Buruli the Flesh-Wasting Disease: Despite the Increasing Prevalence and Morbidity of Buruli Ulcer in Cote d'Ivoire, a Large Section of the Population Remains Ignorant of Its Existence. Josephine Akarue Finds out Why

Article excerpt

It is almost midday. Outside, the well-manicured, serene gardens capture the picture of an ideal holiday resort. But this is not a vacation camp. This is a world where the reality of the flesh-wasting disease, Buruli ulcer, has etched grim marks on victims and forever altered the course of their dreams. Here, in the sprawling grounds of the Saint Padre Pio Centre for the treatment of Buruli Ulcer in Abidjan, each patient is a stark reminder of a disease whose mode of transmission remains elusive.

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For Teihy Richard, one of the 130 inmates of this Catholic-run centre, life may never be the same again. At 11, he struggles to come to terms with what started as a painless inflammation of the legs. He realises that unless he gets the necessary assistance, school and the dream to drive a car when he grows up may just be that: a dream. In place of football and maths, the former fourth grader has to learn to walk and contend with the trauma and stigmatisation of Buruli ulcer.

Like him, the 30-year-old Anderson Noussoa first experienced a painless inflammation of the right leg. It was not until he had made the rounds of several traditional healers, that in 2003 it finally hit him that he had Buruli ulcer. This hotelier turned farmer only started walking again this year. Still, as he sits in a wheelchair recuperating from his leg surgery, his principal concern is the fate of his family. "It hurts sometimes when I think about it," he says. "Without this centre, we'll all be dead."

Perhaps not. Alongside government hospitals, the Saint Padre Pio Centre is just one of several privately-run centres in the country treating the disease. Yet, Noussoa's lament captures the fears of a growing number of people trapped in the body of a wasting disease that attracts little media or public attention.

Professor Henri Asse, a plastic surgeon and national coordinator for Buruli ulcer treatment in Cote d'Ivoire, attributes the non-existence of current statistics on the disease to inaccessibility to rebel-controlled areas. "I'm aware that there's an increase in the prevalence," he says, "but we don't have precise figures. There are some endemic areas we cannot visit such as Bouake, Man and Danane."

Previous records, however, show a steady growth from two official cases reported in 1982 to 5,000 by 1995. In 1997, the reported cases hit 11,000. Curiously, the name Buruli comes from one of the counties in Uganda where the ulcer was first diagnosed. Today, Cote d'Ivoire, with an estimated 15 million population, has about 22,000 cases of Buruli ulcer, making it the world's highest endemic nation.

Even then, Julien Ake, doctor and national director of MAP International (West Africa), believes this figure is grossly underestimated. "Since not all endemic areas have sanitary centres," he says, "the official figure does not portray the reality."

In addition, he says, in Taabo, (population 36,665) where MAP carried out a pilot research, 245 new cases were found between 2005 and 2006. This implies an incidence rate of 6.65%. The reality could be even more alarming.

Yet, few know the disease. Fewer still know its real name. Some call it la plaie de Daloua, the Daloua wound. Others call it la plaie de la sorciere, the sorcerer's wound. For the vast majority of the rural population, it is simply the flesh-wasting disease. Consequently, victims are either ostracised or ignored. Sometimes, families break up and mothers are forced to pack out with the affected children. Today, an estimated 70% of cases are children under 15.

Medical research reveals that after tuberculosis and leprosy, it is the most common mycobacterium causing ulcers in humans. Still, what raises the most concern to date is that the exact mode of transmission eludes even the experts. Most vulnerable are populations in endemic areas along rivers and places of stagnant waters. In addition, environmental changes triggered by irrigation systems and construction of dams are also known to be causative factors. …