Friday, March 27

Our last day in the Ashanti Region was centered around a visit to the Nkawie-Toase Hospital. This hospital is one of seven centers of excellence for treatment of Buruli ulcer patients. Services include in patient and out patient care. This particular center has a feel towards more comprehensive care of the patient. Not only do they provide non-surgical and surgical care, they have an excellent rehab facility for patients to maintain range of motion and function of affected areas of the body. For example, this may include the elbow, knee or ankle areas. A very high percentage of ulcers affect these areas of the body. The two physical therapy assistants and the to-be-hired physical therapist have plenty of work to do!

Like so many of the Buruli ulcer treatment resources, the rehabilitation equipment was donated by an external NGO, in this case, the Anesvad, Spain, the benefactor of this facility.

Medicine ball hams!

Charles Yeboah gives it all he's got!

Dr. Ampadu, we're impressed!

John feels the burn!

In an effort to sort out how treatment is paid for, we discovered that the cost of treatment for an early category 1 lesion (nodule, plaque, small ulcer) is about 25 dollars. This is compared to the cost of a larger category 2 ulcer, which is 1000 dollars. Treatment funding is fragmented. There is a national health insurance system, for which one must register and pay 7.2-45 cedis annually. However BU treatment is not included as a benefit. The Ministry of Health provides wound dressing supplies and antibiotics (Rifampin and Streptomycin) for treatment. However, all other BU-required services are not reimbursed by the national health insurance program.

Receipts will go to the Ministry of Health, which will reimburse the facility if they have funds. There is currently a great deal of effort being put forth to change national health legislation to include BU treatment as a benefit. In the meantime, since patients do not pay for treatment (a fundamental point underlying success of the National Buruli Ulcer Program), hospitals and clinics provide a great deal of. BU care without reimbursement.

Fortunately, on March 25, 2009, President Mills made a strong statement indicating his interest in "uprooting" Buruli ulcer. This provides hope for those individuals from the Ministry of Health and the 46 treatment centers who work tirelessly to help the patients and families afflicted with this stigmatizing and debilitating disease.

Our Ministry of Health hosts have very gracious in showing us all calibers of facilities and in answering all of our questions. It's been invaluable to be able to see the effects of BU and what is being done to lessen and even eliminate suffering of so many individuals, families and communities.