UGANDA - the early story
FIRST TRIP to LYANTONDE
In 2009 Jenny Craig and Merlin Young went to Lyantonde, Uganda, on a fact-finding trip.
Lyantonde is a truck stop town four hours west of Kampala on the main arterial road connecting Rwanda and the Congo to East Africa and the Indian Ocean. It is also reported to have been home to the first ever officially recorded case of AIDS in Africa.
We wanted to see how health workers would respond to small cone direct moxibustion, to the idea of smouldering plant material on skin, and particularly if they would view it as an acceptable form of treatment for their patients. We also wanted to see how easy it would be to teach large groups of health workers the TB moxa protocol in a short period of time.
Eighteen Health Workers signed up and quickly got to grips with the protocol. This first trip was a great success.
PILOT STUDY in KAMPALA
We returned to Uganda the following year for a week to set up a 12-month pilot study at Kiswa Health Centre in Kampala with the help of the indefatigable Allen Magezi and a keen team of Ugandan TB health workers. (Allen has played a vital part in all our activities in Uganda, and without her determined help, it’s very questionable how we would have fared). These health workers were trained in the use of moxa and they, in turn, trained their TB patients and their 'buddies' or carers.
The original aim was to build up to eighty patients who would be receiving daily moxa treatment and to monitor them on at least a monthly basis - including health indicators, CD4 count where applicable (if they were also HIV positive), and weight etc. After a few months, however, patient enrolment was increasing at such a rate that we agreed with the team on site to cap numbers at 100, so as not to overburden the investigative arm purpose of the pilot.
In fact, the project still grew. In the end, well over 100 patients were trained with the final number unknown. We do know that many dropped out for reasons which included lack of motivation, alcoholism and even unfortunately, in a few cases, death (some very sick patients were being enrolled by the health workerrd in hope that the moxa might help turn their disease trajectory around).
At the end of the study, we had reasonable data on about 50 patients who had been using moxa every day, all of whom had completed or were still enrolled in their 6-month course of first-line TB drugs. Unfortunately, due to many constraints, a regular patient assessment was patchy but anecdotal reports from patients and medical staff were overall still very encouraging. We even had a few reports of dramatic recoveries of some of those patients who had been expected to die and whose recovery was attributed to moxa by both health workers and the patients themselves.
Patients who confirmed that they were using the treatment regularly reported the following: improved appetite, weight gain, reduced joint pains, reduced peripheral neuropathy, and a general increase in strength and energy. Of special note, patients co-infected with HIV reported similar positive outcomes to the TB only group.
Of course, we still didn’t know how much of these effects were down to the moxa and how much were due to the beneficial effects of normal TB drug therapy but the health workers were convinced that patients supplementing their TB drugs with moxa were recovering faster and with fewer side effects.
Whilst we were unable to draw any specific conclusions from the above, some hypotheses could be construed which we believed to be worthy of further targeted more controlled research:
1. That compliance to standard TB treatment (which is one of the major problems for the containment of the disease because of the frequent pernicious side effects of the medication) might be improved if moxa were to be widely used alongside first-line drugs.
2. That the infectious period of the disease might be shortened when moxa is used with drugs. We knew that this would be relatively simple to measure, and, if proved, would suggest that moxa might help reduce the spread of the disease in Africa.
3. That patients co-infected with both TB and HIV/AIDS could particularly benefit from moxa treatment. These patients are repeatedly reported in the medical literature as being especially challenging to treat, and the combination of these two lethal diseases is a particular problem in treating TB in Africa.
What was exciting was that these findings were being confirmed by reports from two similar pilot studies that were now being developed in South Africa, but this time with patients with higher rates of HIV coinfection and with a few patients diagnosed with MDR-TB.
At this point, we were invited to make a presentation at Makerere University’s School of Medicine and from that the opportunity to develop a Randomised Control Trial followed.