Starting point
Buruli Ulcer is a disease which is often called "the little sister of leprosy". The pathogen is very similar to the leprosy bacteria and also has similar consequences: Paralysis of limbs or even amputations. There are differences, however: Buruli patients suffer from large open wounds, the disease itself is not transmitted via contact to other infected people but probably through insects living in wetlands.
This is only an assumption, however, as this disease is so insufficiently studied that even experts are often puzzled. There is no quick and reliable test to detect the disease; only a PCR-test (polymerase chain reaction), a genetic examination of skin tissue taken from the wounds, can yield a diagnosis.
Since the competence centre in Tsévié was opened in 2008 by the then Foreign Minister Frank-Walter Steinmeier and the Togolese Health Minister Kondi Charles Agba, Buruli patients can receive medical care.
The same applies as with leprosy: If the disease is detected early on, a complete cure is possible and long-term consequences can be avoided. For this reason the DAHW Buruli centre is also the centre for the health providers who work in the most-affected regions in Togo to detect possible cases.
Aims of the project
Thus far, tissue samples have been taken in the Buruli centre Tsévié and have been sent to Germany as there was no laboratory in Togo which could carry out a PCR-test. It took five to six weeks before the result was available - furthermore, this unnecessary waiting period delayed the start of treatment for many patients.
For this reason, Franz Wiedemann, representative of DAHW in Togo, started planning a sufficiently-equipped laboratory in the country in 2008. The objective was to build up a functioning national system of diagnosis, which would be able to yield high quality results within one week and which would also be suitable for follow-up examinations of patients.
Activities - what was achieved in 2010?
The health ministry of Togo could not afford an investment of approximately 60,000 Euro and such an investment is also not day-to-day business for DAHW. A solution to the problem could be found thanks to EU funding.
DAHW Togo has worked together with the Buruli expert at the Ludwig-Maximilan University (LMU) in Munich and the Bernhard-Nocht Institute Hamburg (BNI) for a long time. Searching for a vaccine against Buruli Ulcer is part of this international cooperation as well. To this end, high-quality laboratory facilities with well-trained personnel are needed.
In 2010, the new laboratory at the National Hygiene Institut Lomé (INH) was equipped and staff was trained. The partners DAHW, LMU and BNI invested in training and further training and established a system for quality assurance.
Plans for 2011
Starting in 2011, all diagnostic examinations of possible Buruli cases will be carried out in Lomé and the results will be checked by LMU. The time between taking a tissue sample and receiving a diagnosis is shortened to eight days in this way. For patients this means that they will get the correct and suitable treatment within the shortest possible time.
Thanks to modern diagnostic technology, Togo now has a state of the art hospital and can participate in international research projects.
Risks of the project
The variety of tasks which the INH faced in a very short period of time showed how necessary a laboratory of this quality is in Togo. This, however, also leads to bigger wishes and desires: already today there are plans to extend the laboratory for approximately 75,000 Euro in order to be able to treat other illnesses as well.
If donors for these new investments can be found, the laboratory in the Hygiene Institute will be extended – if it keeps its current size the work could become too much for the laboratory. The numerous tasks the employees of the Togolese health system - a system which has to be further developed and extended - face are too many.
