MANUFACTURING ANTIRETROVIRAL DRUGS: A RISKY ADVENTURE IN THE BLACK CONTINENT
One wonders how many of us will selflessly devote our lives to better the lives of others. How many will have the important pharmaceutical qualifications and the definition despite all the odds to support the social equality and the right of people who are infected with HIV/AIDS to free treatment? How many can really forbear the hardship and traumatic experience to manufacture affordable and high quality generic antiretroviral drugs for those in need without getting anything in return?
At the time when HIV/AIDS continues to claim more lives, triple fold in some corners of the world, one very special lady has decided to take it upon herself a seemingly impossible mission of traveling to the expansive and challenging African continent to single-handedly construct pharmaceutical factories and to teach the locals to produce antiretroviral drugs on an industrial scale. This lady only returns to her homeland in Thailand a few times in a year for personal commitments or to receive numerous accolades that so many organizations and institutions bestow on her.
It is a great pleasure for us to introduce to our readers “Mama Tough of Africa” or “The gypsy pharmacist”, Dr. Krisana Kraisintu, a small woman with a very big heart for humanity. She graciously granted us an interview about her long travel to achieve universal coverage for HIV/AIDS treatment for Thai patients and her ongoing adventures in Africa.
A pharmacist by necessity
I come from Samui Island, Surathanee province in the South of Thailand. My father was a doctor. My mother was a nurse. When I was young, I liked to follow my grandma to a temple near our house. I waited for my grandma under the tamarind tree with a small bag of salt while she was praying. When the tamarind fruit fell down from the tree, I picked it up, peeled it and ate it with pinches of salt. Later on when my grandma’s health did not allow her to go to the temple easily and she often stayed at home, I would instead follow my father to the temple. Most of the time, we went to Saun Moke Temple in Surathanee Province. I was lucky to go to the temple often during my childhood. The visits enlightened me on the facts of life. In order for us to know someone well, it is not enough to know him or her at present, but more importantly to look to his or her background. The person’s background and the path that person chooses to lead his or her life donate a good indicator to the way he or she behaves and cures others. Everything has its cause and effect.
My father wanted me to continue his legacy as a doctor. I was not keen on sciences but in fact preferred arts, poems, music and painting even though I also excelled in sciences and mathematics. The reason that I studied pharmacy was because I missed one point on my exam’s score, 319 marks instead of 320 marks to be accepted for medicines. Nevertheless, I enjoyed learning pharmacy. It was not difficult and I considered it my duty to make efforts to study well.
After completing my bachelor degree, I felt that I needed to acquire more knowledge in pharmacy so I traveled to Britain to further my study. When I first arrived there, I spent time studying English literature, Shakespear and the likes because I love arts until my father reminded me that it was time to pursue my pharmaceutical education. He told me that the wall of our house did not have enough space to hang all the certificates from my arts courses. I began my postgraduate study at the University of Strathclyde in Scotland and then my doctorate at the University of Bath.
Life as Head of the organization
When Dr. Krisana returned to Thailand, her life took on the career of a pioneered pharmacist for the next 24 years from assuming the position of the Head of Pharmaceutical Department to the Director of Research and Institute at the Government Pharmaceutical Organization (GPO).
After completing my education in the United Kingdom, I came back to Thailand and applied for a job as a lecturer at the Prince of Songkha University, Surathanee Province in the South of Thailand even though my father had applied for the job for me at GPO. I felt that I wanted to make a advocate to my hometown so I worked there for 2 years. The University appointed me as Head of the Pharmaceutical Department which really surprised me. I did not expect and did not feel comfortable to be the Head of the Department because it meant that I had to act the part, smiling when I did not feel like it and tried to get along with people to move work forward. I have always been the Head of the organization and shoulder all its burdens and responsibilities all my life. Now I feel much happier to be a freelance pharmacist, having only friends and students.
Two years of being a lecturer made me wonder if I could find another job that I can use my knowledge and education more productively and put to use for the public my pharmaceutical potentials. I was attracted to apply for a job at GPO when I learned that GPO’s policy was to work for the benefits of Thailand and Thai patients. I wished to produce high-quality and affordable drugs for Thai people. GPO appointed me as Head of the Research and Development Section.
During her tenure as Director of Research and Development Institute of GPO (from 1987 to 2002), Dr. Kraisintu developed 64 herbal based- medicinal products ranging from medicines to supplementary food and cosmetics in addition to various medicines for the treatment of diabetes, high blood pressure, high level of cholesterol and specific drugs for children. As a consequence, Thai patients are able to afford high quality medicines and enjoy a long and healthy life. Dr. Kraisintu’s love of herbal medicines and her family heritage in medicinal and herbal treatment contribute greatly to her pursuit of promoting the widespread use of Thai traditional herbal medicines in modern forms, i.e. tablet and dissolvable powder, for poor people in rural Thailand.
The miracle medicines for AIDS patients.
From 1992 to 2002, Dr. Krisana worked on the formulation evolution and bioequivalence studies of HIV/AIDS -related drugs. Her unwavering conviction of AIDS as a social issue and her dedication to increase access to HIV/AIDS treatment in Thailand resulted in the successful research and generic manufacturing of Zidovudine (AZT) to prevent the HIV/AIDS virus’ transmission from mother to child in 1992. Her achievement raised the pharmaceutical and health profile of Thailand as the first developing country to manufacture generic HIV/AIDS drugs. In 1998 Dr. Krisana developed one of the first generic ARV fixed-dose combinations, which has now been chosen by WHO as the first regimen treatment for HIV/AIDS patients in poor countries. In Thailand, this drug (GPO-VIR) is used in the national HIV/AIDS treatment programme, making it free of charge for 100,000 patients. It is made available due to the fact that Dr. Krisana’s formulation drastically reduces the prices of the finished products from the original prices. Dr. Krisana further developed 5 other types of antiretroviral drugs for the patients. Her invention has enabled GPO to export antiretroviral drugs to neighbouring countries of Thailand such as Burma, Lao, Cambaodia and Vietnam where poor patients are in grand need of high quality and affordable drugs.
What are her aspirations?
I have a great compassion for children. Every time I see a sick child, I feel for him or her. Children are our country’s future. That was the reason which prompted me to work on evolution and research of antiretroviral drugs. I took me three years (from 1992 – 1995) to achieve this goal. The first six months were very difficult because I did all the work by myself. Nevertheless, it was unbelievable that my consecration paid off until this day. In 1995 Thailand became the first developing country to produce a generic antiretroviral drug.
It has been a long road of struggles and obstacles for me to develop the formulas and manufacture generic antiretroviral drugs. From the beginning, I had to search and import raw materials from aboard, overcame the stiff and at times hateful opposition from people in my organization as well as from Multinational Drug Companies. My name was put on the blacklist of most of multinational drug companies which meant that if I ever got diseased and needed medicines that are manufactured by those companies, they would not in any circumstances allow me to be cured using their medicines. I had to defend myself in court against the lawsuits of multinational drug companies because if I succeed in bringing about the generic production of antiretroviral drugs, they would lose financially. The prices of their medicines are much higher than my generic versions. I am grateful for the support of NGOs, the media and friends as well as well wishers in America and France who sent me important information to fight the lawsuits. My thanks also extend to the Ministry of Foreign Affairs of Thailand for the humanitarian projects in Africa at the moment.
The first generic antiretroviral drug that I manufacture is ZIDOVUDINE or AZT to prevent the HIV/AIDS virus’ transmission from mother to child. For me, I only wanted to help the poor patients to get access to the needed medicine and utilized my knowledge to that ends. I never wanted to compete or seize benefits from multinational drug companies.
After that I developed more formulas and more people joined in the team. One of the most successful antiretroviral drugs that GPO has manufactured is GPO-VIR, a cocktail of three drugs. It is very popular because it reduces the dosage of drugs that AIDS patients have to take each day and the cost is very much affordable for the patients.
What was the reason that you left Thailand to travel to produce medicines in Africa?
“I keep my promise.” Actually it was not my promise but the promise of the Thai government that was announced during WHO’s conference that Thailand will help African countries by transferring the technology in the production of anti-retroviral drugs to them. I was assigned to write a proposal but once I submitted it to the Ministry of Health of Thailand, it was ignored. No one cared to keep the promise but me. When I met Africans during international meetings, they would ask me when Thailand would send the team to help them on this issue. Until September 2002 no action on the Thai side was taken to fulfill that promise, so I decided to resign from my position as Director of Research and Development Institute of GPO and traveled to Africa.
My mother accompanied me to Africa for the first time. She cried everyday for 2 months wanting to return to Thailand but I was not able to bring her back to Thailand due to my work obligation. She was worried and did not want me to pursue my goal of increasing access to life-saving medicines locally in Africa but I was determined to carry on my life there. As far as I am concerned, I love Africa, the wild animals, the nature and the endless journey. The first country that I went to work is Congo. I did not know anything about Congo at the time and spent all my pension money of 1 million baht on all the expenses for my trips, accommodation and food there.
Since 2002, Dr. Krisana has devoted her time, energy and efforts for humanitarian purpose of assisting poor African countries to establish local pharmaceutical production. Her goal is two-fold; first utilizing her expertise and experience in guiding these countries to build high standard pharmaceutical factories and second to transfer the technology in the production and quality control of essential medicines such as antimalarial and antiretroviral drugs on an industrial scale to local health and pharmaceutical personnel. The ultimate result is self-reliance and sustainable access to life-saving medicines for the patients.
From 2002 to 2005 Dr. Krisanan provided technical support and know-how to Pharmakina in Bukavu, Democratic Republic of Congo (DRC) in the setting up of an ARV plant and the manufacturing of ARV fixed-dose combination known as AFRI-VIR. At the same time, she was responsible for the structuring of an ARV plant and an antimalarial drug unit at Tanzania Pharmaceutical Industry (TPI) in Arusha. Subsequently, TPI was able to manufacture artemisinin-based anti-malarial drugs for both adults and paediatric patients in 2003 and ARV fixed-dose combination known as TT-VIR in October 2005.
For the past 7 years, Dr. Krisana has worked in 15 African countries, for examples, Benin, Burundi, Gabon, Kenya, Mali and Uganda. She is determined to carry on journey to other African countries to achieve her humanitarian mission until the last day of her life.
Happiness is in the heart.
Living in Africa is quite a challenge for anyone let alone a foreign lady. However, Dr. Krisana embraces life in Africa with an open heart. She is happy whenever she sets foot on that continent and never gives up her hopes and dreams to see the local people enjoying a healthy life despite having to overcome dangers to her life and insurmountable obstacles. She told us that….
Life is hard enough without bringing upon oneself more unhappiness. I love myself and I want to be happy. That is why I don’t keep all the negative feelings and make myself unhappy. I don’t spend time thinking too much of the future or the past. I think of the present and do the best I can.
Once I traveled to Nigeria in response to an invitation to give a lecture on technical assistance in the Pharmaceutical Industry. It was dangerous in Nigeria during the day let alone at night. I arrived at the airport alone at 1 am because my flight delayed for many hours. The person who was supposed to come to pick me up at the airport was not there and the security people did not allow anyone to stay inside the airport at night. I had to take a taxi to the hotel and on the way was stopped 5 times by the locals with guns pointing at me. I did not have precious belongings with me and answered their questions that I came to Nigeria to help them. I was very afraid but had to be brave and had a conversation with them about my country, that I ate rice just like them. It was very dark and I couldn’t see them, only their eyes and white teeth. In the end, they let me go and did not take anything from me. The same incident repeated 4 times during the 20 kilometers distance to the hotel.
My next adventure was in Congo. I was sleeping and woke up in the middle of the night because of the loud noise and sudden bright light. I thought to myself why it was morning so soon. It turned out that it was not dawn that woke me up but a bomb that was fired with the house I was in as a target but it missed and hit the house next door instead. I was frightened. I think there are people who want to finish me off because my work stands in their way of making huge profits out of patients.
I cannot answer people’s question why I continue to do this work in Africa. I am not young anymore and have to forbear the hardship and all the inconvenience of life over there while I can choose a much more easy life in Thailand. For me, it is happiness that I experience in Africa. I am happy to help people, to see them enjoy a healthy life. I feel that I practice “Dhamma” when I live and work in Africa. I never hope to receive anything in return. I am impressed by the generosity and hospitality of the Africans even though they are very poor. The eyes of the African children are innocent and hopeful. I want to help them as much as I can and by doing that my life is worth living.
What are your incentives?
Humans no matter how strong need incentives and moral assistance to carry on with their lives. For Dr. Krisana, the life-transforming experience of one African child becomes her incentive to this day.
At the beginning, I intended to stay in Africa for 5 years but something happened and I want to continue my work there until the day that I cannot physically walk up the stairs of the plane. I have no ambition, no particular goal. I am content to teach the locals to produce their own medicines in Africa. I feel bonded with the people there. Africa is my house.
One turning point for this decision to stay on occurred on the day that a seven-year-old boy named Jacob was brought into the health clinic in Benin where I was teaching the locals to make antimalarial drugs. The boy was infected with Malaria and about to die. His mother was weeping and begged us to help him. The antimalarial drug was just produced, not yet tested for quality control at the laboratory. We had no choice but to use it to save Jacob’s life. Within a few minutes, he was conscious again and his fever quickly subsided. He was better and alive. His mother was very happy and grateful. She thanked me many times. I was very glad to save one child from death. The experience with Jacob gave me the incentives to do my work. I felt energized and could overcome all the odds, never give up, never get bored and never fed up.
Repaying her gratitude
At present, Dr. Krisana not only works to improve the lives of Africans, she also teaches and lectures in Thailand as well as set up a pharmaceutical factory at Ubon Rajathanee province in the North-east region of Thailand.
I go back and forth from Thailand to Africa, spending a lot of time on the plane. Nowadays I give a series of lecture at universities all over Thailand. I set up a pharmaceutical factory at Ubon Rajathanee University and train the pharmacy students a hand-on experience in manufacturing herbal medicines. I like Ubon and feel that it somehow resembles Africa in its nature, simplicity and way of life. I want to help raising the incomes of farmers who grow medicinal herbs. In increase, I want to repay my gratitude to the University for extending help to Burundians by donating a tabletting machine for making antimalarial drugs there in September 2008.
During our long conversation with Dr. Krisana Kraisintu, we can feel the immense extensive energy of this 57 year-old grey-haired lady touching us. Our last question for the interview that day was what formula of medicine that she wishes to invent evolve to cure treat what disease. Her answer was, “The drug that reduces greed. I would give it to Thais, then to other people in foreign countries. If people have less greed, we can solve many diseases and problems.”
Source: Interview from Voyage Travel Magazine.
Source : http://www.krisana.org/