“It Is Me Who Endures but My Family That Suffers”: Social Isolation as a Consequence of the Household Cost Burden of Buruli Ulcer Free of Charge Hospital Treatment

Despite free of charge biomedical treatment, the cost burden of Buruli ulcer disease (Bu) hospitalisation in Central Cameroon accounts for 25% of households' yearly earnings, surpassing the threshold of 10%, which is generally considered catastrophic for the household economy, and calling into question the sustainability of current Bu programmes. The high non-medical costs and productivity loss for Bu patients and their households make household involvement in the healing process unsustainable. 63% of households cease providing social and financial support for patients as a coping strategy, resulting in the patient's isolation at the hospital. Social isolation itself was cited by in-patients as the principal cause for abandonment of biomedical treatment. These findings demonstrate that further research and investment in Bu are urgently needed to evaluate new intervention strategies that are socially acceptable and appropriate in the local context.Author Summary: The cost burden of free of charge Buruli ulcer disease (Bu) hospital treatment is not sustainable for a majority of patients and their families in Central Cameroon. The long term nature of Bu taxes the patients' and their families' resources often to a breaking point, consequently often leading to the abandonment of patients by the family. In the study area, 62% of families ceased providing social and financial support to the patient, which resulted in the patient's isolation at the hospital. Significantly, social isolation was cited by in-patients as the principal cause for abandonment of biomedical treatment. Paradoxically, this phenomenon was observed in settings where hospital in-patient treatment, room and board were provided free of charge for the patient and caretaker. These findings show that despite the significant reduction in costs for medical care, in its current form, hospital treatment for Buruli ulcer often remains financially and socially unsustainable for patients and their households, leading to the abandonment of biomedical treatment or altogether avoiding it. Further investment and research are urgently needed to evaluate new intervention strategies that are both socially and financially acceptable and appropriate in local settings.