Here in CAR the mission is now without nifurtimox. As I wrote about before, it is one of the key medications to treat sleeping sickness. We need this essential medication for this neglected disease.

Hortence, a 10 year old girl, with the severe cerebral form of the disease needed just 1 ½ pills, twice, in order to complete her treatment. You’ll perhaps remember in previous blogs I was forced into prescribing her the far more uncomfortable 14 day regimen of intravenous eflornithine because of MSF’s rupture of nifurtimox.

Luckily though, on Sunday, when I was filling in for the pharmacist on his day off, I found an empty bottle of nifurtimox. Whimsically, I shook it. The rattle of a few pills caught my interest and hope. I opened it. Inside were small pieces of nifurtimox – 17 in total. I found a clean piece of cotton gauze and carefully put the shards of nifurtimox together. I stared long at them and went over to Cyriaque - one of our nurses. I asked him if he agreed there were enough pieces to make up 3 pills. He agreed – definitely he said. I felt better and knew we were doing the right thing. We evenly divided up the shards in two small pill bags and then next day, after receiving the 2 doses of 17 pieces of nifurtimox, Hortence went home.

This was a good ending to what could have been a difficult 2 weeks for Hortence. It was also a sad and frustrating commentary that we are reduced in this mission to piecing together shards of pills for a wholly treatable and eventually fatal disease. Now that the shards are gone, everyone will need 2 weeks of intravenous eflornithine - 4 times a day - and that will be difficult for many of our patients.

Warm wishes from the Central African Republic,

Raghu Venugopal