An important study programme is now up and running in Kampala
It arose directly from a feasability and fact finding trip last December to Lyantonde, a truck stop town four hours from Kampala on the main route connecting Rwanda and the Eastern Congo to the whole of East Africa. Lyantonde has an unfortunate reputation as a focus for prostitution and HIV/AIDS, the town being home to the first ever officially recorded case of AIDS in Africa.
During the last two days at Lyantonde, we introduced eighteen Ugandan health workers to direct moxa.
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Our aim was to assess how they would feel about the idea of burning something on the skin, and whether they would consider it an acceptable therapy to try out in their own work places. Additionally we wanted to assess how easy it might be to teach African health workers basic moxa skills. We soon had them all rolling moxa, both making and burning tiny cones with impressive dexterity.
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The following day we were invited to demonstrate moxa treatments on two patients, one of them a very sick man co-infected with TB and HIV. He was terribly wasted by the two diseases, cared for by his sister who was vainly trying to administer his daily medication. After we had finished treating him, using the minimum possible stimulation of moxa because of his dreadful condition, we used a trainee to help us explain to his sister how to use moxa and how to locate a treatment point, leaving her clear instructions on a simple protocol to follow every day, building up dosage if he strengthened.
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What we suspect we witnessed at this moment was something we had not even considered previously – that teaching the carer of such a sick person a simple moxa protocol fundamentally offered her something meaningful to do for her brother, and was offering her something maybe even more important as well – hope. We’re not sure yet how significant this might turn out to be.
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To our knowledge this was the first time that a moxa protocol for TB from the 1930’s has ever been used to treat anyone co-infected both with TB and AIDS anywhere in the world. Two weeks after we got back we got the following extraordinary feedback: “Frank's response was truly fantastic. I wish you had seen the joy in his sister/attendant as she explained to us how he had improved. I think everyone was just so excited, as he seemed so ill.”
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Two days after the treatment began, it transpired that Frank was out of bed, walking tentatively in the ward, and eating.
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Cautiously, we found ourselves asking whether this simple treatment might really be able to make the sort of difference we hope it might.
Allen Magezi (a person to whom we are deeply indebted who is tirelessly helping the project) arranged for us to visit Kiswa Health Centre in Kampala before we returned to the UK. Kiswa is a desperately under-resourced facility with one doctor and around twenty-five healthworkers seeing up to 2,500 patients in a day. We met Molly Busingye, the centre's "in charge", and Magdalene Ichumar, the sister in charge of the TB unit and gave them a brief introduction to moxa, explaining how it had been used to combat TB in Japan in the past, and outlining our training plans.
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What resulted was a second trip in early March, this time to train health workers on site who in turn can train the patients and their "buddies" (those responsible for ensuring that these patients take their drugs every day). In the end we trained twelve health workers at two centres (Kiswa and Kisenyi), and collaboratively set up a programme of investigation to run over the next twelve months. Before we'd left fourteen buddies were already trained with a further twenty-six identified. The aim is to build up to a minimum of eighty patients who will be receiving daily moxa treatment and will be monitored on at least a monthly basis - including health indicators, CD4 count where applicable, weight etc.
The team at Kisenyi
Part of the team at Kiswa
In every sense we consider this trip to have been a succes, but what we encountered, however, in terms of rates of co-infection with HIV/AIDS and also incidence of drug resistance was truly alarming. Sister Ichumar was plain speaking when asked what happens to those who fail First Line drug treatment and are therefore deemed drug resistant: "We have nothing for them", she said. "We have to leave them to die".
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It became quite clear to us that drug resistance is occurring as primary infections, meaning that drug resistant strains are loose and free to increase in incidence and frequency in the community. Since Uganda is not a country identified as having high incidence of drug resistance, this is really worrying because it suggest that this is typical of any conurbation south of the Sahara. This leaves us more determined than ever to complete these investigations.