

Did you ever imagine you would lead this organization?

I feel very fortunate. Destiny has given me this opportunity much earlier in my career than I anticipated, and I’m very motivated to succeed. I have a lot more gray hairs now than I did a year ago, but that’s part of the job. There’s still a lot to do, and our work will continue focusing on improving the health of the people who are most in need and most vulnerable.