Moxafrica in South Africa
South Africa has the highest global rates of drug resistant TB, the most frightening strains, and the highest rates of HIV-TB co-infection all of which makes for such an immense challenge for pharmaceutical treatment.
It was our goal right from the outset to set something up in the country because of this. At the end of last year we were wondering whether we'd ever get there for lack of funds. There's more information on how we set the projects up below.
Initially we trained seven "carers" (these are local rudimentarily trained health workers who minister in the neighbourhood) in the moxafrica treatment protocol in New Crossroads, a township neighbourhood in Nyanga, Capetown; and we trained six carers (as above) in Robertson - a town about a hundred miles north of Capetown. We have compiled a short two minute movie of the two trainings and would love it if you took two minutes to view it on Youtube.
Four months in (July 2011)
We spent two days in each township, escorted into various areas within the township.
In Nyanga we saw and interviewed nine of the thirty-three patients so far enrolled on the programme. In Robertson (Nquebela) we saw seven of the eleven patients enrolled so far.
We think it fair to suggest that, generally, the patients enrolled in South Africa are on average much weaker than those enrolled in Kampala. This was the aim of the programme, because we knew how serious the problem is in the townships of South Africa despite the drugs and diagnostics being available.
Despite these patients being far weaker (several originally bed-ridden), we've seen very similar response to what we saw in Kampala including some very clear recoveries from extreme illness which both patients and carers put down the moxa. No problems were identified, and we were really impressed with how the carers have applied themselves to the programme.
Just over 50% of the patients we saw were also HIV+, and yet again we are seeing no discernable difference in response between these and those who are just infected with TB. Two of the patients are confimed MDR-TB, both having spent eight months in hospital and both on the second year of their drug treatments. One was almost deaf from the side effects of the drugs, and both were chronically weak.
One of the MDR-TB patients is also HIV+, and has given us much food for thought. She is quite easily the slowest responder we have seen so far. It is very early to draw any conclusion, but we wonder whether the combination of drug therapies (second line TB drugs and HIV drugs) which are known to negatively interact creates an additional block to the host immune response. The other MDR-TB patient is at a similar stage of second-line TB treatment, but has responded well to the moxa treatment. The difference may be that she is not also taking HIV drugs.
Survival rates for MDR-TB patients is often estimated to be below 50%, so we know that we must pay particular attention to these patients, since we believe moxa might be of particular benefit for them.
The set up of the programs
Each program is set up similarly - with each carer being asked to train in turn five patients and to provide us with feedback on each patient's response through a simple pro forma system. This means that we are hoping to harvest a controlled profile of response from a total group of sixty-five patients - thirty-five in Capetown and thirty in Robertson.
The localities in each program are very different - and in truth we have no clear idea of the local incidence or prevalence of TB in either, nor of drug-resistance nor of HIV co-infection - but we can be sure that in all aspects they will be worse than in Kampala. Seeing how the pictures emerge and how each project develops will be educational for us, we're sure, and we know that we have much to learn still.
In Nyanga
- we have Andre Sorger on hand to chivvy things along. Andre is a dynamic guy, a member of faculty of the School of Natural Medicine at the University of the Western Cape(UWC) - and he is clearly impresse and excited by the respoinses seen so far, and committed to helping its progress. He visits New Crossroads regularly as part of outreach work which he supervises at the centre with his acupuncture students from the UWC.
Secondly, we are engaging on the project with SACLA (the South Africa Christian Leadership Association). SACLA was founded in the darker days of apartheid as an advocacy organisation - and initially had Bishop Tutu as its patron. We feel really privileged to be working with them. They have lent us one of their admin workers (who has TB herself) to help us in terms of keeping records. She will make sure that the carers are submitting their reports regularly and will also arrange their stipend payments and should be giving us monthly reports of progress, as well as holding the local stock of refined moxa and distribute it as and when needed.
Additionally, we also have the support of Thoko Mtulu, who was an original SACLA founder, who is a quite extraordinary woman. She has also been impressed by what she has seen so far, and is both generous and patient with her time with us, enriching our understanding of what living in a township really means. Frankly it feels a little humbling to find ourselves associated with someone like her.
the team at Nyanga
In Robertson
- we have Tim Knight on hand to help. He is a UK trained acupuncturist who lives in the town, and who became very interested last year in the Moxafrica idea. He's not trained in Japanese-style small cone moxibustion, so the actual treatment has been something new to him, but that really is no problem. Tim is providing monthly reports from Robertson, and holds the local moxa stock.
a patient testing her new moxa skills on her carer
The plan is to run both of these programs for twelve months and review results.
Looking forwards, we intend to revisit at similar intervals in the same way that we did in Kampala - every four months for the course of the year.
It's always nice to be able to add a little anecdote to a report such as this, and we have one! On the second day of initial training at Nyanga, we supervised the trainee carers training their first patients in the moxafrica protocol. Apart from teaching the specific mechanics of preparing and applying small cones of moxa safely this also includes interviewing the patient, explaining the treatment and establishing their informed consent to take part in the programme. Our first patient was a wiry elderly lady and we watched while the carer explained the issues in Xhosa ("clicks" and all) - after which she spoke vehemently in reply at which point the carer broke out in laughter. "What did she say?" we asked, a little anxiously. We got an answer we hardly expected. She had said: "If you don't give me this moxa treatment I am going to arrest you!".
The patient and her carer who she says she'll arrest
if she doesn't get her moxa treatment!
