Understanding perceptions on 'Buruli' in northwestern Uganda: A biosocial investigation

Georgina Pearson,Richard Odame Phillips

doi:10.1371/journal.pntd.0006689

Abstract

BackgroundAn understudied disease, little research thus far has explored responses to Buruli ulcer and quests for therapy from biosocial perspective, despite reports that people seek biomedical treatment too late.Methods and findingsTaking an inductive approach and drawing on long-term ethnographic fieldwork in 2013–14, this article presents perspectives on this affliction of people living and working along the River Nile in northwest Uganda. Little is known biomedically about its presence, yet ‘Buruli’, as it is known locally, was and is a significant affliction in this region. Establishing a biosocial history of ‘Buruli’, largely obscured from biomedical perspectives, offers explanations for contemporary understandings, perceptions and practices.Conclusions/SignificanceWe must move beyond over-simplifying and problematising ‘late presentation for treatment’ in public health, rather, develop biosocial approaches to understanding quests for therapy that take into account historical and contemporary contexts of health, healing and illness. Seeking to understand the context in which healthcare decisions are made, a biosocial approach enables greater depth and breadth of insight into the complexities of global and local public health priorities such as Buruli ulcer.

Highlights

While the findings relate to where this study took place, the lessons learnt and biosocial approach used could be usefully applied in other settings where Buruli ulcer is endemic, and for understanding the local context of other neglected diseases and global health priorities
A so-called neglected tropical diseases, Buruli ulcer occurs in rural areas with limited access to safe water, basic medical care and education [1]
The accounts presented in this article clearly show how statements of late presentation for biomedical treatment and healthcare-seeking are misleading and oversimplified

Summary

Methods and findings

Taking an inductive approach and drawing on long-term ethnographic fieldwork in 2013–14, this article presents perspectives on this affliction of people living and working along the River Nile in northwest Uganda. Little is known biomedically about its presence, yet ‘Buruli’, as it is known locally, was and is a significant affliction in this region. Establishing a biosocial history of ‘Buruli’, largely obscured from biomedical perspectives, offers explanations for contemporary understandings, perceptions and practices. We must move beyond over-simplifying and problematising ‘late presentation for treatment’ in public health, rather, develop biosocial approaches to understanding quests for therapy that take into account historical and contemporary contexts of health, healing and illness. Seeking to understand the context in which healthcare decisions are made, a biosocial approach enables greater depth and breadth of insight into the complexities of global and local public health priorities such as Buruli ulcer

Author summary

Introduction

Methods

Findings

Conclusion