In an assessment in 2001, over 200 cases of Buruli's ulcer that needed surgical treatment were found. More than half were in children under 15. MSF, along with partner organisations, has started an intervention to assist a population in Cameroon that is threatened by Buruli's ulcer.
The project is focusing on the population in the districts of Ayos and Akonolinga, in the central area of Cameroon, defined by the Nyong river. Buruli's ulcer is a disease that manifests itself in skin lesions and swelling, leading to physical disablement. More than half of the victims are children.
The MSF project started in early September. In Western Africa, thousands of Buruli ulcer cases are identified each year, but it also exists in other tropical and sub-tropical marshy areas. Like tuberculosis and leprosy, it is caused by a mycobacteria - in the case of Buruli Mycobacterium ulcerans. The MSF project follows an October 2001 assessment done by the Cameroon Ministry of Health, ALES (Aide aux Lépreux Emmaüs-Suisse, a Swiss NGO assisting people suffering from leprosy) WHO and MSF.
The project will also include a plastic surgeon from the Geneva University Hospital who will provide assistance in the most severe cases. In last year's assessment, in a population of 100,000, there were more than 400 cases. Of these, some 200 patients were considered to be in need of surgery.
More than half of these severe cases were children under the age of 15. Based on these results, MSF has decided, in close collaboration with the MoH, to start a project based on treatment and information. The first stage is scheduled to run for one year and, upon completion, the national health structures should be able to continue the established activities independently.
There is no effective treatment. The only solution at the present time is to cut away the infected parts. If caught early enough, this can be little more than minor surgery. However at an advanced stage, skin grafts, similar to what is done for serious burns, can be necessary.
Very little is known about the Buruli's ulcer. It is found near stagnant water but how it is transmitted to the human body or why the immune system cannot fight it is still unknown. It often develops without a person knowing - or realising the seriousness of the condition. The arms and legs are often where the Buruli ulcer manifests. Early stages can be a sense of swelling under the flesh. But as there is often no fever, pain or other indicators of trouble, many people do not seek help, thinking the problem shall pass.
Left without medical care, the lesions can develop into enormous swelling and skin lesions where surgery - often drastic - is the only possible action. In the worst cases, most of the skin, the subjacent fabrics and even of the bones can be completely destroyed. There is no effective treatment. The only solution at the present time is to cut away the infected parts. If caught early enough, this can be little more than minor surgery. However at an advanced stage, skin grafts, similar to what is done for serious burns, can be necessary. At times, if the condition has developed with no treatment, amputation maybe necessary.
Severe surgery, and obviously amputation, can leave a person handicapped. It is not always successful. In up to 30% of the cases, the Buruli ulcer reappears after surgery. In addition, major surgery is very expensive and can represent a major financial burden on the national health systems. Research to assess the effectiveness of antibiotic treatment is urgently needed. If successful, this may drastically reduce the cost of treatment that currently, is limited to surgical procedures.
WHO has therefore developed in 1998 the UN Buruli Ulcer Initiative in order to set the disease as one of the priorities. In the first stage, the hospital of Akonolinga will be equipped with the necessary surgical instruments.
An MSF logistician will organize the basic restorations required to bring the facilities to the required level - including a permanent supply of running water in the operating room. An MSF nurse will train the hospital personnel regarding hygiene, cleaning of the wounds, choice of therapy, and other techniques. An expat surgeon will coordinate the surgical operations and train the hospital doctor incrementally so the hospital staff can eventually take on the responsibility for the surgery.
In a country where the medical care if usually a fee-based service, this treatment, including the hospitalisation, will be free, thanks to an agreement MSF has negotiated with the Cameroon government. ALES will run the information component of the project in order to sensitize the population and health officers in order to detect cases in an earlier way. ITS (Basle Tropical Institute) showed an interest in the research part of the project, concerning confirmation and treatment follow up.