Sudan: Market of Death
January 2001 – 24’00”
| Early morning southern Sudan | 10 00 00 | music in actuality
|
| tending a sick girl, Angelika | 10 00 06 10 00 07 | music change JO music Q1 |
| | 10 00 14 10 00 20 10 00 26 | Commentary It’s no surprise children die of disease in Africa. But here’s a new 21st century twist: Drug companies have stopped making the medicine that would cure Angelika. Welcome to the logic of the global market. |
| Unreported World background Unreported World The Market of Death jeep towards camera down track | 10 00 28 10 00 29 10 00 32 10 00 36 10 00 37 |
music change actuality music
|
| travelling shots | 10 00 43 10 00 45 | North of the equator, near the source of the White Nile, we crossed into rebel controlled southern Sudan. We’d heard an old and terrible disease had returned. |
| Saira to camera super reporter Saira Shah | 10 00 52 10 00 53 | Saira A hundred years ago it wiped out half a country’s population. By the 60’s it was almost eradicated. Now sleeping sickness is back – it’s just the kind of ancient disease that the modern global village we’re all supposed to live in nowadays ought to be able to wipe out without any problem at all. |
| travelling shots | 10 01 09 | Commentary But it’s not happening. Sleeping sickness is killing three hundred thousand people every year. So what’s going wrong? I was on my way to meet a doctor I hoped would have some answers. |
| WS Tembura village super Tembura, Southern Sudan | 10 01 28 10 01 29 |
music out
|
| | 10 01 33 10 01 35 | Tembura sleeping sickness hospital was overflowing with hundreds of sick people and their relatives.
|
| Dr Mickey Richer tending to Angelika | 10 01 40 |
|
| | 10 01 42 | I found Dr Mickey Richer catching up after a trip abroad. Angelika’s family had walked for weeks to get here hoping to give their daughter a chance of life. |
| Dr Mickey intercut with shots of asistant and Angelika | 10 01 59 | Dr Mickey Richer This is a nine year old girl from Central African Republic and she's been sick with abnormal behaviour for about a month.
|
| | 10 02 04 | Commentary Angelika has sleeping sickness. Thousands of parasites are attacking her brain.
|
| | 10 02 10 | Dr Mickey Richer She came here just a month ago? One month ago?
|
| | 10 02 22 | Commentary Angelika’s family knows if nothing is done she will slip into insanity, a coma and death.
|
| | 10 02 28 | Dr Mickey Richer Let's put her on her side. There you go. OK there you go.
|
| | 10 02 38 10 02 44 | There’s no modern, miracle cure on hand to end Angelika’s suffering.
The global economy is driven by money. And developing drugs for diseases that hit poor people doesn’t pay.
|
| Dr Mickey pan down to Angelika | 10 02 58 10 03 03 | Dr Mickey Richer OK. She's having obviously uncontrollable movements and shakiness and when stimulate her, mouthing movements you can see inappropriate behaviour, very classic of untreated sleeping sickness.
|
| pan to Dr Mickey Angelika | 10 03 17 10 03 20 10 03 25 | Saira But how serious is this?
Dr Mickey Richer Well, we're going to start her on her medicine and hopefully she will do all right but the sicker you are the more likely you’re to react to that medication also, so. |
| | 10 03 31 | sick man singing
|
| man with sleeping sickness Angelika | 10 03 34 10 03 36 10 03 44 10 03 50 |
Commentary All around us was the evidence of the damage this disease does to the human brain.
Untreated it’s always fatal but it can take years to die of sleeping sickness.
|
| other patients | 10 03 53 10 03 57
10 04 03 | The disease is rising here three times faster than HIV. But unlike HIV [singing out] it doesn’t affect people in rich countries. So there are no high tech [music in] drugs, no massive laboratories.
|
| sunset | 10 04 03 10 04 08 | music in JO music Q 1
|
| | 10 04 12 10 04 14 | Saira How serious a disease is it in this area.
music out
|
| Saira and Dr Mickey sitting with tilley lamp Dr Mickey Saira Dr Mickey musical instrument pan up to man playing and singing | 10 04 15 10 04 22 10 04 30 10 04 35 10 04 46 | Dr Mickey Richer Well, sleeping sickness is a serious disease because it is a hundred percent fatal if untreated. And the prevalence of the disease is really steadily, steadily risen upward and in some villages it's actually as high as 45 percent. Say the man of the family got it well that affects the whole family because the man can't work but his wife has to take care of him and that means he can't take care of the family, the children eh. So that when one family member has it it just destroys the whole community [actuallity music in] |
| river bank and villagers | 10 04 56
10 05 02
|
Commentary People around here use the rivers for bathing and drinking water. But the tstese fly breeds near water – and a single bite from this fly can be enough to pass on the parasite that causes the disease.
|
| | 10 05 17 | singing out |
| people in hospital corridor patients preparing injection | 10 05 18
10 05 20 10 05 23
10 05 34
| People with sleeping sickness have no consumer power. Drugs labs in the West are splicing genes and cloning embryos. But here they get a drug developed in 1929 whose active ingredient is arsenic. The idea’s to give enough poison to kill the parasite without killing the patient. |
| patient Dr Mickey shows glass vial | 10 05 36 10 05 39 10 05 41
| Dr Mickey Richer This is Melarsoprol, as you can see, in a glass vial, it comes in a glass vial.
|
| injection | 10 05 45 10 05 46 | Commentary Each injection is a gamble with death. Melarsopol kills around one in twenty patients.
|
| Dr Mickey John growning pan down to see needle as it is removed |
10 05 53
10 06 05 | Dr Mickey Richer We don't draw it up before the patient comes to sit in that chair because what it does is it is such a caustic substance that it's dissolved in it melts the plastic of the syringe.
|
| and back to John’s face and he leaves | 10 06 13 | Commentary They told me it was like having acid in your veins.
|
| Dr Mickey preparing another injection Dr Mickey intercut with shots of injection |
10 06 16
10 06 28
10 06 30
10 06 39
10 06 53
10 06 55 | Dr Mickey Richer Oh John, khalas, khalas. That's how much it hurts and burns and stings. Makes an adult man cry, eh.
Saira It really did look painful.
Dr Mickey Richer Yes, it is. But melarsopol would cause destruction, burning, stinging in the tissue and then death of those cells. And don't forget it's the preparation that it is preserved in too there's, the glycerine glycoate is really a caustic agent, so, it's like an acid, it's antifreeze, it's similar to antifreeze, so.
Saira What you put in your car?
Dr Mickey Richer Right, that antifreeze, yes.
|
| preparing another injection Sylvia’s face pan down to foot | 10 06 58 10 07 04 | Commentary Patients go through this every day for ten days. Sylvia’s already had nine injections. The last one will be the hardest
|
| looking for vein |
10 07 10
| Dr Mickey Richer You can't use one vein usually more than one or two times because Melarsoprol burns the vein.
|
| Sylvia looking intercut with shots of injection |
10 07 17
10 07 20 | Saira Do you think you could get some in there.
Dr Mickey Richer We can try. I think we will try it.
|
| |
10 07 23 | Commentary For all this agony, the drug doesn’t even work on a third of patients. |
| injection – needles bending |
10 07 28
10 07 48 | Dr Mickey Richer It's a lot more painful doing the injections here in the leg because you're right on the bone and there's not a lot of tissue to cushion, eh. This when you give it right on the bone like this it is very painful, exquisitely.
John the needles bent, John, careful. |
| Sylvia watching pan down to injection | 10 07 53 | Commentary Arsenic injections may kill one in twenty patients, but compared to modern treatments they’re cheap – about thirty pounds for each course.
|
| Dr Mickey pan down to 2-s with Sylvia and back to Dr Mickey | 10 08 02 10 08 06 | Saira What's happened?
Dr Mickey Richer Er,it got clotted. Sylvia, we'll let you rest just for a minute and then we'll try Justin here and then we'll come back one more time. Maybe we'll try a bigger vein.
|
| | 10 08 21 10 08 22 | Saira That really must be like torture for her. Dr Mickey Richer It is and it's every day she gets er …. |
| Sylvia gets up and leaves |
10 08 36 | Commentary Sylvia won’t ever be a priority for drugs companies. They only sell one per cent of their drugs in Africa. Eighty per cent of their market’s in the West. |
| sunrise cockerell | 10 08 48 10 08 56 | |
| interior hospital Angelika | 10 09 01 10 09 05
|
Commentary The next morning, Angelika’s still waiting for her Melarsoprol. |
| ext hospital Dr Mickey and Saira walk to storeroom | 10 09 16 10 09 18 10 09 23 10 09 24 | Then Mickey tells me something horrific. A better drug has been discovered – but it’s no longer being made. |
| they go into storeroom looking | 10 09 34 | Dr Mickey Richer Woo a lizard. You know a lizard and snake tails they seem the same but it was a lizard. |
| for DFMO | 10 09 42 | Dr Mickey Richer These medicines are far too old to use. It's chilling to think doctors had better drugs a decade ago than they do today. Instead of sleeping sickness treatment advancing, it’s gone back in time. |
| Dr Mickey finds vial of DFMO | 10 09 55 10 10 05 | Dr Mickey Richer I'm looking for DFMO. We do have it here, I know we do. So we will just find it. Ah here it is, we have found it. Um let's see, [music in] I guess my pants are as good as anything. I’ll try to get it off so you can read the label, heh. It is, it’s a vial of DFMO. |
| | | music in JO music Q2 |
| old vials DFMO WS storeroom Dr Mickey & Saira | 10 10 17 10 10 32 10 10 35 | Commentary DFMO’s expensive to make. Ten times more than Melarsoprol. It was originally developed for prostate cancer – it’s pure chance it cures sleeping sickness. If it had cured cancer, it would still be produced. But it didn’t – so Africa has to do without. music out |
| CS vial Dr Mickey 2-s Dr Mickey shots around storeroom | 10 10 34 10 10 35 10 10 40 10 10 44 10 10 49 10 10 51 10 10 58 | Dr Mickey Richer Since it's not there cost effective for the drug company er it's not longer going to be made.. Saira That's quite an extraordinary situation. Dr Mickey Richer Yes and I think probably not a situation that exists anywhere else in the world, huh. If we had an illness in the United States that a drug would cure but you know, it wasn't cost effective, I think they would still produce it. But here, er we have a drug that we know works and yet it is not being made because the people that need it can't buy it. |
| | 10 11 06 | music in JO music Q3 |
| | 10 11 08 | Commentary It’s no good just blaming drugs companies. The one that made DFMO – Aventis gave away the licence free to the World Health Organisation. But the WHO couldn’t find anyone to make it for a price it could afford. The world’s supply of DFMO will run out this year. |
| WS countryside man singing shots of village and villagers | 10 11 31 10 11 36 10 11 40 | music change man – actuality singing |
| tree and birds | 10 11 44 10 11 58 | Commentary Southern Sudan can’t count on outside help anymore. In the past, colonial masters or superpowers found it in their interests to supply medical aid. Now Southern Sudan’s slipped into civil war. The government’s lost control. Healthcare’s left to the free market. |
| villagers waiting to be screened | 10 12 00 10 12 04 | music out |
| | 10 12 08 | Every day Mickey sends a screening unit to outlying villages. If they can spot the disease in its early stage, before it reaches the brain, they can use a modern drug called pentamine to kill the parasite. |
| taking blood sample | 10 12 26
|
|
| girl watching Jenty watching another having blood taken woman watching | 10 12 31 10 12 32 10 12 34 10 12 45 |
The villagers know that if the test shows the disease has reached their brain they face a possible death sentence. What they don't know is which will kill them, the disease or the drug that's meant to cure them.
|
| Jenty begins to cry before blood sample | 10 12 51 |
|
| microscope | 10 13 08 10 13 10 |
music in JO music Q4
|
| pan up to technician | 10 13 11 | The doctors look for evidence of the parasite in the blood. If they find just one parasite it means sleeping sickness.
|
| pan over to Jenty | 10 13 23
10 13 25 | One girl is unlucky.
Six year old Jenty has got the disease. Tomorrow she’ll have more tests to see how advanced her illness is. |
| ext hospital sunset | 10 13 33 |
|
| Jenty and mother walk towards hospital Dr Mickey greets Jenty | 10 13 42 10 13 44 10 13 51 | It’s Jenty’s day of reckoning. [music out] Melarsoprol’s so dangerous Micky doesn’t want to use it unless the parasite has reached her brain. If it hasn’t she can be treated with pentamanine. |
| Jenty Dr Mickey Jenty lumber puncture |
10 13 54
10 14 04 10 14 05
10 14 07
10 14 31 10 14 35 | Dr Mickey Richer Are you good. Yes, turn round. We know we're going to have a procedure here and we look suspicious.
Saira She does look a bit suspicious. What are you going to do here?
Dr Mickey Richer Well the disease has two stages, early on if somebody has just been bitten by the tetse fly the parasite is in what we call the periphery of their body er just in the blood and in the lymph system. Once the disease progresses, later on, it's called stage two disease and that's when the parasite invades the brain, so now we're trying to differentiate if she has early disease, stage one or later disease, stage two.
|
| |
10 14 37 | Commentary If Mickey had one drug to treat both stages of sleeping sickness, none of this would be necessary. |
| Jenty with mother pan to Dr Mickey |
10 15 21
10 15 24
10 15 26
10 15 36 10 15 39 | Dr Mickey Richer OK so let's go, we've one got a few drops.
Saira Is that enough.
Dr Mickey Richer Yes, this is enough, we usually try to take 1cc. So this is less but we’re only going to do a few tests. Jenty kelas.
So what we’ll do now we've got the cerebral spinal fluid, Duncan, who is our laboratory technician here will test it for the three perimeters we look for in the cerebral spinal fluid.
|
| Jenty laying down | 10 15 51 | music in JO music Q5
|
| microscope shots | 10 15 52 10 15 55 | Commentary If Jenty has fewer than five white cells in the sample, the parasite hasn't yet reached her brain. |
| Dr Mickey |
10 16 08
10 16 09
10 16 12 | Dr Mickey Richer How many? Four?
Laboratory technician [music out] Four cells.
Dr Mickey Richer Four cells.
|
| Jenty | 10 16 13 | Commentary Because she’s been caught early by screening, Jenty can be treated by the safer drug. She’s been spared Melarsoprol. |
| countryside children walking | 10 16 24 | music in JO music Q6 ??? |
| interior hospital and patients | 10 16 31 10 16 33
| Only one in a hundred drugs developed is for tropical diseases – and many of those are by-products of cures for more lucrative illnesses. When it comes to sleeping sickness there’s none of the research that goes into afflictions of the rich. |
| Dr Mickey Saira Dr Mickey | 10 16 44 10 16 45 10 16 47 10 16 53 10 17 01 10 17 04 | Saira I was wondering what the parasite actually does [music out] inside your brain. Dr Mickey Richer Well actually it's a good question. Er no one knows exactly what it does in the brain. Taking care of lives and the living is the priority here and yes research needs to be done but it's not something anybody has done research on. There's been some, I'm not saying there's none but this is an age-old illness and we still don't know the exact mechanism of what's going on in the brain because there's not been there's not been that research. |
| morning sky | 10 17 12 | music in JO music Q7 |
| hospital shots | 10 17 14 10 17 19 | Commentary Africa’s millions of sleeping sickness victims need a stroke of luck to break the vicious circle of market forces. Amazingly that could happen. |
| | 10 07 25 | It’s this crazy: by sheer chance DFMO has been found to slow facial hair growth. Millions of women in the West want it. |
| | 10 17 35 | So the razor giant Gillette is about to turn the best cure for sleeping sickness into a cosmetic face cream for women with moustaches. |
| | 10 17 47 | The global village is beginning to look like a jungle where only the rich survive. |
| putting on gloves | 10 17 57 | music out |
| Angelika sleeping Saira Angelika | 10 18 04 10 18 05 10 18 07 10 18 14 | Saira Well it’s the little girl we saw yesterday, Angelika and she’s having her first her Melarsopral. And they’re worried about her because she's been having such convulsions. |
| Anne | 10 18 15 10 18 17 | Commentary Mickey’s assistant fears Angelika may not survive the treatment. |
| pan to Angelika’s arm | 10 18 18 | Anne … in the tissue right. She's such small veins and she's in such poor condition in regards to being malnourished that we're a bit afraid her veins are going to collapse, so we basically have one chance probably er to give her the injection. We have looked on both arms and her feet and we've found one real small one right there, OK |
| Angelika Anne | 10 18 45 10 18 48 | Dr Mickey Richer So what we need the mother is just to reassure her, talk to her through it and help her relax. |
| Angelika pan to arm | 10 18 51 10 18 53 | Commentary Of course if the drug companies still made DFMO for sleeping sickness Angelika wouldn’t be facing an injection of arsenic. |
| | 10 18 58 | Anne It's going to burn so we want her to be at least as comfortable as possible. and tell the mother, explain to the mother … |
| Anne | 10 19 06 10 19 14 | Commentary The only way scenes like this will end is if Gillette’s hair removal cream catches on in the West. That could push down the cost of producing DFMO. And a drug company might make it again for sleeping sickness. |
| injection | 10 19 22 | In the meantime it’s business as usual |
| pan to Angelika’s face | 10 19 24 | Anne One, two, three. |
| Anne injection | 10 19 35 10 19 41 10 19 51 | We tell the patients it's normal to have a burning sensation going up the arm. It's such a toxic drug that we try to …. vein as quickly – well we want to keep the Melarsoprol over 3-5 minutes just because it is so, it's so toxic it can eat the syringe so that we have plastic possibly going into the vein as well. |
| |
10 20 00 | Saira What's that going to do to such a tiny baby?
|
| pan to Angelika’s face pan back to injection Saira and Anne |
10 20 02
10 20 25
10 20 28 10 20 30 | Anne Well, we're going to have to rotate the vein. What we do is we usually try the right arm first OK let's go real slow, OK. We'll try the left arm today and then we'll try the right arm tomorrow and if we can't find any veins then we will go into the feet. But often with patients like this we don't really have an option.
Saira Angelika do you think she is going to be OK
Anne She's extremely weak and we've seen yesterday that she has definite neurological problems, she had a facial tick … I don't know.
|
| WS Angelika having injection | 10 20 42 | music in JO music Q8 |
| Angelika twitching |
10 20 45
10 20 52 | Commentary Two weeks later, after nine more injections, Angelika was discharged. They hope the treatment has been successful but unless DFMO becomes available they fear if she relapses she will die. |
| Saira to camera | 10 20 04 10 20 08 | Saira Of course drugs companies aren’t charities. But we seem to be living in a some sort of moral vacuum, [music out] which means if you’re a doctor in the third world you’d better hope that some drug developed for animals or even a cosmetic will turn out to cure a disease that kills millions of people. |
| sunrise | 10 21 20 | music in JO music Q9
|
| | 10 21 26 | Commentary On average costs three hundred million dollars to develop a new drug.
|
| | 10 21 31 | music out
|
| Dr Mickey and Saira talking | 10 21 31 | Dr Mickey Richer
|
| dark sky | 10 22 00 | music in actuality music
|
| travelling to village in jeep | 10 22 06 10 22 08 | Commentary It’s my last day here and I joined Mickey on a five hour drive to the settlement of Ibba. Sleeping sickness is ravaging this community.
|
| walking shots village huts Mickey and Saira into shot | 10 22 16 10 22 17 10 22 28 |
Our first visit was to a man who’d been threatening his family. A classic sign of the creeping insanity that comes with sleeping sickness.
He’s already had two courses of arsenic injections. They haven’t worked because the parasite’s getting resistant. His options are running out.
|
| | 10 22 40 | music out
|
| Dr Mickey talks to Michael and family | 10 22 33 10 22 45 10 22 47 | Dr Mickey Richer Ah this is him. Michael, Michael?
Commentary Mickey tells me a colleague sent her a drug used on a similar disease in South America, she's got not idea if it will work here, but a desperate situation calls for desperate measures. |
| Michael | 10 22 57 10 23 14 10 23 48 | Dr Mickey Richer Michael. Ask him if he has a headache. Does he think the sleeping sickness has come back?
Before we take him back he has had the relapse medicine, now the only medicine I have is a drug that's not used very much in sleeping sickness – it's the only other medicine I can give him. But I cannot promise that he will not die, eh, so you must explain that, it's not for sure that I can cure him. Do they still want me to take him? You understand?
|
| helped to his feet and walks from village to jeep | 10 23 57 | music in JO music Q10
|
| | 10 24 13 | In a profit-driven world the absurd becomes logical. There are effective modern drugs to cure sleeping sickness in animals but not humans. It’s more profitable to cure a cow than a person. So Michael is almost certainly going to die.
|
| | 10 24 39 | music out
|
| Dr Mickey and Saira Michael helped into jeep Dr Mickey and Saira Michael | 10 24 39 10 24 48 10 24 57 10 24 58 | Dr Mickey Richer He's an ideal candidate for DFMO. If I had DFMO I wouldn't even talk of an experimental, untried drug, I would just put him on DFMO, if we could get it. I'd just use that first choice no doubt in my mind because I know that works. But I don't have it.
|
| everyone into jeep and drives off fade to black | 10 24 04 10 24 06 10 25 30 | Commentary Of course the global economy has brought benefits, and not just to the rich world. But market forces don’t make exceptions for good causes. What governs the sale of computers, clothes or food governs medicines too. Those who can’t pay, don’t get. |
| Unreported World titles background Roller – Reporter Saira Shah | 10 25 31 10 25 32 10 25 33 10 25 54 |
music in actuality man singing
music out
|
| | | music JO music Q11
|
| trailer inserted travelling shots of Ambon destroyed building pan L to see Jonathan Miller walking rioting in streets carrying dead | 10 25 55 10 25 56 10 26 06 10 26 13 10 26 17 | Saira Next week. [music in] Jonathan Miller has become one of the first journalists to make the hazardous journey to Ambon, an Indonesian island torn apart by bloody conflict
Jonathan Miller This city used to be known as the queen of the east, today it’s better known as the Sarajevo of Asia.
Saira Indonesia joined the global economy, now it’s paying the price. [music change] Unreported World, next Friday, on 4.
|
| | | music change JO Unreported World title music
|
| Unreported background MBC © | 10 26 22 10 26 23 10 26 25 |
music out |
| Ends | 10 26 26 |
|