TB drugs: poor countries hanging by the thread

Julius Kiiza, 26, was like many youths his age a few years back. He loved to hang out and live a good life. Never in his wildest dreams did he think he was developing a virulent form of Tuberculosis – the multi drug resistant TB (MDR-TB).

I met him at Hoima regional referral hospital TB ward. As he motioned towards me, it was as if his legs would snap under the weight of his body.

Kiiza, a father of four, was diagnosed with MDR-TB on November 28, 2013. Prior to this, Kiiza was already grappling with HIV which was discovered in 2011.

He was to later develop a wracking cough, characterized with chest pain.

“I would lose breath especially at night because of chest congestion,” he said.

Kiiza was diagnosed with TB and was started on the regular eight month drug regimen. Five months down the road Kiiza was found to have MDR-TB.

MDR-TB occurs when bacteria do not respond to Isoniazid and Rifampicin, the two most powerful, first-line anti-TB drugs.

Because of Kiiza’s co-infection (HIV and TB), he swallows at least 20 pills a day and he will be receiving an anti TB injection daily for six months.

 NEW RESEARCH ELUDES LDCs

While identifying those with the active disease will provide a long-term public health benefit, Moses Mulumba, a patent lawyer says that without new, simple and affordable treatments for MDR-TB, this is impossible.

“If pharmaceuticals developed one tablet a day for TB, this would mean reduced pill burden and greater adherence. However, such developments for the developing world are deficient due to the lack of return on investment opportunities for pharmaceutical companies,” says Mulumba, the executive director of Center for Health, Human Rights and Development (CEHURD).  

Most recently, Britain/Sweden pharmaceutical, AstraZeneca announced it was pulling out of all early stages of research and development for malaria, TB and neglected tropical diseases to instead focus on cancer, diabetes and hypertension.

Welcome to the world of intellectual property (IP), where giant pharmaceuticals determine drug availability and pricing.

Prices of drugs vary depending on whether the drug is under patent – 20-year protection by the manufacturer – or generic, where the patent has expired.

In the private sector market, the brand/patented version of Linezolid, an MDR-TB treatment drug, costs $65 (approximately Shs 166,400) for a daily pill. For a patient taking a pill a day for two years, this amounts to over $49,000 (over 125m). It is produced by Pfizer, an American pharmaceutical corporation.

Generic versions of the drug, produced by Hetero, an Indian pharmaceutical company, cost of $8 (Shs 20,000) per pill.

When asked whether he would have afforded Linezolid had it not been provided freely, Kiiza laughed sarcastically: “I think I would have died a long time ago because I don’t have a cent!”

Because majority of Ugandans still survive on less than $1 (Shs 2,560) a day, Uganda receives TB drugs through aid.

The case of ARVs provides a dramatic illustration of the global impact of Indian drug firms.

In 2001, Indian drug company Cipla, introduced first line treatment for HIV at $ 350 (Shs 896,000) per person per year, a stunning offer at the time.

Other Indian firms followed Cipla’s model and today, 80 per cent of people living with HIV who are on treatment in developing countries rely on Indian generic drugs. 

TRADING AWAY LIVES

Uganda being a member of the World Trade Organization (WTO) is under obligation to develop rules that comply with WTO guidelines. Among these is the Trade Related Aspects of Intellectual Property (TRIPS) agreement requiring all members to standardize minimum standards of IP, including patents for pharmaceuticals.

IP rights give the creator an exclusive right over the use of his or her creations for a certain period of time, such as 20 years, for a scientific innovation like medicine.

The pharmaceutical industry in developed countries strongly depends on the patent system in order to recoup research and development costs.

“TRIPS sustain a regime of private monopoly rights which impedes access to essential medicines because of prohibitive prices. It also delays production and market entry of generics because producers will have to wait 20 years for a patent to expire,” Mulumba explains.

Moreover, countries such as India and Brazil where generics are produced now grant medicines patents in order to comply with their obligations as WTO members. New drugs are already patented in these countries meaning that production of affordable generics is now restricted.

Such a restriction led Cipla to establish Quality Chemicals Limited in Uganda because that law does not hold for LDCs.

Under TRIPS, LDCs are supposed to enforce patents on all medicines by 2021. Tentatively, this means the end of all generic drugs.

In response to the TRIPS agreement, WTO delegates issued the Doha declaration on November 14, 2001 which exempts LDCs from implementing patent law for pharmaceuticals until January 1, 2016. This was extended to 2021 last year.

ENFORCING PATENTS IN UGANDA

To guarantee intellectual property rights to innovators, parliament this year passed the Industrial Properties Act. It spells out protection for products and processes in all fields of technology, including medicine.

Mulumba forecasts that the law will only work if there is government commitment to invest in research and development, develop human capacity and offer attractive incentives such as tax holidays to innovators.

“The law integrates flexibilities such as the bolar provision which enables researchers’ reverse-engineer drugs even when the patent on it has not yet expired. But all the seven plants we have are not doing research because of high production costs,” he says.

Another policy is the Anti-Counterfeit Goods law which prohibits the manufacture, trade and release of fake goods on to the market. Contentious, however, is the fact that it regards generics as counterfeits.

 “This is part of a global agenda to keep developing countries from importing from third parties like India and Brazil where the cost of production is much cheaper. All these things are happening because we are a disorganized lot. We Africans are doomed unless we wake up!” says Edgar Tabaro, a patent lawyer with Karuhanga, Tabaro and Associates.

SOLUTIONS TO A GLOBAL CRISIS

In 2000, the UN Security Council declared HIV a global security issue and resolved to establish a Global Fund (GF). GF is the biggest financer for HIV and TB programmes in Uganda, having channeled at least $ 200m over the years.

“In October, Uganda is sending the GF another proposal for HIV/TB funding to enable us scale up prevention and treatment efforts,” Prof Vinand Nantulya, chairman Uganda Aids Commission said.

Uganda is also a member of WHO’s Global Drug Facility (GDF), the largest supplier of quality TB treatments. Nantulya says it is through this that the country procures TB medicines and innovative tools such as the GeneXpert at reduced prices.

“Uganda needs to develop collaborative research so that our scientists can catch up with others in the developed world and partnerships such as the Global Alliance for TB drug development should be more actively supported to allow for the development of drugs that are free of patent restriction,” Tabaro urges.

Currently, 11 TB vaccines are in clinical trials worldwide. WHO estimates that the earliest a vaccine could be licensed is 2020. BCG (Bacille Calmette Guerin) vaccine remains the only vaccine against TB in general use.

This story was supported by the African Center for Media Excellence. 

Better TB management urgently needed

I had heard about Tuberculosis (TB) and the wreckage it causes in a patient’s life just in the passing, until I set out to document issues hindering drug access.

The dismal condition of a patient I found at Bulondo Health Centre III in Wakiso district exceeded my saddest expectations.

Fred Musoke’s lips were chapped, dry and red, bones almost visible and his skin dark as ebony.

He tossed and turned, seeking comfort, coughing and spitting into his lesu.

Death, he said, would be a reprieve.

“I feel feverish all the time and do not have appetite. The woman that I wanted to marry left me about two months ago because of this sickness,” he muttered from behind a dark green mask covering his mouth and nose. He keeps the mask on to avoid spreading the TB to others. Before I could talk to him, I was handed one too.

Before getting TB, Musoke, 31, was a market vendor selling second hand clothes. Then five months ago he was diagnosed with TB.

“I was admitted two weeks ago after becoming so ill one weekend that I could not walk,” he said.

Because Musoke has HIV, he is no stranger to the health centre. It is here that he has been getting ARVs. 

However, his struggle is further complicated by inadequate drugs at the facility.

“Many of our health facilities do not have some of the most required drugs such as Ethambutol, Isoniazid and Rifampicin needed to treat regular TB and also Septrin which is necessary in fighting opportunistic infections like TB in people with HIV,” says Expedit Mwambazi, Wakiso district’s TB focal person

The centre’s laboratory room was crawling with spiders and wasps instead of diagnostic equipment. It has been so for over five years according to one of the health workers. 

Many health centres do not have TB units, which has perpetuated the mixture of TB patients with other patients. The World Health Organization (WHO) warns that people with TB can infect up to 15 other people through close contact.

TB remains the biggest killer of people living with HIV, causing nearly 50 per cent of deaths. Primah Kazoora, a TB survivor, says malnutrition, living in slums and poorly ventilated houses also accelerate the development of TB.

THE LETHAL ANNIHILATOR

Tuberculosis is one of the deadliest and most disabling diseases. It is an airborne disease caused by a type of bacterium; mycobacterium tuberculosis, transmitted by being in proximity to coughing, talking or sneezing patients. 

If not treated promptly and consistently, says Dr Alphonse Okwera the head of Mulago hospital’s TB treatment centre, it weakens the patient, damages the lungs and may spread throughout the body.

In its advanced stages, the sputum comes with blood.

TB affected lungs/Photo-Courtesy

TB kills some 4,700 Ugandans every year.

In its 2013 report, WHO noted that of the 8.6 million people that fell ill with TB in 2012, 1.3 million died. At least 95 per cent of these deaths were recorded in middle and low income countries such as Uganda, Ethiopia and Swaziland.

“In 2012, an estimated 530,000 children became ill with TB and 74,000 HIV-negative children died of TB. At any given moment, 12 million people globally are suffering from an active infection,” reads the report.

TB kills someone approximately every 25 seconds and an estimated nine million new cases develop each year.

The WHO report ranks Uganda 18th out of 22 high-burden countries that account for 80 percent of new TB infections worldwide. According to Ministry of Health and the National TB and Leprosy Programme (NTLP), there were approximately 49,000 new TB cases in Uganda in 2011. 

“The high burden of the TB disease is mainly in the urban and peri-urban centres, with Kampala accounting for 7,800 cases, Wakiso 1,300 cases and other regional towns account for between 1,300 – 1,600 cases each,” says Dorothy Namutamba, the program officer at the International Community of Women Living with HIV/Aids, Eastern Africa (ICWEA).

Although its burden is spread across all age groups, TB exacts its greatest toll on individuals during their most productive years, from ages 15 to 44.

CHALLENGES IN THE TB COMBAT

Uganda in 2000 pledged, as part of the Millennium Development Goals (MDGs), to halve TB prevalence and deaths by 2015. But despite setting up over 1,200 diagnostic centers nationwide it is still far from these goals.

Namutamba says one of the major setbacks is lack of priority and limited information about TB in communities.

“Unlike HIV which has gained ground through community sensitizations and literacy programmes implemented by government and the civil society efforts, TB has been left to the laboratories and the health care providers,” she says.

In an assessment study by ICWEA on the availability and accessibility of TB/HIV services in Kampala, Wakiso, Mityana and Mubende districts between 2010 and 2012, majority of the interviewees showed low knowledge on TB .

“When a person develops active TB, the symptoms including cough, fever, night sweats, weight loss and blood stained sputum, may be mild for many months. This may lead to delays in seeking care,” says Dr Okwera.

Another challenge is the long duration of treatment, lasting at least eight months. 

RISE OF A SUPERBUG

Because of the seemingly long duration, many patients abandon the drugs. 

“Only 78 per cent of those with the disease undergo successful treatment and the other fraction are those that die, fail on treatment and those for whom follow up is lost,” says Dr Frank Mugabe, the acting program manager, NTLP.

Lack of drug adherence has urshered in new drug resistant forms of the bacterium, spreading a new phenomenon of Multi Drug Resistant TB (MDR-TB).

MDR-TB is a form of TB caused by bacteria that do not respond to, at least, Isoniazid and Rifampicin, the two most powerful, first-line anti-TB drugs.

Currently, the two year drug regimen for MDR-TB costs $3,000 compared to $10 to treat regular TB.

“[Comprising] about 20 pills a day and painful injections for six months, MDR-TB treatment is difficult to adhere to. Even if patients adhere, half are likely to die from this type of TB,” says Dennis Kibira, a pharmacist and deputy director of the Coalition for Health Promotion and Social Development (HEPS-Uganda).

In a move to nip resistance in the bud, Dr Mugabe says the country has improved its ability to test for drug-resistant TB by introducing the GeneXpert, a rapid testing machine that can diagnose TB in sputum samples in less than two hours.

GeneXpert machine/Photo-Courtesy

Nevertheless, there are only 14 treatment sites in the country. The ICWEA survey notes that Mubende hospital at the end of March 2013, had five patients who had been confirmed with MDR TB but sent them home because of the hospital did not have drugs to treat them.

“We need a shorter treatment option to transform TB treatment from an agonizing ordeal, to a shorter, more tolerable, more effective and more affordable treatment course,” urges Kibira.

In our second part, we shall examine how patent rights are prohibiting access to new drugs and diagnostic technology in Uganda. 

This story was supported by the African Centre for Media Excellence.

Kiyingi cheats death with son’s liver

Staying active and engaging in sports has been Fredrick Kiyingi’s lifestyle since childhood.

However, as he grew older, his daily life was affected so much that by 30, he could not partake in any physical activity.

He was 37 years old when a medical examination by Prof Michael Kawooya, a senior radiologist at Mengo hospital revealed that his gall bladder was releasing toxins into the liver. It was also on the verge of rupturing. 

Kiyingi, now 47, was born with a liver problem medically termed as choledochal cyst.

Dr David Ndawula, the medical director of Kampala Family Clinic says a choledochal cyst occurs when the bile duct, a vessel that leads bile to the intestines from the liver, is structured abnormally.

“This causes bile to accumulate in the duct resulting in duct damage and formation of a cyst (fluid-filled sac),” Dr Ndawula explains.  

He says that a liver transplant becomes necessary when the liver has been damaged to the extent that it cannot perform its normal functions. This is known as liver failure.

The liver is one of the largest organs in the body. It produces bile necessary in digestion of fats, makes agents needed for blood clotting, removes toxins from the blood stream and controls blood sugars, among other functions. 

“Although liver failure can be managed by medication, this can sustain one in good health for a short while. A liver transplant is the only cure for liver failure,” he says.

RUNNING OUT OF STEAM

In 2001, an acute pain on the right side of his abdomen became a bedfellow. It caused him severe loss of appetite and nausea.

“To keep the pain at bay, I devotedly relied on drugs meant to cure peptic ulcers because doctors suspected I was suffering from these,” said Kiyingi, the safety and security coordinator of US Peace Corps - Uganda.

He used the drugs between 2002 and 2005.

But by May 2005, Kiyingi was starting to feel much more tired. His body darkened and thinned so much that he suspected HIV.

“Once, I went to Kampala family clinic in Nsambya to buy pain killers and told Dr Ndawula that I had HIV. He told me to open my mouth and stick my tongue out and hinted on the possibility of a gall bladder and liver complication,” the soft spoken father of two said.

He was referred to Prof Kawooya who treated him immediately, noticing that the gall bladder was about to rupture.

Ruptures are most commonly caused by an inflammation of the gallbladder. The most common causes are gall stones. The initial symptom of a gallbladder rupture is a sudden onset of sharp or severe pain.

Kiyingi was later admitted at Case Clinic.

“I stayed at Case for three months and while here, I had jaundice, fever, more pain and my skin got darker,” he recalls.

Ndawula says jaundice is caused by the liver’s failure to remove bilirubin, a brownish yellow substance found in bile.

Kiyingi was operated upon and his gall bladder, plagued with gall stones was removed together with a fraction of the affected liver.

Dr Ndawula says a portion of a liver can be removed because of the liver’s unique ability to regenerate. It is the only organ in the body with this capability.

WORSE BECOMES WORST

Just two weeks after the first operation, his stomach started swelling tremendously because the improvised plastic bile duct was misdirected.

“Immediately, I was rushed to Mengo hospital in an ambulance and about three litres of dark green bile were drained from my body,” he reminisces.

A metallic tube was inserted into his body to drain the excess bile and liver function tests showed that his liver had completely deteriorated. He was thus linked to Prof Godfrey Lule, a consultant physician and gastroenterologist at Nairobi hospital.

To raise money needed for treatment in Nairobi, Kiyingi sold all his six cars and ended a transaction meant to purchase a house.

At Nairobi hospital, a magnetic resonance imaging (MRI) test revealed that Kiyingi’s liver was completely rotten. He was now referred to Apollo hospital in India for further treatment.

He arrived at the hospital on December 24, 2013 and examinations revealed that he had liver cirrhosis –an abnormal liver condition in which there is irreversible scarring of the liver.

 “The doctors here told me that I had only six months to live unless I underwent a transplant for which I needed $60,000 and a donor,” he says.

Fortunately his son, Laurin Baalu, 18, was willing to part with a portion of his liver.

THE FINAL STRAW

He was operated upon on March 12 at the Health Care Global Enterprises in Bangalore-India. He remained in the intensive care unit for two weeks and was discharged on April 17.

Although Kiyingi has been down the hatches, he is one of the few lucky ones; he is on the road to recovery. His chocolate skin complexion is back and he has resumed work.

However, he is now on life medication and needs $ 16,385 (about Shs 42m) to clear HCG’s hospital bill

For contribution, Kiyingi can be reached on 0776578667 or direct account deposits may be made to A/C no. 1100035091-Housing Finance Bank or 6004149376-Barclays Bank.

Parents launch appeal to save 7-year-old Maria

Unlike many children her age, Maria Achola is not having a joyful, playful life.

Seven-year-old Achola is confined to a hospital bed, tubes and wires running across her weak, painful body.

For more than two months, Achola, a pupil of St Ponsiano Ngondwe primary school in Bweyogerere, has been battling acute hepatic encephalopathy. It is a debilitating condition in which the liver cannot remove toxic substances from the blood. This results in a buildup of toxins in the blood stream, which may cause brain damage.

According to medical records from International Hospital Kampala (IHK), where was admitted by the weekend, Achola first presented at the hospital on May 2, with two-week abdominal pain, yellow eyes for one day and a high-grade fever.

Achola at IHK 

In hospital, Achola, the last born of six, continued to have high-grade fevers and profuse vomiting, all supported with intravenous maintenance fluids and antiemetics-drugs effective against nausea and vomiting. She was later discharged and followed up as an outpatient. But her condition worsened, and she was readmitted after three weeks.

A gastroenterologist, consulted from Nairobi, guided her care and provided contacts for a liver centre in India.

According to Dr Sarah Bonita Musoke, a pediatrician at IHK, in children such as Maria, the Hepatitis A virus (HAV) is associated with hepatic failure and may result in death if left untreated.

“Achola was not immunized against Hepatitis A. Her liver is inflamed and she is experiencing brain impairment,” says Dr Musoke, adding that Achola needs urgent treatment.

HAV is transmitted mainly through eating contaminated food or through blood transfusion.

Dr Musoke adds that in Achola’s case, the onset of encephalopathy requires that she gets a liver transplant.

Achola is currently at stage two of the disease, characterized by drowsiness, gross mental impaireness, slowed response, sullenness and disorientation from time to time. HE has four stages and at stage four, a person goes into coma.  

“We have consulted Indraprastha Apollo Hospital in New Dehli, India who have recommended that she be transferred to their centre for a transplant,” Dr Musoke says.

Achola is now in IHK’s high dependency unit (HDU), with persistent coagulopathy (clotting and bleeding disorder) and a deteriorating sensorium complicated with bacterial sepsis.

The transplant package, which includes surgeries of both the donor and recipient (including 21-day stay of the recipient and 10-day stay for the donor), consumables and bed cost, is valued at $35,000 (about Shs 90m). A pre-transplant evaluation is estimated at $3000 (about Shs 7.6m), while travel and meals are estimated at $12,000 (about Shs 30m).

Achola’s parents are appealing to the public for donations to help save her life. Her father, Vincent Adoko, may be reached on 0772516035 and A/C no: 2520512181-Centenary Bank, Namirembe Road branch.

Prevent dental diseases with good hygiene, diet

Taking good care of your teeth is a good way to avoid toothaches, expensive trips to the dentist and tooth loss. But poor oral hygiene, health and care can affect the health of your whole body.

For some, it has caused oral cancers and others, bad breath.

Sarah Nassozi’s journey through tooth decay is a tale to tell. Over the years, two premolars on her left side of the mouth became brown and their enamels (hard outer layer of the teeth) started chipping off.

Then once, while having dinner, her food got stuck in a hole between her teeth, large enough for the tip of her tongue to reach. This was the beginning of her nightmare. Soon, her teeth hurt so bad that it brought her fever.

“I was hospitalized and could not eat anything for three days until my tooth was gouged out,” she recalls.

Dr Muwazi at his job

Nevertheless, the teeth trauma did not end at that. Two years after removing her first tooth as an adult, Nassozi, 26, is back at Mulago hospital’s dental unit, removing yet another decaying tooth.

Although tooth decay or cavities are largely preventable, Dr Isaac Okullo, dean of the Makerere University school of Health Sciences, says they remain the most common chronic disease of those who present with tooth problems.

They are commonly among children aged six to 11 years and adolescents aged 12 to 19 years.

“When sugar sticks onto or between teeth, it holds bacteria which break down foods and produce acid that destroys tooth enamel. This causes tooth decay,” Okullo says.

He advises people not to eat sugary foods in between meals because it is unlikely that one will clean his or her mouth. Snacking should also be limited.

Additionally, excessive intake of soft and energy drinks such as sodas and red bull respectively should be avoided as these contain acids and artificial sugars which are harmful to the teeth.

PREVENTING

GUM DISEASE

Associated with the sugar and bacteria action on teeth is gum disease.  It occurs when the gums holding the teeth are affected by dental plaque: a colorless substance that sticks on the teeth which will hold bacteria and sugars to the teeth.

Dr Okullo says if this plaque is left unchecked it causes redness and inflammation of the gums.  As a result of this irritation, the gums can begin to pull away from the teeth and the gaps which have been created become infected.

“If gum disease is not treated quickly, the bone which supports the teeth can be destroyed and teeth can be lost. Gum disease is a major factor in tooth loss as we age,” says Okullo.

Also, some teeth end up being held by the gum around them which means that a small force and take the tooth out.

Inside Mulago's dental clinic 

Dr Louis Muwazi, a dental surgeon at Makerere University, says one is at risk of gum disease if he or she is a smoker, has diabetes, crooked teeth as they are harder to clean. Muwazi says important signs and symptoms for one to look out for in regard to gum disease include gums that are red and tender, gums that have pulled away from your teeth, pus coming from between your teeth and gums and teeth which look longer than before because of gum recession.

To avoid gum disease, Dr Muwazi advises people to daily brush their teeth at least twice a day (morning and when going to bed) using fluoride toothpaste in order to remove plaque.

If the plaque is not eliminated, it can continue to build up, which will then feed on the food fragments left behind and can cause tooth decay and gum disease.

However, ‘over-brushing’ the teeth may cause gums to bleed.

“It is vital to change your toothbrush every two to three months or sooner if the filaments become worn. When the bristles become weak, they no longer clean properly and may even damage your gums,” Dr Muwazi notes.

Dental visits every six months are recommended for oral examinations and professional cleaning of teeth. Mulago hospital’s dental unit charges Shs 20,000 for teeth cleaning.

Coping, dealing with acid attacks

On June 2, 2010, Charles Ssebowa, experienced a most horrendous crime. It was as permanent as it was cruel. The accompanying scars, psychological trauma and stigma are hard to fathom. Ssebowa, 37, is an acid survivor.

It was a Wednesday; at around 9pm. Ssebowa, his wife, and two children were riding home from work when someone doused them with acid.

A great fall and sharp shrills followed. They could not see. Their bodies were burnt. The children writhed in pain. 

“When the acid was thrown on us, I felt a burning sensation on my face and did not discover that it was acid. However, my wife shouted and alerted me that acid had been poured on us,” recalls Ssebowa, whose right side of the face is scared.

Luckily, the gathering crowd hurriedly poured water onto them, partly easing the stinging pain.

Ssebowa in his current state

Many would wonder of what use water is against acid; but according to Dr Ben Khingi, a plastic and reconstructive surgeon at Mulago Hospital, water helps to dilute the acid on one’s skin and is recommended as first aid.

After the administration of first aid, the family was driven to Mulago Hospital for treatment. Their tormentor is still out there, the torment a constant thorn in Ssebowa’s flesh.

“After two months in hospital, my first born child, aged five, died. And two weeks later, the one aged two died,” says Ssebowa, peering on the floor, still hurting that he did not bury his children.

That September, his wife also died.

Dr Khingi says it is important for acid burn patients to get first aid as soon as possible. Otherwise, the acid penetrates further into the skin, affecting the bones and nerves.

“Such patients heal with worse disfigurement, for example thick scars compared to those who received first aid promptly,” he says.

In Uganda, acid is easily accessible at service stations, laboratory stores that supply schools and people that deal with car batteries.

Since its establishment in 1985 the Acid Survivors Foundation Uganda (ASFU) has registered 429 acid attack victims.

“According to our statistics, about 40 acid attacks occur annually with many more going unreported and the attempt of the attacker is to kill or at the very least, leave their victims with severe skin deformities,” says Hilda Wanaha, ASFU’s program manager.

ASFU is a nongovernmental organisation that supports victims of acid violence through legal aid, direct survivor support such as medical support and campaigns against acid violence.

Majority of these attacks are attributable to love-turned-sour, business and conflict wrangles and 56 per cent of victims are women.

ABOUT ACID BURNS:

An acid burn is usually considered a deep second degree or third degree chemical burn as it burns not only the skin but penetrates to the fourth layer of skin and damages the tissue. The chemical usually affects the nerve endings.

Dr Khingi says an acid burn takes an average of four to five months for an acid burn to heal properly.

“For one to heal completely, one usually undergoes about 10 surgeries aimed at getting the dead skin out, letting the skin heal and to enable to free movement of the affected muscles in the affected area,” he explains.

For the six months that Ssebowa spent in Mulago, he underwent 10 operations and these are what helped him regain his sight.

At Mulago Hospital, a single operation costs between Shs 3m and 5m and one will need about Shs 50m for the entire course of treatment and recovery. The hospital receives between six and 40 cases of acid burn patients annually, with 13 per cent dying.

Some of the acid survivors being taken care of by ASFU

RECOMMENDED FIRST AID:

After acid gets into contact with any body part, mostly the face, the immediate first aid is to pour a lot of clean water on the person for 20 to 30 minutes. Dr Khingi says dirty water should not be used as this may expose the person to infections.

Take off all clothes, jewelry and shoes stained with acid and continue to flush with water until the burning sensation starts to fade.

Wrap the affected area in clean sheets or sterilised gauze to prevent dirt from getting into contact with the affected area.

Get the patient medical attention as soon as possible.

 TREATMENT AT FIRST HEALTH FACILITY:

More irrigation of the eyes should be done.

Thereafter, pain control using strong pain killers such as Tramadol should be administered. Ritah Sanyu, an acid survivor and peer counsellor at ASFU, says an average of Shs 350,000 may be spent on pain killers per cycle of treatment.

The patient may now be referred to a surgeon who uses saline water to clean the open wounds.

“Saline water further dilutes the acid, ensures that affected cells do not swell and reverses the acid effect,” Khingi expounds.

WOUND TREATMENT

Hygiene is one of the most vital elements to remember during wound treatment as infection is the commonest cause of death among these patients. In Ssebowa’s scenario, the acid caused dents in his children, exposing them to infections.

The room and washroom used by patients should be thoroughly cleaned with disinfectant two or three times a day.

Skin grafting, where a part of the skin is taken from an unaffected area and used to cover the open skin and surgery to cut out the dead skin may also done during treatment.

“After the wound/burn heals, a series of reconstructive surgery is then done to correct the contracted skin,” Dr Khingi notes, adding that regular sessions of physiotherapy are required to ensure that the affected nerves gain their mobility to prevent physical handicap.

Sanyu advises that patients should eat a lot of protein and carbohydrate-rich food, such as beans, peas, cassava and potatoes, for quick recovery of damaged tissues.

Nevertheless, challenges of costly and long periods of treatment and inadequate man power remain. Currently, there are only four plastic and reconstructive surgeons at Mulago.

LONG TERM CARE

After the wounds have healed, Sanyu says it is important for a patient to keep the skin moisturised by applying petroleum jelly.

In many instances, acid burn patients are stigmatised by the public and hence need constant counseling.

“This stigma greatly demoralises them, [blunts] their self-esteem and it is common that many contemplate suicide,” Sanyu says, adding that social reintegration is also necessary for their families and communities to accept them.

Wanaha says that training patients to engage in self-sustenance projects such as agriculture is also important in boosting self esteem.

Currently, Ssebowa, who has completely healed, sells charcoal and vegetables for a living.