HART Plan of Action 2004
The World Health Organization believes that decentralizing healthcare to the district level is the key to the provision of primary healthcare and infectious disease control in developing countries. HART aims to improve levels of overall health in the Ghana by strengthening the existing healthcare system.

HART proposes the following comprehensive approach to improving overall understanding of Buruli Ulcer and strengthening the healthcare system in the rural areas of Ghana:

Mobile Surgical Units

HART's main goal is the eradication of Buruli Ulcer. Mobile surgical units will be the main focus of treatment options. The units will be deployed first in Ghana and then as demand warrants. Community outreach will be crucial in developing an awareness campaign that will allow HART to deliver its product. HART’s different endeavors will give the capitol that is required to continue to provide its services to the areas of the world that are struggling to treat Buruli Ulcer.

TREATMENT: Currently, treatment options are not available for most people living in remote areas of West Africa. Most people in the endemic areas can not even cope with the cost of living standards. Surgical treatment of Buruli is currently averaging $800. People living in remote areas of developing countries have no extra money for such expenses. HART will continue to provide free treatment of Buruli Ulcer to those suffering from both early and late stage ulcers, and will implement mobile surgical units to help relieve the burden currently faced by local providers. Mobile surgical units will provide a way for HART to collaborate with the local providers by facilitating local doctors as staff for the units and the materials needed to perform the treatments. OUTREACH: As community outreach is often the only source of organized health care in remote areas, HART volunteers provide basic care and instruction to those inflicted with Buruli Ulcer.

RESEARCH: HART has created a research component to further examine this devastating disease and hopes to aid in the development of appropriate treatments. HART's research component aims to understand both Buruli Ulcer and the problems and stigmas associated with it

EDUCATION: The purpose of the education team is to increase levels of understanding and awareness in rural endemic communities on the different aspects of Buruli Ulcer. Educating local health care providers, traditional healers, community leaders, community health workers, community members in general, and elementary age children helps to propagate the awareness of the disease and its severity. Education at all levels emphasizes early detection and treatment, which is known to be the most effective method of providing care to those with the Buruli Ulcer.

Anthropological and epidemiological research

A team of HART researchers will be involved in planning and carrying out anthropological and epidemiological research that seeks to improve our understanding of the Buruli Ulcer in the GA district as well as strengthen HART’s overall capacity to help the victims of the disease. HART believes that this information might also help persuade policy-makers to increase the percentage of resources earmarked for the control of this dreadful disease. In an effort to identify modifiable risk factors in the population, several case-control studies will be performed. These studies will focus on the influence of nutrition and environmental exposure on BU prevalence at the sub-district level. A special focus on the traditional management of this disease and the traditional healers who treat it will also be conducted. This information is crucial to the development of a successful surveillance and disease control program at the sub-district level.

Surveillance and control

HART will continue to evaluate and improve on the recent BU surveillance and control program initiated in select villages in the Amasaman sub-district last May. In order to obtain a more accurate assessment of the disease burden, we will extend this limited approach to a more comprehensive surveillance program for 2002. Traditional healers in the region will be a major component of this expanded program. As previous projects in this region such as Traditional Birth Attendant (TBA) training and the Guinea Worm Eradication Program (GWEP) have proven effective, we will use such projects as models for a sustainable BU active surveillance program at the sub-district level. Furthermore, by seeking culturally appropriate ways to integrate traditional health beliefs and traditional healers in the primary health care system, we hope to improve collaboration between the Amasaman health center staff and the traditional healers in the region. We see such collaboration as an essential key to the development of efficient and sustainable surveillance programs that ultimately will increase the number of pre-ulcerative cases reported at the Amasaman health center.

Active intervention and treatment of BU patients

HART will continue to provide free treatment of Buruli Ulcer to those suffering from both early and late stage ulcers. However, while HART surgeons can do a great deal to reduce the current patient load, we believe our first priority is to provide local healthcare providers and local medical interns the opportunity to obtain the skills needed to manage these cases independently in HARTs absence.

Surgical follow up from previous trips that HART has conducted in the past

Over 170 operable cases of BU were documented during HART’s recent stay in the Amasaman sub-district. Of those cases, only 17 received treatment from HART surgeons. Prior to our departure, all probable case documentation was forwarded to the Ghanaian MOH for future treatment. The effectiveness of those surgeries performed, as well as the outcomes of the remaining cases must be carefully reviewed and evaluated.

Study of genomic variation and development of in vitro models for M. ulcerans research

In collaboration with Dr. Richard Robison and the Brigham Young University Department of Microbiology, HART has initiated lab research on Mycobacterium ulcerans, the causative agent of Buruli Ulcer. For the purpose of this study, M. ulcerans isolates were obtained from 17 patients operated on during the surgical portion of the HART’s most recent trip to Ghana. The main foci of this research are regional genomic variations of M. ulcerans and experimental design of new in vitro models for chemotherapy trials.