25 February 2011 (IRIN)
Photo: Aurélie Fontaine/IRIN
People with Buruli "must not be stigmatized", a Ghanaian doctor said
ASHANTI/GREATER ACCRA REGIONS, - In his job as head of Ghana’s Buruli ulcer control programme, Dr Edwin Ampadu moves between delight over promising new medicines and frustration over long-held misconceptions that delay limb- and life-saving treatment; between victories like a young boy walking again and distress over a woman whose ulcer returned after surgery and skin grafts.
The World Health Organization (WHO) in March will hold its annual meeting on Buruli ulcer, caused by a bacterium for which the mode of transmission is not fully understood. Without early detection and treatment Buruli can lead to extensive destruction of skin and soft tissue. Delayed treatment may cause deformity, long-term functional disability such as restriction of joint movement, extensive skin lesions and sometimes life-threatening secondary infections, according to WHO.
IRIN spent two days with Dr Ampadu on his monthly hospital visits in Ashanti and Greater Accra regions, hearing his views and those of patients and other medical staff. Last year Ghana registered 1,048 cases of Buruli, according to the national Buruli control programme.
At Amasaman Hospital in Greater Accra, a woman shows up with her emaciated 14-year-old son on her back. His wound is too severe for him to walk. A nurse pumps an air freshener to chase the stench from the infection which has eroded his thigh, nearly reaching his groin.
The family had kept the boy at home a long time into his illness, praying for him, thinking his wound was due to a curse.
“Ninety to 95 percent of patients first go to traditional healers before coming to hospital,” said Isaac Lamptey, head doctor in charge of Buruli at Obom Health Centre a few kilometres from Amasaman. “Most of them think the wounds come from malicious spirits. We have to educate people; we go into the villages to explain that the ulcer is not linked to bad spirits.”
Experts say the most powerful tool against false beliefs surrounding Buruli ulcer is successful treatment.
Photo: Aurélie Fontaine/IRIN : Ghana registered 1,048 cases of Buruli ulcer in 2010
But as Addai Abaijye, surgeon and director of Saint Peter’s Hospital in Jacobu, Ashanti Region, explains, stigma is another reason for delay. “We still need to really educate people in remote zones, because some families hide people stricken with Buruli.”
Saint Peter’s used to have a separate building for families of Buruli patients, but people were seen as outcasts and the isolation fed the fear that Buruli was contagious through simple contact. “So a few years ago we decided to receive these families in the same clinic as everyone else. They must not be stigmatized.”
Early detection vital
Early detection of Buruli ulcer is vital for treatment and can save a limb or even a life. The disease comes in two phases - presenting as a painless nodule, a blotch or some swelling - allowing a window of time to treat with antibiotics and avoid the debilitating effects, experts explain.
Ghanaian doctors are trying a new medicine - a pill instead of injections to facilitate proper dosage, particularly for people living in remote areas.
In Amasaman District Buruli is widespread. A surgeon comes from Accra each month to perform operations.
“When patients come [if it’s still early enough] we start with two months of antibiotics,” Dr Ampadu says. “But if that doesn’t work we operate.”
At Amasaman Hospital's government-funded building dedicated to Buruli patients, a girl and a boy lean on crutches near the entrance. Each has a leg deformed by Buruli.
The 37-bed facility has a room for men and a room for women. On this day 10 patients are in each, recovering from surgery.
Yao Appiah-Kubi, 49, hopes to have a skin graft soon. “It all started as just a spot on my leg; it itched, I scratched it. Then it swelled and became painful. I started an herbal treatment. Then I saw a programme on TV about Buruli ulcer and decided to come to hospital. They gave me medicines and eventually operated; it doesn’t hurt any more.”
Dr Ampadu orders two young men to walk the length of the room. They are in rehabilitation; if they don’t walk on their treated legs, he says, their legs will remain stiff.
“This is not a hotel! You must walk, even if you don’t feel like it.”
Dr Ampadu and his colleagues are investigating the case of 50-year-old Céla Akouofi. She has had an operation and a skin graft, but the ulcer returned. “We have taken a tissue sample to see why it has not healed yet; we’re still waiting for the results,” Ampadu explains. She works in the fields, often in water; the doctors wonder whether there is a link.
Later in the day, in the small consultation room in Obom’s health centre, Dr Ampadu explains Buruli ulcer to medical students and nurses who work in nearby villages. Obom District registered 24 Buruli cases in 2010. The doctor shows how to dress a wound, explaining that bandages must be changed regularly and patients’ fingers and limbs massaged to avoid stiffness.
A woman named Lucky Lotsu sits in silence nearby, part of her elbow eaten away by an ulcer.
--------------------------------------------------------------------------------------
Buruli ulcer (Mycobacterium ulcerans infection)
Buruli ulcer is caused by a germ that mainly affects the skin but which can also affect the bone. The causative organism is called Mycobacterium ulcerans, which although different, belongs to the same family of organisms that cause leprosy and tuberculosis.
Buruli ulcer has been reported in over 30 countries with tropical and subtropical climates but it may also occur in some countries where it has not yet been recognized. Limited knowledge of the disease, its focal distribution and the fact that it affects mainly poor rural communities contribute to low reporting of cases. Progress is being made now to develop tools for early diagnosis, to understand exactly how infection is transmitted and to improve treatment.
Symptoms
Buruli ulcer often starts as a painless, mobile swelling in the skin called nodule. Infection often leads to extensive destruction of skin and soft tissue with the formation of large ulcers usually on the legs or arms. If patients seek treatment at the early stage, antibiotics can prove to be successful. Delayed treatment may cause irreversible deformity, long-term functional disability such as restriction of joint movement, extensive skin lesions and sometimes life-threatening secondary infections.
Early diagnosis and treatment are vital.
Prevention and Treatment
Research for a vaccine to treat Buruli ulcer is continuing, although the current Bacille Calmette-Guérin (BCG) vaccine appears to offer some short-term protection. A safe and effective vaccine may be the most effective way to combat Buruli ulcer in the long term.
Current WHO recommendations for treatment are as follows:
A combination of rifampicin and streptomycin/amikacin for eight weeks as a first-line treatment for all forms of the active disease. Nodules or uncomplicated cases can be treated without hospitalization.
Surgery mainly to remove necrotic tissue, cover skin defects and correct deformities.
Interventions to minimize or prevent disabilities.
Initiative
The Global Buruli Ulcer Initiative (GBUI) was established in 1998. It is a partnership of Member States, academic and research institutions, donor agencies, nongovernmental organizations and the World Health Organization. The GBUI is dedicated to raising awareness about the disease, improve access to early diagnosis, treatment and promotion of research to develop better tools for the treatment and prevention of Buruli ulcer.
In March 2009 a meeting grouping together heads of state and high level officials of endemic countries in Africa met in Cotonou, Benin where the "Cotonou Declaration" on Buruli ulcer was adopted.
http://www.who.int/buruli/en/
http://www.irinnews.org/report.aspx?ReportID=92036
Photo: Aurélie Fontaine/IRINPeople with Buruli "must not be stigmatized", a Ghanaian doctor said
ASHANTI/GREATER ACCRA REGIONS, - In his job as head of Ghana’s Buruli ulcer control programme, Dr Edwin Ampadu moves between delight over promising new medicines and frustration over long-held misconceptions that delay limb- and life-saving treatment; between victories like a young boy walking again and distress over a woman whose ulcer returned after surgery and skin grafts.
The World Health Organization (WHO) in March will hold its annual meeting on Buruli ulcer, caused by a bacterium for which the mode of transmission is not fully understood. Without early detection and treatment Buruli can lead to extensive destruction of skin and soft tissue. Delayed treatment may cause deformity, long-term functional disability such as restriction of joint movement, extensive skin lesions and sometimes life-threatening secondary infections, according to WHO.
IRIN spent two days with Dr Ampadu on his monthly hospital visits in Ashanti and Greater Accra regions, hearing his views and those of patients and other medical staff. Last year Ghana registered 1,048 cases of Buruli, according to the national Buruli control programme.
At Amasaman Hospital in Greater Accra, a woman shows up with her emaciated 14-year-old son on her back. His wound is too severe for him to walk. A nurse pumps an air freshener to chase the stench from the infection which has eroded his thigh, nearly reaching his groin.
The family had kept the boy at home a long time into his illness, praying for him, thinking his wound was due to a curse.
“Ninety to 95 percent of patients first go to traditional healers before coming to hospital,” said Isaac Lamptey, head doctor in charge of Buruli at Obom Health Centre a few kilometres from Amasaman. “Most of them think the wounds come from malicious spirits. We have to educate people; we go into the villages to explain that the ulcer is not linked to bad spirits.”
Experts say the most powerful tool against false beliefs surrounding Buruli ulcer is successful treatment.
Photo: Aurélie Fontaine/IRIN : Ghana registered 1,048 cases of Buruli ulcer in 2010 But as Addai Abaijye, surgeon and director of Saint Peter’s Hospital in Jacobu, Ashanti Region, explains, stigma is another reason for delay. “We still need to really educate people in remote zones, because some families hide people stricken with Buruli.”
Saint Peter’s used to have a separate building for families of Buruli patients, but people were seen as outcasts and the isolation fed the fear that Buruli was contagious through simple contact. “So a few years ago we decided to receive these families in the same clinic as everyone else. They must not be stigmatized.”
Early detection vital
Early detection of Buruli ulcer is vital for treatment and can save a limb or even a life. The disease comes in two phases - presenting as a painless nodule, a blotch or some swelling - allowing a window of time to treat with antibiotics and avoid the debilitating effects, experts explain.
Ghanaian doctors are trying a new medicine - a pill instead of injections to facilitate proper dosage, particularly for people living in remote areas.
In Amasaman District Buruli is widespread. A surgeon comes from Accra each month to perform operations.
“When patients come [if it’s still early enough] we start with two months of antibiotics,” Dr Ampadu says. “But if that doesn’t work we operate.”
At Amasaman Hospital's government-funded building dedicated to Buruli patients, a girl and a boy lean on crutches near the entrance. Each has a leg deformed by Buruli.
The 37-bed facility has a room for men and a room for women. On this day 10 patients are in each, recovering from surgery.
Yao Appiah-Kubi, 49, hopes to have a skin graft soon. “It all started as just a spot on my leg; it itched, I scratched it. Then it swelled and became painful. I started an herbal treatment. Then I saw a programme on TV about Buruli ulcer and decided to come to hospital. They gave me medicines and eventually operated; it doesn’t hurt any more.”
Dr Ampadu orders two young men to walk the length of the room. They are in rehabilitation; if they don’t walk on their treated legs, he says, their legs will remain stiff.
“This is not a hotel! You must walk, even if you don’t feel like it.”
Dr Ampadu and his colleagues are investigating the case of 50-year-old Céla Akouofi. She has had an operation and a skin graft, but the ulcer returned. “We have taken a tissue sample to see why it has not healed yet; we’re still waiting for the results,” Ampadu explains. She works in the fields, often in water; the doctors wonder whether there is a link.
Later in the day, in the small consultation room in Obom’s health centre, Dr Ampadu explains Buruli ulcer to medical students and nurses who work in nearby villages. Obom District registered 24 Buruli cases in 2010. The doctor shows how to dress a wound, explaining that bandages must be changed regularly and patients’ fingers and limbs massaged to avoid stiffness.
A woman named Lucky Lotsu sits in silence nearby, part of her elbow eaten away by an ulcer.
--------------------------------------------------------------------------------------
Buruli ulcer (Mycobacterium ulcerans infection)
Buruli ulcer is caused by a germ that mainly affects the skin but which can also affect the bone. The causative organism is called Mycobacterium ulcerans, which although different, belongs to the same family of organisms that cause leprosy and tuberculosis.
Buruli ulcer has been reported in over 30 countries with tropical and subtropical climates but it may also occur in some countries where it has not yet been recognized. Limited knowledge of the disease, its focal distribution and the fact that it affects mainly poor rural communities contribute to low reporting of cases. Progress is being made now to develop tools for early diagnosis, to understand exactly how infection is transmitted and to improve treatment.
Symptoms
Buruli ulcer often starts as a painless, mobile swelling in the skin called nodule. Infection often leads to extensive destruction of skin and soft tissue with the formation of large ulcers usually on the legs or arms. If patients seek treatment at the early stage, antibiotics can prove to be successful. Delayed treatment may cause irreversible deformity, long-term functional disability such as restriction of joint movement, extensive skin lesions and sometimes life-threatening secondary infections.
Early diagnosis and treatment are vital.
Prevention and Treatment
Research for a vaccine to treat Buruli ulcer is continuing, although the current Bacille Calmette-Guérin (BCG) vaccine appears to offer some short-term protection. A safe and effective vaccine may be the most effective way to combat Buruli ulcer in the long term.
Current WHO recommendations for treatment are as follows:
A combination of rifampicin and streptomycin/amikacin for eight weeks as a first-line treatment for all forms of the active disease. Nodules or uncomplicated cases can be treated without hospitalization.
Surgery mainly to remove necrotic tissue, cover skin defects and correct deformities.
Interventions to minimize or prevent disabilities.
Initiative
The Global Buruli Ulcer Initiative (GBUI) was established in 1998. It is a partnership of Member States, academic and research institutions, donor agencies, nongovernmental organizations and the World Health Organization. The GBUI is dedicated to raising awareness about the disease, improve access to early diagnosis, treatment and promotion of research to develop better tools for the treatment and prevention of Buruli ulcer.
In March 2009 a meeting grouping together heads of state and high level officials of endemic countries in Africa met in Cotonou, Benin where the "Cotonou Declaration" on Buruli ulcer was adopted.
http://www.who.int/buruli/en/
http://www.irinnews.org/report.aspx?ReportID=92036
No comments:
Post a Comment