Hospitalized patient in the "Buruli pavilion" in the district hospital of Akonolinga where MSF is working. Photograph by Albert Masias
Feature story |

Cameroon: Treating and raising awareness of little-known Buruli ulcer

Photograph by Albert Masias
Hospitalized patient in the "Buruli pavilion" in the district hospital of Akonolinga where MSF is working. Photograph by Albert Masias

Awareness week for Buruli ulcer underway in Cameroon In the town of Akonolinga, in Cameroon, MSF has been developing treating the little-known Buruli ulcer for the past ten years.

Television and radio advertisements have been broadcast throughout the country, a meeting has been held with journalists and another with medical students, as part of a week-long awareness campaign for a poorly-known disease, the Buruli ulcer, launched by Médecins Sans Frontières (MSF) in Cameroon.

The ulcer is a chronic skin infection caused by a mycobacterium (Mycobacterium ulcerans) is one of the most neglected tropical diseases. It can lead to extensive tissue destruction and create large sores that are extremely difficult to heal and can cause severe physical handicaps, most of them to the limbs.

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

MSF has been working alongside the Cameroonian Ministry of Public Health to diagnose and treat Buruli ulcer since 2002. So far more than 1100 patients have been treated in the town and district of Akonolinga, where MSF built a specialised wing within the local hospital. Over the last ten years the organisation has done much to develop the treatment of the disease.

A devastating but curable disease

Like leprosy, the illness has a devastating impact on its sufferers, and can be fatal. In Cameroon it is seen as a curse, and sufferers are outcast. This myth is perpetuated by the fact that very little is known about Buruli ulcer. Communities living beside slow-flowing water bodies such as ponds, swamps and lakes are hardest hit. It is consequently believed that the mycobacterium is transmitted by a water flea, although this is by no means certain.

Patients suffering from Buruli ulcer suffers from plagues that can be very serious or extended.
Patients suffering from Buruli ulcer suffers from plagues that can be very serious or extended. Photograph by Alberto Masias

The progression of the bacterium within its host organism is also poorly understood. A patient may, for example, experience a sore that then reappears on a different part of the body. The illness affects men and women of all ages, but the majority of patients are aged under 15. Its greatest impact is on poor rural communities, which accounts for the lack of medical attention and research it has received.

“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. However, we have a duty to take care of these ulcer sufferers, who have been neglected entirely,” says Dr Djuma.

As well as providing care for around 100 patients each year, MSF has also improved the methods of diagnosing and treating the illness. The aim is now to encourage Cameroonians to see a doctor as early as possible before the sores worsen, requiring long-stay hospital treatment or even major surgery. Due to the traditional beliefs surrounding Buruli ulcer, many patients are already suffering from an advanced stage when they arrive at the Buruli Pavillon in Akonolinga. MSF has introduced and tested modern wound dressing to speed up the healing process. An oral antibiotic has also been introduced in place of injections.

A collaboration with Switzerland

MSF has teamed up with the Geneva University Hospitals (HUG) to shed light on the link between HIV/Aids and Buruli ulcer. HIV is 5-6 times more prevalent amongst adults suffering from Buruli ulcer than the national Cameroonian average. Co-infected patients develop more severe sores and carry a higher risk of recurrence. The World Health Organisation (WHO) is therefore now recommending that all Buruli ulcer patients be screened for HIV and initiated on antiretroviral treatment upon if seropositive.

Lastly, Swiss dermatological experts and sore treatment specialists are making regular visits to Akonolinga. A team comprising a surgeon, a nurse and an anesthetist is currently on site to operate on patients requiring surgery.

The future aim is to incorporate the treatment of Buruli ulcers and chronic sores into Cameroonian medical training. Therefore, MSF will this week also be raising awareness amongst medical students and doctors in Yaoundé of a disease that remains poorly known in the capital.