Elu-ulee: What riverine and rural Nigerians must know about Buruli Ulcer by Remmy Nweke - ITREALMS

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Neglected tropical disease:
In parts of Igboland, villagers whisper about elu-ulee, a strange sore that eats into the leg without causing pain. In Ogbaru’s riverine farmlands, it is called acha-ere or enyi ule. Among the Yoruba of Ogun State, it is feared as olobutu or egbo adaijina. Doctors know it as Buruli ulcer, a neglected tropical disease caused by Mycobacterium ulcerans. 

Though often overlooked in Nigeria’s health debates, it silently threatens rural and riverine families, where swamps, rice paddies, and riverbanks make perfect breeding grounds.

Buruli ulcer begins deceptively. It often starts as a painless lump or swelling, sometimes mistaken for an insect bite or boil. Over time, the skin around the lump breaks down into a deep ulcer with “undermined edges,” where the wound spreads under the skin. 

The bacteria responsible releases a toxin that destroys tissue, so the sore looks alarming even while the patient feels little or no pain. This absence of pain is what makes it so dangerous: many dismiss it as harmless until the damage becomes severe.

Most at risk:
ITREALMS gathered that communities most at risk include families living near slow-moving rivers, swamps, wetlands, and floodplains. Farmers, fisherfolk, and children who spend hours barefoot in water or mud are particularly exposed. 

In Nigeria, confirmed cases have been documented in Anambra, Enugu, Ebonyi, Cross River, Oyo, and Ogun States, though experts believe the disease is under-reported. In places like Awba-Ofemili and Ogbaru, villagers often say “elu-ulee no na-eweghi mgbu” the sore that does not hurt. By the time pain sets in, much of the tissue may already be lost.

According to health experts, the early signs are easy to miss but vital to catch; A firm, painless lump under the skin that does not go away should raise suspicion. Any sore that lingers for more than two weeks, especially after contact with swamp or river water, is a red flag. 

Ulcers with raised or undermined edges, even without pain, must be taken seriously.

Aquatic connection:
Scientists, ITREALMS gathered, are still studying how the disease spreads, but what is known is that Buruli ulcer is strongly associated with aquatic environments. 

Some research points to insects, others to direct exposure to contaminated water or soil, however, what is clear, is that it does not spread easily from person to person. Families do not need to isolate patients, but communities do need to act fast in recognising and reporting suspicious cases.

Prevention is practical and within reach. Wearing sandals or boots while farming, fishing, or fetching water reduces exposure. Small cuts should be cleaned and covered immediately. 

Wounds from elu-ulee, ITREALMS further gathered, must never be treated with corrosive substances such as ashes, kerosene, engine oil, or battery fluid, practices that worsen infections and delay healing. 

Early reporting of elu-ulee:

Above all, people should report stubborn sores early to community health workers and support local outreach programmes that train volunteers to identify and refer cases.

The good news is that Buruli ulcer is treatable, especially when caught early. The World Health Organization (WHO) recommends an eight-week course of antibiotics, typically rifampicin combined with clarithromycin. Many early cases heal completely without surgery.

Advanced ulcers, however, may require surgery, skin grafts, physiotherapy, and long rehabilitation, whereas delayed presentation not only increases costs but also risks permanent disability and stigma.

On local names of elu-ulee:
Local names reveal how deeply this disease has touched different communities. By recognising and using the aforementioned local names, health workers could connect more effectively with villagers, reduce stigma, and encourage early reporting.

What should communities never do? They should not ignore a painless swelling, assuming it will go away on its own. They should not rely on corrosive local remedies that damage tissue further. And they should not hide the disease due to shame or suspicions of witchcraft. Secrecy only delays treatment and worsens outcomes.

If someone develops a suspicious ulcer, families should note when it started and, if possible, take a photograph to track its progress. The person should be taken to the nearest health centre or community health worker. 

Mention rivers, swamps:

Recent contact with rivers or swamps should be mentioned during consultation. If several people in a village present with similar sores, local government health authorities should be informed, as clusters may indicate an outbreak that requires active surveillance.

In Nigeria, vigilance is crucial. Studies have confirmed the presence of Buruli ulcer in multiple states, but cases often go undetected until late. Patients typically arrive at hospitals after months of ineffective home treatment. 

The longer the delay, the harder and costlier the cure becomes. Community-based detection involving farmers, mothers, teachers, and local volunteers, is essential to reducing the burden.

There is hope:

Researchers, ITREALMS learnt are working on faster diagnostic tests and shorter, simpler treatments. Clinical trials are underway for new drugs such as Telacebec (Q203), which may one day replace months of antibiotics with shorter regimens. 

But for now, awareness, vigilance, and early medical care remain the strongest tools available to rural and riverine families.

Buruli ulcer, whether called elu-ulee, acha-ere, onya nwa dia ala, olobutu, or egbo adaijina; is not a curse, nor is it unstoppable. It is a disease that can be prevented, detected, and treated. What matters is that communities recognise it early, reject harmful myths, and seek care quickly. 

That knowledge could mean the difference between a healed wound and a lifetime of disability.

Remmy Nweke/DoP