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Hortence and her 17 pieces of nifurtimox

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.

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