About Burkina Faso
Located in “the heart” of West Africa, Burkina Faso, ''land of upright people'' in Moré and Dioula languages, covers an area of 274,000km² and its population which is predominantly young, is currently estimated about 17 million. This country (formerly Upper Volta) which is land locked and without maritime outlet, is precisely situated between longitudes 5°West and 2° East and latitude 9° North and 15° South.
It serves as a link between humid countries in its southern neighbors (Ivory Coast, Ghana, Togo and Benin) and Sahel countries in its Northern and Eastern neighbors (Mali and Niger). Humidity increases from the north-east to the south-west and therefore the vegetation goes from north to south from thorny steppes to savannahs and clear forests. The landscape in general is flat and dominated by a huge lateritic plateau; the country enjoys a Sudanese tropical climate that favors the development of the savannah. The temperature varies between 10°C and 45°C, the highest (40°C and 45°C) is recorded between March and June in the north while the lowest is recorded from December to January.
Burkina Faso is crossed by numerous water courses, lakes and dams. Numerous migrations have occurred in Burkina Faso and some ethnic groups as a result reside in, such as the Mossi, the Mande, and the Fulani. Not only these ethnic groups built their own history but also the history of the whole country. This country which was the French colony and became independent since 1960, is among the poorest countries on the planet. Its main asset remains its youthful population and their selflessness at work (especially agricultural and pastoral). Its political history has been made from cuttings including exceptional regimes with a beginning of democracy since the 1990s, and development along with improvement of living standards for its people [1,2].
History of dermatology, venereology, dermatopathology and leprology
From the Colonial Period to 1970
Prevalence of leprosy and syphilis as the first opportunities for the practice of dermatology in Burkina Faso (Upper Volta)
During this period, many infectious diseases which were epidemic and/or endemic dominated the sanitary epidemiological profile of the West Africa and, especially in our country and brought enormous havoc. Among these diseases, trypanosomiasis, onchocerciasis, malaria, syphilis and leprosy were the most important. These infectious diseases which were dubbed as the "Endemic Diseases", had several skin or mucosal manifestations critical to the diagnosis, treatment and follow up of the related disease.
Strategies to fight against these diseases have consisted in establishing consecutive measures and programs. For example, during the colonial period in Francophone Africa, there were the programs against major endemic diseases including the Autonomous General service of Trypanosomiasis and the Mobile General Service of Hygiene and Prophylaxis. These strategies helped to control trypanosomiasis, small pox and measles in 1960. Beside the organization of health services, there was necessity to train human resources for fighting against these diseases. Therefore, excellence centers were setup. Among these centers, we have Marchoux Institute in Bamako and Muraz Centerin Bobo Dioulasso.
Marchoux institute was founded in November 1931 as "the Central Institute of Leprosy" and was given the name “Marchoux” in 1945 after the death of Emile Marchoux. He was in charge of training nurses who were specialists of leprosy. Muraz Center was established in February 1939 by the Physician Gaston Muraz from the colonial Health troops. It was formerly called "African French trypanosomiasis study center”. In 1945 and as part of the versatility of the autonomous general service of the sleeping sickness, this latter center was named "Muraz Center". Muraz was incharge of the training of nurses for the treatment of trypanosomiasis. Both of these centers were reference centers for training and research in the fields of leprosy and trypanosomiasis for Africa in general and Francophone Africa in particular.
In 1960, many of West African country got independence. The Mobile General Service of Hygiene and Prophylaxis that assured the coordination of the various strategies and programs against major endemic diseases in Francophone Africa disappears and each State built its own national service of major endemic disease. Later in April 1960, the need for a coordinating structure led to foundation of the Ministers of Public Health of Young states which was replaced instead of the Mobile General service of Hygiene and Prophylaxis to fight against major endemic diseases (OCCGE) to mandate for continuing the health work during the colonial period. Nurses were trained in these centers to get specialty in leprosy and trypanosomiasis to acquire the skills for the management of these diseases and also other endemic diseases such as syphilis. During their training, special emphasis was placed on differential diagnoses of these diseases which gave them competency for the management of skin diseases.
In that period, physicians were from French militaries and then among African physicians working with so-called native nurses and trained nurses for the major endemic diseases. These health staffs were the first in our country to practice dermatology and even to describe some dermatological diseases.
Skin diseases were treated in all health centers particularly in the centers fighting against major diseases. These centers which were named "TRYPANO", "LAZARET", "service of HYGIENE” and Raoul Follereau center have been the centers of treatment skin diseases for a long time. Hence, people went or were referred to these centers for finding services for treating their skin problems. Additionally, the role of "tablet distributors" who were health workers within the community and trained in the field of major diseases was important.
At that time, majority of the population were illiterate and their role was supervision on the distribution of the tablets and optimizing the health compliance. Their limited knowledge in medicine allowed them to identify patients with skin diseases who could be suffering from leprosy and to refer them to the trained nurses. They also made people alert to prevent many disorders including skin diseases.
Nurses trained in leprosy or "leprosy controllers" were incharge to supervise several health centers. Their role was to validate the suspected case of leprosy and to initiate the treatment. Their knowledge beyond leprosy also allowed them to treat some skin conditions.
The “leprosy controllers” were also supervised by physicians who were trained in the management of the major endemic diseases.
In order to deal with the complications of leprosy, an operating hall was founded in the Raoul Follereau center in Ouagadougou. In this center, some procedures such as nerve decompressions, handsclaw liberations, excision of the lipoma and numerous skin lesions were done. Additionally, the plantar ulcers and other ailments were treated via the skin surgery. As part of a strategy for fighting against Sexually Transmitted Diseases (STDs), the training programs of African physicians and nurses specialized in major endemic diseases focused on the diagnosis and treatment of syphilis with “penicillin delay” – so-called "Extencilline" -and strengthening the differential diagnoses. These competency played a great role in optimizing the practice of Dermatology and Venereology [3-9].
The period from 1970to 1990
The fight against Human Immuno-defiency Virus (HIV) and other sexually transmitted infections created the second opportunity for strengthening the practice of dermatology and venereology in the Burkina Faso
This period saw the arrival of many young qualified physicians trained in France and Senegal who came to strength the centers fighting against the major endemic diseases and to improve the practice of dermatology. In the early1980s, we began recording the first cases of AIDS in the world; in Burkina Faso the first case of AIDS was reported in1983. As part of strategies for fighting against HIV and STIs, several non-dermatologist health workers were trained in the fields of managing the HIV and STIs with an improvement in the management of some skin diseases. In this context, it is important to highlight the participation of Professor Soudré Robert and Dr.Paul Thomas Sanou in the 2nd International Course of the management of STIs and HIV at the Institute Fournier of Paris, in 1985.
Dr Sawadogo Nobila Oumarou after practicing as a general practitioner at urban health Bobo Dioulasso center from 1978 to 1985 began his education in Dermatology specialty from 1985 in Algeria, the Marchoux Institute in Bamako and finally at Bordeauxin France, successively. When backhome, he was assigned for leprosy department to control the communicable diseases, who succeeded to completely control the disease in 1996.
Oumarou was the first and the only physician who practice dermatology from 1989 to 1990. Then, Dr. Adama Traore joined him from 1991 to 1996. During this period, Oumarou worked at the Raoul Follereau center with attendances at CHU YO.
In September of 1991, the real dermatology department was founded at the Centre Hospitalier Yalgado Ouédraogo (CHUYO) which first directed by Dr. Oumarou Sawadogo Nobila and then by Professor Adama Traore until today.
In the early 1990s, two Burkina be physicians, Dr. Paul Thomas Sanou and Dr. Bonkoungou Météat the Houet Health Provincial Directorate noted that consultations for skin diseases and STDs had become more frequent and taken a typical aspects making diagnosis and treatment difficult. Hence, they founded and organized a consultation center of Venereology and Dermatology at the Regional Directorate of Houet in Bobo Dioulasso to manage the HIV. After them, the reputation of the center in the area of the management of STDs and dermatitis
Resulted to the assignment of a great dermatologist Dr. Tapsoba Patrice to patrice in this center from 2006 to 2010.
During this period, the Cuban and Algerian medical missions in different hospitals with teaching dermatology in the growing medicine faculty of Ouagadougou improved the practice of dermatology in our country especially in Ouagadougou and Bobo Dioulasso.
Thus, thanks to Professor Ouiminga who was dean of the school of medicine, and Professor Jean Marie KANGA from Ivory Coast who serviced in dermatology consultations in the Raoul Follereau center from 1983 to 1990. Herein is an opportunity for us to express them avibrant tribute for their important role in the implementation of dermatology specialty in our country.
From 1990 to the present
Arrival of Burkinabe dermatologists and better implementation and organization of the dermatology specialty in Burkina Faso
Dermatology as a whole has really been developed since1990 with foundation of dermatology departments in the Raoul Follereau center of Ouagadougou and Yalgado Ouédraogo University Hospital Center (CHUYO). Whereas at the Raoul Follereau center, dermatology has been and continues to be in the form of outpatient service until today, in CHUYO, dermatology has been developed and has become an important specialty of the Hospital.
Indeed, from 1990 to 1996 two specialists accompanied by two nurses of feredan in-patient building at CHUYO intensive consultations and sometimes hospitalizations in there animation or internal medicine department. They went through different services when asked for expert advice.
From 1997 to 2002, the department of dermatology in CHU YO was transferred to the infectious diseases department where we assure external care services, hospitalizations and expert advice in other services. Finally, in 2003, the department of dermatology was fixed to its own building, inheriting the building of the former Pneumo-physiology department. In this building with a capacity of 14 beds, three dermatology professors, one high level assistant, two assistants, students on training, nurses, secretary, supporting staff and students in practice offer the outpatient service and hospitalization of patients, the treatment of people with HIV, research and mentoring activities of students.
In Bobo–Dioulasso, dermatology activities have long been conducted by the services of the former OCCGE that became Muraz Center and by the Regional Directorate of Health (DRS) for the benefit of Western populations of Burkina Faso.
In the University Hospital Center Sanon Sourou (CHUSS), Cuban dermatologists through the cooperation strategy came to support these activities in a timely manner prior to 2001. In 2001, the Unity of Dermatology of the Internal Medicine Department was created with the arrival of a Burkinabe dermatologist in Bobo Dioulasso. This department became operational in 2009 with the arrival of a second dermatologist (2005). Since 2012 the number of dermatologists has increased up to three.
In Bobo Dioulasso, the medical staffs of the dermatology department consists of one Professor of dermatology, one high level assistant, one assistant and a nurse. The service has a six-bedin-patient unit. The service fulfills its mission of treatment, supervision, training, and research.
The hope lies in the foundation of the new University Hospital center in Bobo Diuolasso, whose first construction activities have already started to offer some infrastructures, technical facilities and staffs to optimize the mission of this young service.
In Ouagadougou, we should also point on the role of the Medical Center of the Camp General Aboubakar Sangoulé Lamizana. Located in a barracks in the city of Ouagadougou, the Medical Centre of the Camp of Unity (CMCU) was established in 1993-1994 and has been renamed since 2010 as “Medical Center of the Camp General Aboubacar Sangoulé Lamizana (CMCGASL). It is a medical foundation of the Health Service of the Army forces that provides specialized consultations to military, their families and civilians. The dermatology department was opened in 2001 by Professor Pascal Niamba with the support of Dr.Namoulniara Diatto Georges and a health nurse in dermatology.
In this period, private practice of dermatology has gradually been developed in various private clinics and denominational health centers.
As conclusion, in our country and in a chronological order, the structures which played a significant role in the growth and development of dermatology and venereology include centers fighting against the major endemic diseases, the Raoul Follereau center, the health regional Directorate center of Bobo Dioulasso, the University Hospital Yalgado Center of Ouagadougou, the University Hospital Sanon Sourou, Center of Bobo Dioulasso, Sangoulé Lamizana Center and recently Saint Camille Health Center, the University Hospital Blaise Compaoré Center and private clinics in Ouagadougou and Bobo Dioulasso [10-27].
Figures who played role in dermatology, dermatopathology, and dermatological procedures
The first persons who had great role in optimizing the practice of dermatology are Dr Paul Thomas Sanou and Dr Sawadogo Nobila Oumarou and Professor Traore Adama. They have been the first Burkina be physicians who embraced the dermatology profession and developed its practice in Burkina Faso.
Dr. Paul Thomas Sanou has been the first Burkina be dermatologist to start dermatology training at the Saint Louis Hospital in Paris and continued it for a few months. Then, he was called back to the country for political reasons. He was subsequently trained in Germany for 2 years in a department of dermatology.
We must express special tribute to Dr. Sawadogo Nobila Oumarou who was pioneer in the art of dermatology in our country. He directed the first dermatology units in the RAOUL Follereau center and CHUYO. He developed the dermatology specialty until his death in 2005. After his death Dr. Kafando Christophe was succeeded. He became coordinator of the leprosy program from 2005 to 2013 and he has been head of the unity for fighting against leprosy, leishmaniasis and Buruli ulcer from 2013 to today.
Following Dr Sawadogo Nobila Oumarou, Professor Traore Adama was assigned as head of the CHUYO services since 1996 to today. He is also incharge of the teaching of dermatology at University of Ouagadougou and in other public and private universities of the country. Professor Traore Adama was trained in Dakar, Senegal and Strasbourg France under the supervision of Professor Bassirou Ndiaye and Professor Edouard Grosshans.
In 1984, Professor Soudre Robert established the pathology laboratory of CHUYO with particular emphasis on the dermatopathology because of his training in this area with the support of Prof. Pluot Michel of Reims in France.
Professor Niamba, beside the foundation and the direction of the Department of Dermatology of the Medical Centre of Camp General Aboubacar Sangoulé Lamizana, has been also Assistant of Professor Traore Adama in the Department of Dermatology of CHUYO. He played and plays a major role in the training of specialists in dermatology.
Professor Barro/Traore Fatou is the third figure who played and plays an important role with Professor Traore Adama and Professor Nianba Pascal in the radiation of the dermatology school of Ouagadougou and of Burkina Faso in Africa and in the world. She is the one who opened the unit of dermatology in the CHU Blaise Compaore in 2012.
Professor Andonaba Jean Baptiste is worthy quoting for his role in foundation of the service of dermatology in the western part of the country particularly in Bobo Dioulasso.
Dermatology society, dermatology journal, and dermatology congress in Burkina Faso
It was in 2003 at the congress of the Association of Francophone dermatologists (ADF) in Sfaxin Tunisia that the idea of creating a dermatology society gathering dermatologists, estheticians and cosmetologists was initiated. Indeed, at the end of the Congress Burkina Faso was designated to host the 27th congress of the association and the need for the organization of the actors to address this challenge had become necessary. The dermatology society of Burkina Faso was founded in September 18, 2004 which was aimed at promoting dermatology, cosmetology and esthetics in Burkina Faso, called Society of Dermatology, esthetics and Cosmetology (SOBUDEC). It has hold, to its credit, the successful organization of the 27th Congress of the ADF in February 2007, the organization of our national days of Dermatology, many promoting sessions and numerous scientific studies.
To conclude, for history purposes, it should be noted that it is during the academic year 2008-2009 that Professors Traore, Niamba and Barro setup a training program in dermatology in Burkina Faso. Since then, seven dermatologists composed of six Burkinabe and one Nigerian were assigned to the Ministries of Health of Burkina Faso and Niger.
Burkinabe dermatologists have played an important role in the creation and animation of the Society of Dermatologists of Francophone Africa (SODAF) in Dakarin 2006 and in its newspaper called Tropical Dermatology in 2013 in Conakry. The professor Traore Adama provides leadership in this sub regional society.
Current status and prospects
The number of domestic dermatologists is growing steadily from the 1990s to the present day from 2 to over 20 dermatologists. However it must be stressed that the dermatologist-population ratio is still very low and especially their geographic distribution remains a major issue so that 8 of the 13 regions in the country are not yet filled.
While the dermatology centers of Ouagadougou and Bobo Dioulasso are considered as the oldest and largest centers, we must emphasize foundation of dermatology units in Ouahigouya, Koudougou and Tenkodogo.
These sights were thus allowed to produce many scientific papers at the national and international levels, whose main themes were infectious and tropical dermatology, including HIV co-infections, leishmaniasis, inflammatory dermatoses and the dermo-cosmetics. Particular aspects on black skin were highlighted. Dermatologists have hosted national and international meetings and through these, shared experiences.
With training dermatology specialty in Ouagadougou, there is hope to achieve three trained dermatologists for regions outside the two regions of Ouagadougou and Bobo Dioulasso in the next 10 years. The outlook for optimum development of dermatology focuses on human resource development, improvement and updating ongoing competency, development of dermatology well-equipped units and services. In this way, the existence of a more dynamic scientific society will also be an asset.
Dermatology is a young, unknown and neglected specialty in our country. Although practiced since the colonial period, its real implementation only dates back to the1990s with some basis is for satisfaction already, but still with many enormous challenges ahead. Future generations must meet these challenges for a better implementation of the specialty in our country and a better quality of the practice of dermatology in order to take into account the concerns of our people and thus better contribute to the development of our country.
I would address my sincere thanks to the family of Dr Sawadogo, to Dr. Paul Thomas Sanou, Mr. Yamkoulga Steve, Dr. Tapsoba Patrice, Prof. Ouminga, Prof. Soudre and all staffs of the dermatology department of Ouagadougou and Bobo Dioulasso.
- http://lewebpedagogique.com/patco/2008/12/27/presentation-du-burkina-faso/du 9 aout 2015.
- http://www.aubergelecailcedrat.fr/presentation-du-burkina-faso- bf_3366561.html. du 9aout 2015.
- GUY MICHEL, N. 1984 InstitutMarchauxou 50 ans de luttecontre la lèpre enAfrique Noire, thèse de Doctorat, Université de Paris XII, 405 p.
- http://sfdermato.actu.com/allf/plus13.pd.du 9 aout 2015
- Benjamin Kokou ALONOU. La politique sanitaire de l'organisation de coordination et de coopération pour la luttecontre les grandesendémies (OCCGE) 1960 -1998 : Revue du CAMES - Nouvelle Série B, Vol. 008 N° 1-2007.
- M. Menard, R. GideletP.Ghipponi. A propos d’un cas de Leishmaniosecutanéegénéralisée chez un nourrisson en Haute Volta, Ann.Soc.belgMéd.trop 1970, 50, 3 : 281-292.
- Oddou.A. Sur 13 cas de leishmaniosescutanées en Haute Volta. Bull.Soc.Med.Afr Noire mangueFrançaise, 1962, 7, 284-287.
- Larivière M, Abonnec E et Kramer R. Chronique de la leishmaniosecutanée en Afrique de l’Occidentale. Bull. Soc. Path.Exot., 1961, 54, 1031-1046.
- Larivière M, Camerlinck P, Reynaud J et al. Premier cas de leishmaniosecutanéo-muqueuse au Sénégal. Bull. Soc. Med .Afr. Noire, 1965, 10, 15-18.
- A Traoré, N Korsaga/somé. P.Niamba, F. Barro, I. Sanou, Y.J. Drabo. Le Pityriasis Rose de GIBERT en milieu scolaire de la ville de Ouagadougou (Burkina Faso) Ann DermatolVenerol 2001; 128:605-9.
- F. Barro/Traoré, A. Traoré, P. Niamba, SS Traore, L Traore, I. Sanou, NO, Sawadogo, B.R. Soudré, E. Heid, E. Grosshans. Les dermatosesbulleuses auto-immunes dans le service de dermatologie du centrehospitalieruniversitaire de Ouagadougou (Burkina Faso) Nouv Dermatol.2001; 20:367-370.
- Barro, F, A Traoré, P. Niamba, Heid E. et Grosshans E. Carcinomebasocellulairesur zone photo exposée, chez uneafricainemélanoderme. Ann DermatolVenerol 2001; 128:137.
- Barro, F, A Traoré, .P. Niamba, D. Ye ISanou, B.R. Soudre, Heid E. et Grosshans E. Association Morbides au cours de troiscas de cytosteatonecrosenéonatale
- NouvDermatol 2001; 20:18-20.
- JP Ortonne , A Traoré et all. Vingtansde progrès en dermatologieNouvDermatol 2001; 20: 429-30.
- A Bougouma, YJ Drabo, ATraoré, AK Sermé, RA Sombié, B Touré, C Ouédraogo/Bougouma, PD Ilboudo. La cholestaseintrahépatique de la grossesse. A propos d’une observation chez une noire afriçaine au Burkina Faso. Burkina Médical 2000-2001; 4:97- 102.
- A Traoré. Miliairesudorale In Thérapeutique en dermatologie de Louis Dubertret. ÉditionMédecine Sciences Flammarion Paris 2001; 542-3.
- Traoré KS, Sawadogo NO, A Traoréet all. Etude préliminaire de la leishmaniosecutanéedans la villede Ouagadougou de 1996 à 1998. Bull SocPatholExot 2001; 94: 52-55.
- F Barro-Traoré , D YéOuattara, A Traoré, . P. N O Sawadogo, I Sanou TR Guiguemde, E.Heid, M Deniauet E Grosshans. Leishmaniosecutanée pseudo-lépromateuse : Analyse de six cas à Ouagadougou Burkina Faso. NouvDermatol 2002; 21: 156-161.
- Barro, F, A Traoré, G Bonkoungou, SS Traoré, P. Niamba, Heid E. et Grosshans E. Nodule cutané, douloureux et hyperpigmenté de la cuisse Ann. Dermatol. Venerol2002 ; 129 : 241-3.
- A Niakara, R Cissé, ATraoré, PA Niamba, F Barro et J Kabore. Localisationmyocardiaqued’unecysticercosedisséminée: Diagnostic échographique d’un cas: Archives des Maladies du Cœur et des Vaisseaux 2002 ;95 : 606-8
- M Ouédraogo, O Goumbri/Lompo, S Kouanda, SM Ouédraogo, S Ouédraogo, K Boncoungou, ATraoré, RB Soudré. Localisationbroncho-pulmonaired’unemaladie de Kaposi chez un patient atteint de SIDA :difficultésdiagnostique et de prise en charge (à propos d’un cas). Sciences et Techniques, Sciences de la Santé 2002 ; 25 : 113-118.
- R Cissé, D Yé, ATraoré, C Lougué, I Sanou, J Lankoandé, A Sawadogo. Le Syndrome du Prune Belly (A propos de deux observations de découverteanténatale à Ouagadougou Burkina Faso) Burkina Médical2002 ; 5 : 89- 94.
- FatouBarro-Traoré ,AdamaTraoré, IssoufKonaté, Si Simon Traoré,. NobilaOumarSawadogo, IssaSanou, B.RobertSoudre, Ernest HeidetEdouardGrosshans. Tumeurscutanéo-muqueuses : aspects épidémiologiquesdans le service de dermatologie du centrehospitalier national YalgadoOuédraogo de Ouagadougou, Burkina Faso Cahiers Santé 2003; 13: 101-4.
- D Yé , A Traoré, R OuédraogoTraore, F Barro, KL Kam, I Sanou, A sawadogo. Impétigo de l’enfant en milieu tropical. Ann DermatolVénéréol 2003; 130: 58.
- B Touré, B Dao, ATraoré, M Akotionga, C Ouédraogo, B Koné. VaricelleetGrossesse, a propos de deux observations au Centre Hospitalier National YalgadoOuédraogo (Burkina Faso) Burkina Médical 2003; 6:123-126.
- J B Andonaba, F Barro/Traoré, B Diallo, I Konaté, O M Goumbri, P Kaboré, Niamba P, A Traoré, B R Soudré. Les cancers cutanés: fréquenceet types histologiques à Ouagadougou, Burkina Faso. Science et technique, Sciences de la santé 2009; 32 (1 et 2): 101-109.
- Andonaba JB, Barro/Traoré F, Diallo B, Sakana L, Niamba P, A Traoré. Aspects épidémiologiques des affections dermatologiques au Centre HospitalierUniversitaireSouroSanou de Bobo–Dioulasso Ann. Afr. Med. 2010; 4 (1): 668-677.