idjwi island, DRC

 2026 marks 20 years since Merlin and Jenny first dreamt up the concept of Moxafrica, to investigate whether moxa could be helpful in treating TB in resource-poor countries, with particular focus on Africa. During the first couple of years, we carried out extensive literature research, sought advice from moxa experts, tried to find helpful medical contacts who might introduce us to institutions where we could work and developed our techniques and protocols by precise measurements of the temperature dosage of small cone moxa. Much of this has been recorded in past NAJOM issues. In those early days, a well-meaning friend told us that working in Africa would be far too difficult because of the many obstacles – social/cultural/political and financial. This was fair comment, but did not deter us! In the past 20 years we have certainly not achieved as much as we would have liked, but have learned an enormous amount about all aspects of TB as well as the many challenges of working in some very difficult situations. We have been joined by some extraordinary and dedicated volunteers, including a wonderful Japanese team and most recently, an intrepid couple from Belgium. 

In this issue we would like to update you on the progress of two current and very different programs in contrasting areas of Africa.

 

Moxafrica in Democratic Republic of Congo

 

Our introduction to DRC came through Michele and Albert Losseau, a Belgian couple who have lived much of their lives in Africa and had contact with a doctor in the huge city of Goma, close to the border with Rwanda. Working there would mean dealing with an unstable political environment, gaining the trust of medics and military government officials to introduce an unknown therapy, hospitals lacking basic diagnostic equipment and even standard TB drugs, as well as difficulties caused by widespread poverty and lack of infrastructure, making it very hard for patients to travel for regular treatment. Added to that, a local volcano threatens to belch out a blanket of choking fumes over the city, requiring mass evacuations.  During an exploratory visit by Michele and Albert last year it became clear that it was not going to be feasible to work there. Undeterred by this, the Losseaus followed another lead which took them to the island of Idjwi, in the south of nearby Lake Kivu. Idjwi is a tropical island of 131 square miles with a population of 300,000, several small hospitals and clinics but very poor infrastructure.  There were at that time no TB drugs available.  Although also under military rule, its isolation and extreme lack of resources mean that activities there are of little interest to the authorities, and our proposal to set up a trial moxa program was greeted with some enthusiasm by the doctors there.  The Losseaus visited health centres, spoke with doctors, demonstrated moxa treatment and learnt as much as they could about life on the island and the challenges facing patients, healthworkers and any potential moxa programme.

In November they returned to Idjwi and set up an initial trial. There was much work to do in preparation for this: Michele, a shiatsu practitioner, had little experience of moxa and underwent an intensive learning curve to develop the skills and confidence to train healthworkers and explain it to patients. Together we worked on protocols and developed a training manual specifically for Idjwi. 

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The aims of this initial trial were to:

• Check interest and willingness to adhere to the project by the local authorities

• Understand how the administrative health structure functions while being under the power of the armed forces of the M23

• Organise a workshop to train healthworkers 

• Perform a first screening of TB patients in the area with a medical follow up including blood tests and sputum tests

• Start first moxa treatment on the small sample of screened TB patients using Doctor Hara’s protocol.

 

Specific challenges for Idjwi

A major problem is the general poverty (everyone was begging) and the insufficient numbers of healthworkers to assist the patients with moxa. 

Reaching patients is difficult due to the lack of transport. There are no tarred roads on Idjwi and the only transport is by motorbike on dirt roads which, thanks to the almost year-round rainy season, are often impassable. Many patients have to walk 1-2 hours to a clinic. Due to these problems, we have to consider funding the patients and healthworkers to be part of our trial. 

Another major issue is the general lack of organisation in screening and selecting TB patients. The only diagnostic method used on Idjwi is the sputum test, which is limited and unreliable. The standard GeneXpert machine used worldwide for TB detection and identifying drug-resistant strains is unavailable and desperately needed. TB infections remain undetected and therefore untreated. Nobody really knows how much TB there is on the island, but we suspect that there may be a high incidence of MDR-TB because of erratic drug supply and we have already come across patients who have had repeated infections.  When standard drugs become available, these will not help in cases of drug resistance, and moxa could offer such patients some hope.  From the point of view of a successful moxa program, it would be a huge advantage to be able to identify drug resistant infections and focus our work on these patients. We are currently trying to address this issue by sourcing a secondhand GeneXpert machine to donate to the Idjwi Health Zone. This is a big expense beyond the usual remit of our charity, but we believe it is essential for the progress of our work on Idjwi.

 If you can help us to pay for a Genexpert please donate here

 

The outcome of this visit was that 14 health workers from 5 different hospitals were trained and 13 patients have been started on the daily moxa program. Their progress will be monitored monthly by the doctors. Regular communication with the healthworkers and doctors is made using WhatsApp. After 3 months it is anticipated to return to Idjwi to assess the whole process.

This is a small beginning to something we hope will grow. Just as one small moxa cone is only the start of a longterm process to heal a chronic condition, so our small but very energised Moxafrica team attempts to help people in chronically poor parts of the world. As Merlin put it: “Idjwi offers us a unique opportunity to further our investigations looking at moxa with MDR-TB while at the same time potentially saving some lives and preventing further destitution for some families in Idjwi. In other words, it has 'MoxAfrica' stamped all over it. Whether it's within our capabilities is, of course, up for debate and is dependent on some uncertainties (not least of which is funding). But at its heart it comes with the commitment, goodwill, and sound common sense and experience of Michele and Albert, so has as good a chance as anything else we've ever attempted” (Merlin Young, 2025 😊)