TB drug shortage redux

I wrote about the TB drug back in December: https://healingnumenor.wordpress.com/2008/12/10/tuberculosis-medication-shortage/.

I wish I could report the situation was improving. In fact, it has worsened. Yesterday, one of the doctors mentioned at a research meeting that the drugs were out in the National TB/Leprosy Control Programme (NTLP). Some of our doctors have dual roles in our research center and at the NTLP. Our research participants have access to medications. However, most TB patients are not enrolled in studies.

I’ll briefly explain the regimens and then the shortages.

TB medications: S=streptomycin; E=ethambutol; H=INH; R=rifampin; Z=pyrazinamide

New TB patients get either: (1) 2 months E+H+R+Z then 4 months H+R; or (2) 2 E+H+R+Z then 6 months H+E.

Retreatment TB cases typically get: 2 months S+E+H+R+Z then 1 month E+H+R+Z then 5 months E+H+R.

Mulago Hospital TB Wards 5&6/NTLP Clinic see about 25% of the nation’s TB burden and about 200-250 TB patients per month. The shortage is especially worse in Kampala then in some rural areas. (We’re ranked 16th in the world for TB burden in the 202/212 countries that report TB cases.)

As of this morning we had:

(1) NO R+H+E formulation for pediatric TB patients.

(2) 2-month initial phase of E+H+R+Z for only 12 patients.

(3) Only 15 one-month boxes of E+H+R for the retreatment TB cases.

(4) Hundreds of H+E but…..they were all expired.

(5) 1300 vials of streptomycin. However, given that it would have to be taken with E+H+R+Z (see #2 above) in the retreatment regimen, the surplus is of practically no use.

Later in the day, I found out that the Daily Monitor had a blame-game story on this: http://www.monitor.co.ug/artman/publish/news/Uganda_in_TB_drugs_shortage_81681.shtml.

I’m not in the position or have the knowledge to offer more on who is at fault than the story does, but off the record I have some hunches. Anyhow, the focus needs to be on the solution and future prevention of shortages as numbers of patients continue to suffer.

I emailed two human rights organizations after my tour of the NTLP pharmacy with one of the doctors and the pharmacist there. Tomorrow morning I am going to the NTLP clinic to see what it is going to be like to tell patients they have TB but that we can’t give them the medications. Tomorrow afternoon I am talking with a reporter and on Thursday there will be a press conference on drug shortages in general. I’ll post how these all go. Click on the comments below for an update.

Mali #8: Timbuktu 2/2

We started the drive over some dunes to get back to the road to Timbuktu. En route to the museums, libraries, and buildings on our walking tour of Timbuktu, we first stopped at the city tourist office to get our passports stamped. (Apparently there is a club in New York City that requires a stamp of Timbuktu to get in, but we could not find anything on the Internet to support that guidebook assertion.) Dust swirled around the streets and corners. Tourists and local residents dotted the streets, the latter occasionally obviously annoyed with our heightened presence in the town. Most stared with curiosity and kindness.

"Well" of "Bouctou" meaning "Large Navel"

As we wound through the corridors of ancient streets, winds of history whispered around the corners. Unimpressive in stature, yes, the city still had a presence unique to itself despite all the warning we received in person and from the guidebooks that Timbuktu could be let down for many tourists. Our first stop brought us to Djinguereber, West Africa’s oldest existing mosque built. Built by Moussa, he paid for its construction with 200kg of gold according to our guide. It can hold 1,500 people, and unfortunately, we were not allowed to enter.

We continued on to the Bibliotheque de manuscripts al-iman Essayouti. This library nestled in an abode building across from the Djinguererber mosque houses so many scripts/scrolls. One scroll displayed in a glass case depicted Ramadan, Tabasky, and the pilgrimage to Mecca (Mohammed bel-Sharif, 15th century). Many manuscripts were found 6m buried for protection during old wars. If the father of one of the stashes had not left the location, so many of the manuscripts would have disappeared forever. Indeed, more are still uncovered. One of my favorite manuscripts functioned as a star map (14th century). Other manuscripts depicted issues surrounding law, inheritance, call to prayer.

Celestial map

We left the library and started learning a bit about architectural symbolism in Timbuktu. Some door and window style find there origins in Morocco. “Jealousy windows” functioned to deter men from eyeing married women as the jealousy window would be used after marriage.

Jealousy window

At this point, you may be wondering what Timbuktu (Toumbouctou) actually means. “Tom” means “well” and “Bouctou” refers to the woman’s name (meaning “large navel” who found the well here a long time ago. History likely became legend, legend became myth, and so the story goes.

We continued on passing the house of 19th century explorer Gordon Laing before we arrived at the Musee Tombouctou Municipal. The supposed Tom of Bouctou was in the courtyard as well as representations of how milk and water were stored. A small museum held some artifacts of the local cultures over the ages, such as the heavy bangles placed around the feet of some women to prevent them from wandering away, we were told. Yikes.

We left and briefly walked into the former home of Heinrich Barth, another explorer. I bought a small beautiful, colorful illuminated manuscript with the  opening quote in Mali #7  written in Arabic from a talented artist. We walked a little more, passing the door outside one of the mosques that legend says will harken the end of the world if opened.

Door harboring the end of the world

We left it shut. But we returned back to the car and opened that door, a door that when shut would next be opened in Essakane at the Festival au desert. The excitement continued to mount…

In front of the large mosque

In the AM before heading to T-town

Timbuktu alley

Manuscript

Celestial map

Jealousy window

Moroccan-influenced doors

Street scene

Door harboring the end of the world

Bangle of oppression

The Bouctou Tom

“Well” of “Bouctou” meaning “Large Navel”

Goat skin water holding tank