Tying things up with the human angle
The intention of this page is first to try to tie everything up without repeating too much..
- to stress the fact that there's such a shameful culture of silence about TB in Africa and a resultant ignorance about the size of the problem
- to point out that the global bio-medical community should do more but probably will do less
- to identify that the enormity of the problems of drug-resistance and HIV co-infection are defeating the WHO
- and that these problems are exacerbated by a whole raft of factors none of which are easily solvable
Moxa is never going to solve these huge problems, but on a small scale it really could make a difference. Everything hangs on the results of the RCT.
But there's one other thing that we haven't touched into at all, which is the human angle.
The current WHO global strategy for treating TB relies on DOTS (and DOTS+ where it's available for MDR-TB) which is a system of what is called directly observed therapy. The system is predicated on the idea that each patient should be actually directly observed to take their drugs each day by a health worker to maximise compliance and to minimise risks of developing drug resistance. It's a great idea but it barely floats in the real world of medical provision in Africa. Last year we attended the "Parliamentary Sub-Committee on Neglected Diseases" in London where it was stated quite clearly that the world is at least 3.5 million health workers short of what's needed (and of course we know very well that many developed countries including the UK are more than happy to accept African-trained healthworkers through their immigration systems...there are more Malawian-trained doctors working in Manchester, UK, for instance, than in the whole of Malawi). 36 sub-Saharan countries are now recognised to have health services in crisis.
In Uganda the best they manage as far as DOTS is concerned is to enrol friends or family as "buddies" - to act as quasi-health workers. In South Africa they use "carers", semi-trained members of their local community who are paid a pittance to visit each registered patient each day and ensure they take their drugs.
These are effectively the front-line foot soldiers of the battle against TB in Africa - either unpaid or barely paid, untrained or barely trained, and unprotected against infection in every damn situation we've seen outside hospitals. They are nearly all women, and many that we've met are extraordinary people. With tiny stipends (and I mean tiny) we've increased some of their wages by 50% (from $50 a month to $75). That's what front-line soldiers in this deadly battle get paid when they get paid at all (in Uganda a working system of voluntary Village Health Teams exist whose members aren't paid at all…)
These are the key people (if you care to really think about it) that the WHO, the epidemiologists and the doctors in their fancy glass and steel buildings are relying on to prevent a medical apocalypse. Each and every day these women and men are at risk of developing disease themselves - and, if they catch it, it may be resistant and might also then infect their children. But they do this job anyway for reasons that we cannot fathom.
Desmond Tutu calls this ubuntu - ubuntu is about looking beyond ourselves – and in so doing, to become more fully human. Ubuntu is a traditional African philosophy which emphasises our common humanity - our implicit interconnectedness and interdependence as fellow human beings.
Actually, such an idea isn't in any way exclusive to Africa. Theodore Roosevelt said much the same thing in 1903:
"The welfare of each of us is dependent fundamentally upon the welfare of all of us."
Dr King in 1965 similarly identified that:
"All mankind is tied together; all life is interrelated, and we are all caught in an inescapable network of mutuality, tied in a single garment of destiny. Whatever affects one directly, affects all indirectly."
As acupuncturists we're not that warm towards Rene Descartes because of his obsession with reducing everything down into tasteless tiny chunks of "nothing butness" rather than seeing them as part of a whole. He defined his philosophy on a principle of "I think, therefore I am". - and what a bloody mess Rene's defining philosophy has got us into. In Malawi they frame their ubuntu into a similar but fundamentally different phrase: "I am because you are", they say. In other words, your TB is my TB.
We lost our first carer this year - to an acute asthma attack, not to TB. We still struggle to believe that someone so vibrant could have been taken so unexpectedly. She was the carer who was most determined to take moxa to the very heart of the sprawling Capetown townships, into the squatter camps full of migrant workers with no medical resource worth shining a light at. The last time I saw Zandile I was walking the streets of the township in the company and care of her and three of her colleagues. At one point she broke off from us and came back with a huge smile on her face with five oranges in her hand to share with us all. Such small things say all that need be said about some people. Moxafrica will never forget her.
This page is dedicated to her memory.