News
(Please note that this page is regularly edited as items become less relevant leaving only the more important postings).
November 18th 2011
Moxafrica has been selected for the "BigGive Christmas Challenge", a fundraising straregy designed to benefit UK charities (specifically smaller ones) to maximise donations and to motivate fundraising. We have just completed the "pledging phase" during which we have raised £3000, meaning that our online donation target is now £6000 with an extra £3000 coming from the BigGive sponsor fund. The online donation phase runs between December 5th-9th.
During this particular week, all donations made will be effectively DOUBLED.
August 19th 2011
We can report that we are now in the process of finalising formal research design with Kampala's Makerere University's Medical School. This research, however, has developed substantially from what was being envisaged following our seminar there in May.
Instead of it being a small pilot study run as part of a masters degree, the proposal has now escalated to being a Phase II Randomised Control Trial, with the Professor and Head of the Department of Pharmacology and Therapeutics as the lead investigator. We cannot say how excited we are by this development, since it could mean so much.
Firstly, it means that the scientist doctors at Makerere are awarding the project the same potentials as we are, having now seen and talked themselves with the patients and health workers at Kiswa Health Centre where we ran the first project.
Secondly, the research initiative has literally leap-frogged two levels, taking it far ahead in terms of our most optimistically projected programmes for more rigorous investigation.
Thirdly, with the Professor's involvement, we can expect that any results will be publishable in the sorts of journals that might make impressions with the medical organisations at the coalface of this disease in Africa (MSF etc) - those organisations which could help implement moxa treatment on a far wider scale than we could ever manage and which really could make a difference.
The proposed research is asking simple but vital questions, and the study design is robust. It intends to establish:
- What are the cure rates of standard first line drug treatment plus MOXIBUSTION versus the cure rates of standard drug treatment alone?
- Does the addition of moxibustion to standard TB treatment, improve lives /decrease morbidity and suffering of the TB patient during and after treatment?
With what we've learnt in Uganda and South Africa, however, not only are we convinced that TB and TB co-infected patients can benefit, but we also think that we can further simplify their moxa treatment when drugs are available, and that it will still be effective.
May 16th, 2011
A week ago we got back from our most recent trip to Uganda. Politically, the country is in some current turmoil, but we fortunately managed to visit the country in between weeks of political unrest on the streets. In contrast to these troubles on the streets associated with soaring basic commodity prices, we have exciting news to recount.
The trip had two main purposes: to "wrap up" the study in Kampala; and to make a presentation on the project to a selected membership of the faculty of the Department of Pharmacology and Therapeutics at Makerere University Medical School. Makerere is one of Africa's oldest universities with a renowned school of medicine, and its senior professor, Professor Paul Waako has particular interests in the use of particular traditional nedicines for the treatment of tropical disease.
The presentation went well, and the Professor intends to assign one of his masters students to collaborate in the design of and to manage a pilot study at Kiswa (the health centre we've been working at), to test out one or more of the hypotheses which have arisen from the conclusions of our own study there. What is even more exciting is that, if the results of this study prove positive, he sees no reason why further more appropriately extensive clinical research might not be developed behind it. This is immensely exciting as a prospect, and potentially places the Moxafrica project ahead of programme in this respect. It will be years before final conclusions from such research might be drawn, but without such research the validity of any work we do will always remain questionable.
Meanwhile we spent three days interviewing patients and healthworkers at Kiswa, including filming their responses to some of our questions. Overall, we can say categorically that the results of this open-focused study has been positive. We ask anyone interested to review the report.
March 31st, 2011
Last week saw the passing of another World TB Day (March 24th), the third since the founding of Moxafrica. This time, we spent the day itself training carers in Robertson, South Africa.
As usual, it was accompanied by a report from the WHO on the state of global drug resistance.
What follows below is a summary of our analysis of the report from the perspective of the Moxafrica charity.
It is not all bad news, but it does smack a little of papering over the cracks. It fails to set the alarm bells ringing nearly as loudly as it should do, and also continues to pretty much generally ignore African countries - the only ones identified as having DR problems in fact are South Africa, the DR of Congo, Nigeria and Ethiopia (and only South Africa has any sort of diagnostic or surveillance infrastructure so it is hard to understand how they have definitively worked these others out). With regards to Africa, it is hardly possible that the report is in any way accurate and is merely reflective of the huge epidemiological hole which the continent is suffering from in terms of available data. We are reminded of the stament made by Dr Jim Yong Kim a year ago. Dr Kim is a Professor of Medicine and Social Medicine at Harvard Medical School, and is former Director of the WHO HIV/AIDS Department. He wrote chillingly: "Every time we look the problem is worse than we thought. Now it is coming together with HIV in sub-Saharan Africa, and it could be the most frightening thing we are ever going to see."
The report also identifies that there are literally no paediatric drugs available for treating DR-TB, while between 10 and 15% of DR-TB patients are estimated to be kids...
Appallingly, it also looks like the South African public sector is paying way more than others who are also treating DR TB. PAS 4g sachets, which are being sold to the South African government at R80 per sachet (daily dose), are being bought by MSF international for R21....
What a business.
It also suggests that, in contrast to the WHO report, as few as 6,000 patients were enrolled in GLC-approved treatment programmes, in comparison to their own estimated 440,000 new cases of DR-TB (around 1.4% ot the total, or a tenth of the WHO estimate).
Furthermore (and these quotations are of direct relevance to the non-pharmaceutical approach which lies at the heart of the Moxafrica project) they state that -
- "The interactions of DR-TB drugs with AIDS nedicines are largely unknown...This is particularly problematic given that TB is the biggest killer of people lving with HIV today"
- "Today's treatment for DR-TB is largely based on experience and expert opinion, not studies or clinical trials, with a large number of "gray areas" where expert opinion may be conflicting"
and
- "The current objective is to develop and deliver a new short term regimen able to treat drug-sensitive and drug-resistant TB, and is also compatible with HIV treatment...it is questionable whether this objective can be achieved within reasonable time lines".
Once again we ask whether moxa treatment just might fill these gaps on exactly these terms. Step by step we are committed to contuining to find out.
November 19th, 2010
We didn't get to Capetown in October to start the parallel study - mainly down to money. Our revised plan is to start in February - the importance of starting as soon as possible, however, has been magnified by another batch of feedback we've gathered this month from Kampala.
Overwhelmingly, the patients have reported positive responses to moxa, sometimes noticed after only a few days. Some of them had begun moxa at the same time as their TB medication so it would be hard to know for sure how much the moxa had helped, but Sister Magdalene Ichumar, who's in charge of TB treatments at Kiswa, said that in some cases the improvements had been far in excess of anything she would expect from drugs alone. Others had started TB medication but found it did not help much or made them feel worse, but then had begun moxa treatment and then quickly improved. These people were quite sure that moxa had helped them where drugs could not.
Almost everyone reported less coughing, less leg pain, better appetite, weight gain and more energy – although one man said that his improvement had been rather different – he had only felt like “half a man” before he started moxa. Quickly his libido began to improve and his wife is now very happy!
There were some really moving stories of dramatic recoveries from people who had been close to death.
One woman had been so ill, weighing only 18kg, that her family had already arranged the funeral. The TB drugs had made her feel worse for 2 months, but then she started moxa and after only one week began to notice the change. Seven months later, she now looks strong and happy, and feels “very well”, but is determined to continue her daily moxa.
Our favourite story concerns Colette, aged 30 who came with her mother (who is her treatment buddy). Colette had an abdominal form of TB which had taken months to diagnose, by which time she was in agony with stomach pain, and extremely weak. Her mother thought she was close to death. She had started TB drugs but on that same day she saw some people being trained to use moxa and asked if she could enrol. She started using all the points at once, determined and convinced that this was the only treatment that could help her. Her mother, who treated her every day without fail, says “After a week I could see huge improvement – she was asking for drink and food which she had not done for a long time. I was so happy”. All the stomach pain disappeared after 2 weeks. Now after 8 months she looks strong and healthy and has a busy job as a cleaner. Both Colette and her mother spent time encouraging the other patients to persevere with their moxa regimes, even if they found it difficcult at times. As Colette told them: "Moxa gave my life back".
Colette (left) and her mother this November
August 17th, 2010
We have found ourselves very recently desperately let down by an organisation here in the UK. We had believed that they were able and willing to help fund the next stage of the project in Capetown. We certainly know that they have both the resources and the legal remit to do so, and we had been negotiating accordingly for nine months. As a result of this unexpected setback, we have a desperate hole in our projected income, since we had been counting on this grant becoming available to us in September. We still have no proper explanation as to why this legitimate source of funding has been denied us at this time.
All of our available resources are focused on rectifying this situation, and we're seeking any available avenue of support. We're still planning to be in Capetown in October.
Below is a photo of a patient in Kampala who is currently enrolled on the programme. She is a "drug-failure", and thus is defined (in the absence of more sophisticated diagnostics) as drug-resistant. Since starting moxa therapy she has strengthened, stopped coughing and has put on weight. For her and her baby, moxa represents her best and only hope. For her and those like her, we have to keep the Kampala project going as well.
If you know anyone who might help, or can help yourself with a donation, please get in touch. You can simply click on the "donate" page
July 18th, 2010
We have some interesting news from Uganda, four months into the year long investigation. Patients enrolled on the programme are reporting interesting and exciting responses - and as importantly, no negative reports. Early days yet, but extremely encouraging. (Please see below for more information).
First, another bleak and alarming report from those at the epidemiological coalface of drug resistance. This article explores some of the dreadful ethical dilemmas facing those trying to flight this disease in its worse drug resistant forms. It also discusses the awful reflection of our failing humanity which this disease holds up in front from of our eyes if we care to look the scourge honestly in its face. The title of the article makes no bones about this: "Apocalypse or Redemption".
http://www.who.int/bulletin/volumes/87/6/08-051698.pdf.
With the subsequent phases of this project planned to include taking it to Nyanga township in Capetown (where drug resistance is rampant) and hopefully from there to the School of Natural Medicine in the University of the Western Cape for more rigorous research, what we're now revealing in Kampala is proving immensely exciting. Patient responses are promising with no reports of negative effects - as good as we could reasonably have hoped for at this stage, and we have full support from the local health workers The reality that these simple treatments could actually save otherwise unsaveable lives seems to be tentatively materialising out of the dreamier realms of hypothesis into a misty dawn of real possibilities.
What we think now is that simple moxa treatment really can make a difference - no longer "might" but "can". Step by step we are systematically testing potentials, and with each step we are becoming more confident of its ultimate possible significance. But the responsibilities associated with this grow exponentially as well. We have to keep watch over both the bigger picture (properly developing a systematic progressive investigation with the final goal of rigorous recognisable research) and the smaller picture (the day to day humanitarian welfare of patients enrolled on the programme in Uganda).
At this stage we never intended to be amassing anything that might satisfy a rightfully sceptical medical world. First and most importantly, we have to satisfy ourselves and potential funders or collaborators – beyond reasonable doubt.
We have focused so far on 7 possible identifiable improvements:
a) sleeping - improved in nearly every case, either because of reduced coughing, less sweating or (in one case) because of an inability to lie on one side because of water in a lung which had apparently resolved with moxa use.
b) breathing and coughing - improved in every case but one (who wasn't using the whole protocol), including one who stated that the coughing had stopped completely after only a week's treatment.
c) energy and strength - improved in every case but one.
d) appetite - improved in every case. This suggests that deeper self-healing mechanisms may be being re-engaged in a naturally wasting disease.
e) weight gain - this was reported in nearly every case.
f) joint pains - in every case except one was positively commented upon, sometimes very positively.
g) blood counts - unfortunately we had no reports on this. The local CD4 count lab had broken down so this data may prove difficult to confirm, but they are hopeful that it will be repaired.
There were important questions we needed to have answered to some degree by this stage, and we list them below, together with their current answers:
1. Are we satisfied that the 1930's Japanese reports on which we are basing our protocol approaches were bona fide?
Based on the recent visit, we can be confident that this is not only "yes", but that they were far from exaggerated. The tradition of treating TB in Japan with moxa no longer survives today so this had always been a fundamental concern.
2. Do we think that these approaches might be applicable and transferable today in Africa?
Based on the earlier visits (which confirmed that African health workers and patients were open to direct moxa therapy) we already believed that this would be the case. Based on seeing the patients last week, this is confirmed with one proviso: it's clear that for many reasons there has been a high dropout rate from the total cohort; it is to be expected that this phenomenon is likely to repeat in the future, so we need to develop strategies accordingly.
3. Do we think that moxa can be taught so that it is both safe and effective?
Based on the responses so far, the answer is unequivocally "yes".
4. How effective do we think moxa might be?
The best answer we can give right now is - every possibility exists that it could at least contribute to saving lives, and importantly might save lives when other treatments fail or are unavailable.
5. Do we think that moxa might help treat drug-resistant TB?
Over half the patients were relapsed drug failures, so can be assumed to carry resistant strains. Based on their responses, the answer is "yes" but much more information needs gathering on this massively important group.
6. Do we think that it is also applicable for use in cases of co-infection with HIV/AIDS?
This vital question remains unanswered at this stage. Two reasons to be cautiously hopeful in this immensely important regard remain, however: firstly, the response we witnessed from a dying co-infected patient in Lyantonde last December (see “the Acupuncturist” date….); secondly our limited experiences with HIV patients in the UK suggests that daily moxa treatment significantly can improve CD4 count.
7. Might it have a negative effect on parallel drug regimes?
No-one reported that they had stopped taking their drugs which was encouraging. Side effects may also have been being reduced.
All told, we think we've now satisfactorily proved that the reports we uncovered from Japan from eighty years ago weren't exaggerated, and that the treatment protocol we’ve developed is basically safe and adaptable to Africa. It's our responsibility now to develop this project as carefully as we can.
The next steps.
We’re looking at maintaining as stable a Ugandan cohort as possible of around seventy patients, reinforcing the data gathering processes so that we can get a wider survey of responses from this group, including rates (unfortunately) of mortality and morbidity.
We will continue to recruit using three challenging criteria:
1. Drug failure/relapse.
2. Weak and struggling patients as identified by the health workers
3. Co-infected patients.
We have agreed one over-riding golden principle with the participating health workers (whose skills and dedication we are in awe of): that we proceed with the programme with two parallel aims - investigation and helping patients - with neither having priority. In other words if it is felt a patient might benefit from being taught moxa but might not actually benefit the investigation, that this should not prevent them being taught and supplied with moxa. Meanwhile, we will collaboratively learn as much as we can so that we can refine wherever possible.
We are desperate to maintain financial momentum to feed the project. We find ourselves simply too far away from the smooth tarmac of middle of the road research to be considered feasible by biomedical funders, whilst ironically we’re considered too biomedical by those funders who normally fund projects in the developing world – we quite simply fall between these two stools. Our budget, meanwhile, is (and has to be) peanuts, and our resource is proportionately diminutive. The frustrations these factors create for us are immense - we are left spending more effort and energy fundraising than actually progressing the project.
March 24th, 2010
Once again it is International TB Day.
Today we make this posting in memory of Frank, the Ugandan we treated in hospital in December in Lyantonde who was dying of HIV-TB co-infection. This week we have heard that he is dead.
It's difficult for us to make complete sense of this, particularly because we have no further information.
Frank as we found him in December
Frank was our first moxa patient in Africa - indeed we believe he was the first patient anywhere in the world with TB-HIV co-infection to have been treated with a moxa treatment protocol for TB resurrected from 1930's Japan. He was thus our number one patient. In Japanese, "number one" is "ichiban" and means not just the first, but also equally the most important. For exactly this reason, when we returned to Uganda earlier this month we had hoped to trace him and develop the treatment more fully with his sister, but we were unable to find any trace of him. The last we'd heard, he was walking in the ward and was eating, and he appeared to have subsequentlty left the hospital but no-one knew where.
Did he continue with the simple moxa treatment? Did it help prolong his life, or merely prolong his suffering?
This stuff is hard to make sense of. We know for sure, though, that despite his condition he clearly responded to the moxa treatment. Richard Mandell, the director of the PAAP was one of those who let us know about Frank's death, and he'd seen what had taken place when we treated him. This is what he wrote: "I do not know for how long his struggle continued, but I will never forget the joy associated with that one treatment.
It's equally hard to make sense of the most recent WHO global report on Drug Resistance in Tuberculosis, published to coincide with the anniversary of the original identification of the tuberculosis bacillus. In relation to Frank and in relation to what we found earlier this month in Kampala it is pretty bewildering. For instance, it merely tentatively identifies TB's possible association with HIV - "If confirmed such a finding could have significant implication for control of the dual epidemics in Sub-Saharan Arica". This seems at least a little of an understatement.
Of course we have no idea actually if Frank was drug resistant. " Contemporary diagnostics for MDR-TB are available in less than half of the MDR-TB high burden countries", and Uganda isn't even considered high-burden. But how could it be? The last survey from Uganda is thirteen years old, and in any case was only done on a local basis. In fact the report actually states that the "estimated numbers [of drug resistant cases] in many African countries are based on mathematical modelling rather than empirical studies".
This means that still no-one really has any real idea as to what's happening in terms of drug resistance on the continent with the highest rates of TB and TB mortality. It means that the resource is still inadequate to control it - in fact the report startlingly discloses that "no low income country anywhere has continuous drug resistance surveillance in place". (South Africa, it can be noted, is not included as a "low income" country). So the very places where this disease thrives most still have the least resource to combat it. Plus ca change, plus c'est la meme chose (perhaps more appropriately translated as "the more this mutates the more it is the same thing"). This lack of appropriate targeted resource is exactly why TB was never driven into submission as it should have been since the 1940's.
In Kampala we found unexpected and almost unbelievable evidence of drug resistance (certainly in the context of the WHO report). Of the first patients enrolled on our programme, over 35% were drug resistant (defined simply by being still sputum positive after six weeks of drug treatment). According to the WHO report it should have been less than a tenth of this - and even more frightening more than half of these were primary infections. This means that a pool of drug resistance is already in existence in Kampala , and it suggests that the same may be the case in any conurbation south of the Sahara.
What we hope we have left in place in Kampala is a seed - with a group of feisty health workers engaged in a struggle to manage the unmanageable who are now trained in the Moxafrica treatment protocols, and who in turn are training the "buddies" of their patients to implement daily treatment. We must wait to see how this develops over the next months - but we hope we will see signs that it may help.
For more information, please look at our "Uganda" page.
We are also now desperate for financial support. If you think you can help, then please click on the "Donate" page.
December 27th 2009
Early this month we visited Uganda, to Lyantonde.
The trip produced two important firsts:
- the first training of African health workers in direct moxa techniques
- and the first treatment of a TB patient co-infected with HIV/AIDS
For more detail of this trip please click on the "Uganda" link (the third link on the panel on the left).
November 8th 2009
The realisation that the “tradition” of treating TB with moxa seems to have effectively actually died out with the practitioners who were still doing these treatments into the 1940’s has been a sobering one for us. It has also been one which we were reluctant to make. We have come to realise that the absence of living or working practitioners with actual experience treating this disease with moxa means that we have no alternative but to tread this path on our own in the sure knowledge that it has been trodden before, but less certain of its twist and turns than we had anticipated. One thing that we are surer of than ever, however, is that there is a certain urgent need for this path to be trodden.
May 24th 2009
Last week we were sent an extraordinary recent WHO publication on Drug Resistant TB entitled "Airborne - a Journey into the Challenges and Solutions to stopping MDR and XDR-TB". The paper powerfully discusses treatment implementation in such diverse locations as the Philippines,Tajikistan and Lesotho. Importantly, it focuses on the urgent necessity of ramping up the mobilisation of both diagnostic and pharmaceutical resources to comprehensively fight TB globally. Within its pages there are some jaw-droppingly shocking observations from some important experts in the field, and we wish to quote them here. (We are fully aware that these individuals might well find some of our own ideas challenging and problematic from their biomedical perspectives, but we include their comments because they so powerfully highlight just how serious this problem is, and particularly how it is developing in Africa. We hope, therefore, that they might forgive us if their remarks are used in this particular arena since ultimately we share a common cause.)
Doctor Peter M Small is the Senior Program Officer for TB at the Bill and Melinda Gates Foundation. He writes: " We are combating a disease that kills someone every 20 seconds, with a 125-year-old diagnostic test that fails to diagnose half the number of cases, with an 85-year-old vaccine that does not protect adults and with 40-year-old drug regimens that you have to take for six months."
Elsewhere he says: "We are pitifully behind. To be honest, even our understanding of the epidemiology is severely limited. We don't actually know where the worst conditions are. Nor do we know whether in most places the situation is getting better or worse."
Doctor Hindi Satti is a Director of Partners in Health in Lesotho, possibly the best resourced country in Sub-Saharan Africa in the fight against TB: " We're finding higher rates of side effects among patients than anywhere else in the world - and we think it's due to co-infection."
Doctor Jim Yong Kim was a founder of Partners in Health, is a Professor of Medicine and Social Medicine at Harvard Medical School, is former Director of the WHO HIV/AIDS Department and is an expert on TB and a hero in the global war against AIDS. He writes chillingly: "It's not just one or two drugs. We need four or five immediately. People aren't sounding the alarm loud enough. Every time we look the problem is worse than we thought. Now it is coming together with HIV in sub-Saharan Africa, and it could be the most frightening thing we are ever going to see."
Doctor Margaret Chan is the Director General of the World Health Organisation. She sums it up: " XDR-TB could take the world back to the era that predates antibiotics, with nothing in hand to guarantee treatment success."
For the last month we have been being scared by the media (and most probably by the pharmaceutical industry as well) by the spectre of a pandemic of swine flu. A far worse pandemic is very clearly already on the loose and has been for years - for some curious reason the media have found it so far relatively uninteresting, and the pharmas have found it too unprofitable to focus their energies and resouces upon. This is just too bad for those who are accused of over-hyping the problem to attract aid, it would seem. And even worse for those directly affected by this dual pandemic.
March 27th 2009
This week has seen "World TB Day" (March 24th, an anniversary of the day the TB bacillus was identified) come and go. Once again, it attracted little in the way of media attention.
A couple of reports emerged, however. The World Health Organisation revealed that rates of co-infection of TB with AIDS, particularly in Africa, have been "significantly" underestimated. A letter was also publlshed in the London Times, signed by twelve expertes on TB and infectious disease in the UK. It identified that the major agencies involved in the fight against TB are still facing "serious shortfalls" in funding. They called for world leaders attending the forthcoming G20 meeting to "fulfil urgently the promises they have made to avoid potential devastating effects"..
Stories of successful local campaigns in desperate circumstances do exist (google: Khayelitsha South Africa, TB, and MSF for instance) but they happen only with the help of dedication and resource. In Uganda, in contrast, the national referral hospital in Mulago is reported as currently suffering from a stock-out of anti-TB drugs. What this adds up to is that there have been no drugs suitable for treating kids with TB since December, and out-of-date drugs are currently being used for adults. If this is the case in a central hospital, we wonder what must be the state of medicine in more remote areas.
We received a response this week from a member of the WHO to some tentative contacts we'd made some months ago. In the context of the Uganda report, it makes for difficult reading: "It is difficult to envisage field testing moxa with and without first and second line medication - surely given the wealth of experience of using drugs for treatment of TB this cannot be ethically acceptable."
We have to ask - where is this "wealth" in Mulago, Uganda today? We know that what we are proposing is challenging - but surely it must be worth investigating in the clinical realty that exists.