ASSOCIATION FRANCAISE RAOUL FOLLEREAU

ASSOCIATION FRANCAISE RAOUL FOLLEREAU

Support from the Association Française aise Raoul Follereau for Buruli ulcer control 2005-2006 2006 Jehan-Michel RONDOT Director, Support and Programmes

AFRF 1995-2006 a 12-year partnership with Buruli ulcer control Since 1995 Raoul-Follereau has taken up a new challenge A bold, yet simple and pragmatic strategy, in keeping with the recommendations of the WHO Advisory Group on Buruli ulcer, and then of the TAG Responding to requests from countries through partnership

A strategy that hinges on three complementary lines of action A- Improving patient case management B- Support for research C- Spreading knowledge and awareness

AFRF 2005-2006 2006 «you don't change a winning strategy» Considerable progress has been made in the last 5 years Even so, much remains to be done, as Mycobacterium ulcerans has certainly not revealed all its «secrets» The immediate task is to consolidate what has been achieved and to give priority to meeting patients' needs

A- Support for case management Our efforts are mainly focused on two countries where the disease is endemic, Côte d Ivoire and Benin,, which have for many years been partners in our leprosy control efforts. Since 2005, AFRF has also been active in the Republic of the Congo in support of the work of the new PNLUB

In Côte d'ivoire: continuing our work in uncertain circumstances

The Raoul Follereau Institute in Adzopé (IRF) Our support was exclusively earmarked for the IRF in Adzopé,, a hospital run by the Ministry of Health In 1999, AFRF signed an agreement with the Ministry of Health to finance «case management» of 200 Bu patients at the IRF Adzopé Manikro. Since that date, it has provided drugs, reagents and consumables worth 115 000 euros each year. Today, the grave crisis besetting Côte d Ivoire d is having a dramatic impact on health programmes. Nevertheless, in very these trying circumstances, IRF has managed to keep its services running: in 2005, AFRF dispatched the required drugs and consumables.

The Centre Demi Emile in Angré,, Abidjan Since 2005 we have been providing assistance in the form of drugs for this centre which is run by Father Marco The Centre, which has been «relocated» on account of the division that has split Côte d'ivoire, continues to provide case management for patients from all over the country in the south

In Congo along with leprosy, Buruli ulcer 2005 saw the beginning of a new form of cooperation between the Congolese Ministry of Health's recently established PNLUB and AFRF, which was invited to become a partner. Our support, which is both financial and material, is used to build up the capacity of the national PNLUB coordinating office. It is also used to provide case management for BU patients in the region of Pointe Noire, where the disease is endemic and which has been assigned priority.

In order more precisely to determine the terms of our collaboration, Dr Augustin Guédénon, the Association's Medical Adviser, made an evaluation mission to Brazzaville. After this, the national coordinator in Congo made a study mission to Cotonou to benefit from the experience garnered in Benin (a fine example of south/south synergy and cooperation)

In Benin, AFRF a partner of MoH and of PNLUB Help in running the PNLUB coordinating office Capacity-building for the benefit of the National Mycobacterial Reference Laboratory LNRM Support for the CDTUB, which lie at the heart of the national system.

CDTUB Pobè The «Raoul et Madeleine Follereau» Centre for Detection and Treatment of Buruli Ulcer was officially inaugurated in April 2004 The Pobè Centre, which is an integral part of PNLUB, represents AFRF's response to a request by the Government of Benin, and is designed to complete the national network so that it offers nationwide coverage. The Centre has: 4 wards (26 beds), an outpatient consulting room, an operating theatre and a laboratory

After having built and equipped the centre, Raoul- Follereau bears the full operating costs. Dr Annick Chauty is responsible for running the centre; both administrative and medical management are in the hands of Dr Chauty and her team. In 2005, 284 cases of Buruli ulcer were treated at the centre In line with the recommendations of WHO, prevention of disabilities has been integrated into the centre's activities; the first step was the recruitment of a physiotherapist and provision of the first items of equipment; the initial results are already very encouraging.

Gbémontin Centre The Gbémontin Centre at Zagnanado in Zou Run by sister Julia, it was the first centre in Benin and the forerunner of the commitment we have made. The centre's activities are diverse, although case management of Buruli ulcer patients is still very important. For 12 years AFRF has been making a regular contribution to the operation of the centre, in the form of drugs and medical consumables. In 2005, the centre treated some 300 BU patients.

Lalo CDTUB At the request of Benin's Ministry of Public Health, since 1 January 2005 we have been helping to the run this centre. Lalo CDTUB is located in Mono Couffo it has 40 beds for patients 150 BU patients were treated there in 2005

B- Support for research programmes Since 1995, AFRF has been funding research programmes whose aim, through a better understanding of MU, is to prevent and treat the disease. The programmes include «studies of Mu ecology» and «therapeutic trial of aminoside-rifampicin association to treat clinical lesions caused by Mu infections»,, carried out by Pr Carbonnelle and Laurent Marsollier at Angers Medical Faculty. (2002-2003) 2003) «Genome analysis» by Pr Stewart Cole Institut Pasteur, Paris.

This research has opened up new paths, and AFRF has continued to support researchers over the years, as it has high hopes of both simplifying treatment and improving diagnosis and even prevention. In 2005, 229 000 were spent on research programmes on Mycobacterium ulcerans.

C- Disseminating information and raising awareness In conjunction with WHO, AFRF has paid for the French language versions of BU documentation at a total cost of 60 000 euros. In 2005, it paid for the French version of the documentary «Buruli ulcer: Education is the key» at a cost of $5000 The manual on Prevention of Disability in Buruli Ulcer, at a cost of $10 000 It is keeping up its effort to inform and educate the French public about this poorly known disease. Its publications and annual meetings are used as an opportunity to put out messages which catch the attention of the media.

It covers part of the cost of publishing an printing the «Bulletin de l ALLFl» many of whose pages are dedicated to the effort to control Mycobacterium ulcerans infection There is no doubt that these efforts as a whole, together with those of each one of us, have led to the development of a genuine awareness at the national and international levels. Nowadays, the disease is something less of a «mystery» and somewhat less «neglected».

Overview and prospects : Major progress has been made in only a short period; the studies under way are promising, although there are still many uncertainties about Mycobacterium ulcerans. This makes it all the more important for us to consolidate our achievements and to press ahead with research.

Better case management and control of Buruli ulcer one of the primary objectives is to simplify medical treatment. investigations also have to be continued in order to make diagnosis easier. Consolidation of our achievements is the responsibility of the national programme directors, who are responsible for implementing the strategies adopted.

The Association Française aise Raoul Follereau can assure them of its willingness to help and its commitment to fostering the necessary coordination of their programme's partners at the national level.