Ethnographic study of Buruli ulcer wound management practices in a traditional therapeutic setting in Ghana

Introduction: Buruli ulcer (BU) is a skin-related neglected tropical disease (skin NTD) considered to be a disease of the poor. This study explored BU wound management in a traditional therapeutic setting in the Atwima Mponua District of Ghana and described the social interactions observed. Method: Ethnographic data about the practices of a herbalist renowned for his experience in treating BU wounds were obtained using direct observations, photography, and informal conversations. Results: At this therapeutic setting, we observed wounds cleaned and dressed using gloves, gauze, antiseptic solutions, non-sterile scissors, and a petrol and bark preparation supported with prayers. Most clients of the traditional healer indicated that they experienced their BU as a stubborn wound that needed powerful medicine to cure it, and believed the wounds might have supernatural origins. Key reasons clients provided for seeking care at the traditional therapeutic setting included trust in the traditional healer, his practices, respectful care, a friendly and non-stigmatising environment, low-cost and flexible payment options, and people’s opinions about the potency of traditional plant medicines. Discussion: Our findings suggest that the traditional healer enjoyed substantial public legitimacy from his clients due to his perceived interest in helping affected individuals achieve cures using culturally and financially appropriate ways to manage wounds. However, we also observed the use of non-sterile procedures and unregulated preparations, which may be potentially deleterious. The willingness of the traditional healer to collaborate with the formal healthcare system to meet the health needs of people with wounds could form the basis for future collaborative approaches between the two healthcare systems to address inequities regarding clients’ access to care.