Prepare the veg - Peel and finely chop the onion. Destem and deseed the green pepper, then dice enough for ½ cup. Cut the stems from the greens of the ramps and chop. Give the greens of the ramps a rough chop as well.
Brown the ground beef - Brown the green beef. Remove from skillet with a slotted spoon and set aside.
Sauté the macaroni and the veg - Sauté the macaroni, the onion, the green pepper, and the ramp stems until the veg is soft.
Assemble and simmer - Return the meat to the skillet, add the tomatoes, ramp greens, water, salt and pepper, and Worcestershire sauce. Cover and simmer for 25 minutes. Serve immediately, with Parmesan and/or cottage cheese on the side as an optional garnish.