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.

A bone infection almost cost Jonah his leg

Play is the ingredient that gives infancy its flavour. We chuckled, giggled, rolled in the sand, jumped off mounds, chased our peers and climbed trees. In turn, wounds, scars and bruises were sculpted on our skins.

But did you know that a bad injury could result into something more tragic, like a bone infection?

Seven-year-old Jonathan Wasswa, a resident of Nkumba has lived through the pain of a bone infection, medically called osteomyelitis.

Jonah (L) plays with a friend

HIS STORY

Wasswa was at his best on the morning of December 26, 2012.

Standing on a low stool, he chorused, ‘mbuuke mbuuke?’ (should I jump, should I jump?) His friends responded, ‘buuka!’ (jump) and he did. The jump left him with a broken bone and swollen limb. The pain stung every part of his body making the little child wail.

His mother, Maria Specioza Nalwanga consulted a herbalist who wrapped Wasswa’s injured leg with herbs, as pain relief agents and treatment. The herbs lasted one week but did no good. His leg turned yellow and the swelling got bigger.

On February 14, he was taken to Mulago hospital for an X-Ray which revealed an internal bone fracture. His leg was put on traction, a set of mechanisms to straighten broken bones or relieve pressure on the spine and skeletal system, and the leg was encased in a cast.

Jonah and his mother after his incident of an injured leg

“Before [the cast could be removed], his leg oozed large volumes of pus, so much so that it seeped through the two mattresses on his bed, and on to the floor,” Nalwanga recalled, adding that he was taken back to Mulago.

It was discovered that he had a wound on the inner side of the left knee. By then, he had lost appetite and was immobile. On April 9, 2013, he was referred to CoRSU (Comprehensive Rehabilitation Services in Uganda) in Kisubi for surgery to rid him of the dead bone due to osteomyelitis.

ABOUT OSTEOMYELITIS

Osteomyelitis is a bone infection often caused by bacteria called staphylococcus aureus. In children, it usually affects the long bones of the arms and legs.

“Patients usually present with pain, swelling, pus discharge in the affected area and sometimes, one may be unable to use the affected limb,” explained Dr Paul Muwa, an orthopedic specialist at CoRSU. Additionally, patients might have fever and chills and feel nauseated.

Osteomyelitis is more common in children because their bones are more vulnerable as they are not fully grown. Malnourished children and those from poor socio-economic backgrounds are more prone to the condition.

If not treated quickly, it leads to the chronic stage with severe bone destruction that may necessitate amputation.

Adults are also predisposed to bone infection because of increased incidence of diabetes and poor dentition and frequent surgical procedures such as open heart surgery and dental extractions.

At CoRSU, bone infection is the orthopedic condition with the highest number of surgical procedures. Out of 3,018 procedures last year, 747 were due to osteomyelitis.

DIAGNOSIS AND TREATMENT

Records indicate that it is sometimes difficult to diagnose osteomyelitis in infants and young children because they don't always show pain or specific symptoms in the area of the infection. 

When Wasswa was admitted at CoRSU, he was examined and had a bone X-Ray.

“The X-Ray revealed that one bone overlapped the other and that the head of the femur (thigh bone) had been eaten by bacteria,” Moses Kiwanuka, CoRSU’s head of community-based rehabilitation said.

Immediately, Wasswa was put on antibiotic treatment through an intravenous drip (IV) to stop the bacteria in its tracks. In some instances, like it was in Wasswa’s, Kiwanuka said osteomyelitis can become severe and a hole may develop in the bone.

Pus and a collection of bacteria may have formed in the hole and this calls for a surgical procedure to drain the pus to allow the bone to heal completely.

Once the condition improves, a patient is discharged but continues with oral antibiotics for several weeks.

Dr Muwa, however, noted that recovery depends on the state of a patient’s condition i.e. how much of the bone is involved.

PREVENTION AND HOME CARE

A vibrant Jonah relaxes in the lawn

Kiwanuka said the easiest way to prevent osteomyelitis is to practice good hygiene.

“One needs to keep wounds clean and this can be done through traditional sterilization using cotton wool and warm salty water and cover it with sterile gauze or a clean cloth to avoid its exposure to infection,” he urged.

For those that have undergone surgical procedure, regular exercise such as walking helps in restoring the mobility of the affected body part. Kiwanuka also calls for improved nutrition, a balanced diet, to boost the body’s immunity.

 Before the infection, Wasswa mainly fed on rice, groundnut sauce and matooke. Today, his diet has widened to include eggs, small fish (mukene) and posho. The lively and warm Wasswa now spends his days helping ‘mummy’ in the garden.

The possibility of him returning to school and graduating into a medical doctor is as ripe as it was two years ago.

QCIL spearheading production of new generation ARVs, antimalarials

Quality Chemicals Industrial Limited (QCIL) in partnership with the Cipla Ltd, an Indian multinational pharmaceutical, is currently producing new generation antiretrovirals (ARVs) and anti-malarial drugs. These drugs are here to address the challenge of drug resistance which is caused primarily due to non-adherence to drugs sometimes perpetuated by drug shortage.

For malaria treatment, QCIL has embarked on the production of artemisinin based combination therapy (ACT) under the brand name, Lumartem. It is a first line treatment against uncomplicated malaria as recommended by the World Health Organization (WHO).

This follows the population’s resistance to conventional medicines such as Chloroquine.

Lumartem contains artemisinin and lumefantrine, two active anti-malarial ingredients and is significantly cheaper than its sister brand-Coartem. 

Samuel Opio (R) showing President Paul Kagame a sample of Lumartem

“We are also in the process of producing another ACT; a combination of Artesunet and Amodiaquine which is recommended by WHO as the first line treatment for uncomplicated malaria in many of the franco-phone countries,” said Samuel Opio, QCIL’s head pharmacist.

QCIL also recently introduced the first Tenofovir-based combination, a newer generation of ARVs with better safety pro- file and greater efficacy under the brand name-Duomune. It is a fixed dose combination of tenofovir, disoproxil fumarate and lamivudine.

The recommended dose of Duomune is one tablet, taken orally, once daily.

Opio says Duomune reduces pill burden as it is taken once a day and has been found to significantly reduce the transmission of HIV.

With currently installed capacity of 75 million tablets per month, QCIL is positioning itself to supply the region with life saving medicine. 

Samuel Opio, QCIL (R) during a tour with President Yoweri Museveni (C)

WHY FOCUS ON MALARIA AND HI

Despite remarkable progress in combating the disease burden in Uganda, progress in meeting MDG six of combating HIV/Aids and malaria is still dampened by high prevalence and incidence of the two diseases. Today, there are some 630,000 Ugandans in need of ARVs to manage the HIV/Aids. Yet only 350,000 are receiving it leaving nearly a half of the population without treatment.

Deaths due to malaria in Uganda number 312 daily and over 100,000 annually. Because malaria covers a continuum that extends from asymptomatic infection to acute infections and death, many survivors bear the toll of non lethal effects such as anaemia, low birth weight and hypoglycaemia without attributing it to malaria.

According to Uganda’s 2011 Demographic and Health Survey, malaria is the significant cause of death to 99 out of every 1,000 children under five years. This is way above the MDG goal of having only 58 deaths per 1000 children. This is worsened by the fact that more than three quarters of Ugandans live in highly endemic areas.

Owing to the fact that Uganda is among the most highly malaria-endemic countries in Africa, Gross Domestic Product loss from the disease is estimated at $23.4 m (Shs 58 b) which translates to seven per cent of the health budget. The health sector was allocated Shs 825b in the 2013/14 national budget.

At household level, malaria episodes result in reduced productivity because of the inability to work. Conversely, malaria, said Opio, increases HIV replication in one’s cells. 

REGIONAL MARKET THE DRUGS

QCIL is the only facility in East and Central Africa licensed and prequalified by WHO to produce generic drugs. Generic drugs are comparable to the brand-name drug but are sold at a significantly lower price than the branded ones.

It’s sister company, Cipla, one of the world’s largest producers of generic drugs and is offering advanced technology, technical assistance and staff training to QCIL.

With this boost, the local pharmaceutical supplies ACTs and ARVS to Kenya, Tanzania, Rwanda and Burundi.

“In the recent past, our installed capacity was 60 million tablets because we initially sought to meet the local demand of 50 million tablets. With a boost of another 25 million tablets, we are able to supply the region,” said Opio during an interview. 

CHALLENGES

The biggest challenge is market access. There are huge multinational companies which import medicines from production plants some which do not meet the WHO recommendations and sale them at highly subsidized prices. This limits access for the drugs produced by QCIL.

There is also a challenge of limited skilled labour.

“Many graduates have the knowledge but lack the practical skills. But with current technological transfers with CIPLA, we are bridging this gap,” Opio said.

QCIL currently has 250 employees and 70 per cent of these have science backgrounds including pharmacists, bio chemists, chemists, mechanical engineers.

There is also a challenge of donor dumping which comes in the form of aid. 

FUTURE PROSPECTS

In the next five to 10 years, QCIL is aims at increasing its production capacity.

Plans are also underway to establish an Active Pharmaceutical Ingredient (API) Plant which will provide the region with a source of affordable and quality pharmaceutical raw materials for example artemether which is grown in the western part of the country.

 This will reduce costs of importing the raw material from India, china and Vietnam. However at present, Quality Chemicals does not have extraction technology required to produce artemisinin at 100 per cent purity.

“Artemether will be exported to India where they will purify the plant and extract its medicinal component which will then be imported by Uganda. But we believe that the purification process can be done here,” Opio explained. 

QCIL is also considering transitioning fully to the production of Tenofovir based combinations and paediatric formulations in form of dispersable tablets dissolvable in water. Realisation of these formulations is expected within the next two years.

With the deadline extension of the World Trade Organization’s (WTO) Trade Related Aspects of Intellectual Property (TRIPS) to 2021, Opio says QCIL together with Cipla are considering production of newer molecules that can be availed even after TRIPS has ended. The original deadline was 2016.

According to the TRIPS agreement, least developed countries (LDCs) are supposed to enforce patents on all medicines by 2021. This would mean the end of all generic drugs. Patents guarantee the right to exclude others from making, using, offering for sale or selling the invention 20 years from the date on which the application for the patent was filed.

“We welcome the extension but we still need a further extension until we have developed enough capacity. The only capacity we are talking about right now is QCIL which is the regional capacity. We also need to build on research,” said Opio.

WAY FOWARD

As part of overall sustainability, treatment for malaria, Opio said it is important to invest in the future by developing a strong research and development centre that can tap into the potential of local medicines.

“As QCIL, we believe we are ready for this but we need partners to be able to scale up,” he said.