Cameroon: Raising awareness about Buruli ulcer

© Albert Masias — An MSF doctor examining a patient in the Buruli Pavilion in Akonolinga

MSF is running a week-long campaign in Cameroon to raise awareness about the little-known disease Buruli ulcer, launching television and radio advertisements, and meeting with journalists and medical students.

Buruli ulcer is a chronic skin infection caused by a mycobacterium (Mycobacterium ulcerans). It can lead to extensive tissue destruction, create large sores that are extremely difficult to heal and can result in severe, long-term physical disability.

“The aim of this campaign is to bring people’s attention to the methods of detecting and treating this illness, and to fight the discrimination that people with the disease have to face,” explains MSF head of mission Dr Mitima Djuma.

MSF has been diagnosing and treating Buruli ulcer alongside the Cameroonian Ministry of Health since 2002. So far more than 1,100 patients have been treated in the district of Akonolinga, where MSF has built a Buruli ulcer treatment wing – the Buruli pavilion – within the local hospital.

A devastating but curable disease

Like leprosy, Buruli ulcer has devastating physical consequences on its patients, and can be fatal. It is prevalent among communities living beside slow-flowing bodies of water such as ponds, swamps and lakes, although the mode of transmission is still unknown.

The progression of the bacterium within the body is also poorly understood. A patient may, for example, experience a sore in one place that is later felt on a different part of the body. Buruli ulcer affects men and women of all ages, but the majority of patients are under 15 years old.

As well as providing care for around 100 patients each year, MSF has improved methods of diagnosis and treatment. The team has introduced modern wound dressing to speed up the healing process and replaced injections with oral antibiotics.

“It is true that Buruli ulcer affects relatively few people and that treating them will not halt the spread of the disease, since the mycobacterium exists in nature and cannot be passed from human to human,” says Dr Djuma. “However, we have a duty to take care of the people suffering from this disease, who have been entirely neglected,”.

Early treatment is vital

Part of the reason why Buruli ulcer receives very little medical and research attention is because it is prevalent among poor, rural communities. This lack of knowledge about the disease perpetuates beliefs that it is a curse, which can lead to social stigma and exclusion. These beliefs are also a reason why patients tend to be in the advanced stages of the disease when they first arrive at the Buruli pavilion.

The aim now is to encourage people with symptoms to see a doctor as early as possible, before their sores worsen and patients have to undergo long-stay hospital treatment or even major surgery.

Collaboration with Swiss university hospitals

MSF is collaborating with the Geneva University Hospitals (HUG) to research the link between HIV/AIDS and Buruli ulcer. HIV is 5-6 times more prevalent among adults suffering from Buruli ulcer than in the general population of Cameroon. Patients co-infected with both diseases develop more severe sores and carry a higher risk of Buruli ulcer recurring. The World Health Organization (WHO) now recommends that all Buruli ulcer patients be screened for HIV and, if tested positive, begin antiretroviral treatment.

A team of Swiss dermatological experts and sore treatment specialists make regular visits to Akonolinga. A surgeon, nurse and anaesthetist are currently conducting surgery on site.

The future aim is to incorporate the treatment of Buruli ulcer and chronic sores into Cameroonian medical training.