ASHANTI/GREATER ACCRA REGIONS, 25 February 2011 (IRIN) - 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.
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.

Source: The Integrated Regional Information Networks (http://www.irinnews.org )