The story at Kiswa
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 from Lyantonde. 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.
What resulted was a second trip in early March 2010, 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 considered this trip to have been a success, but what we encountered, in terms of rates of co-infection with HIV/AIDS and also suspected 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".
It became quite clear to us that drug resistance is occurring as primary infections in Uganda, 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 suggests that this is probably typical of any conurbation south of the Sahara, leaving us more determined than ever to complete these investigations.