Doctors Without Borders

[Voice from the Field] Central African Republic: Singing About Sleeping Sickness

Thu, 19 Nov 2009 21:38:00 GMT

Central African Republic 2009 © Raghu Venugopal/MSF

MSF nurse Katherine Sisterman teachs children in Maitikoulou a song about sleeping sickness in their native language, Mbai.

Listen to the song about sleeping sickness:

With help from a patient and national staff, Katherine Sisterman, a U.S. nurse on her first assignment with Doctors Without Borders/Médecins Sans Frontières (MSF) in northern Central African Republic (CAR) developed a song to teach people about human African trypanosomiasis, also called sleeping sickness or trypano. Here, she describes how the song came to be.

Greetings from Maitikoulou, Central African Republic.

It has been five months since I started as a nurse for MSF in Maitikoulou, northern CAR. Our project is in a rural, rebel-controlled area where MSF is the only health care provider—and the only international presence in general. We are here mainly to treat sleeping sickness, which is, in short, a deadly disease caused by the bite of the tsetse fly. Of course, there are numerous other health needs, including pediatric malnutrition and severe cerebral malaria. Our patients walk many kilometers and sometimes cross rivers by pirogue—a small, flat bottomed boat—to access our free health services.

Sleeping sickness is a neglected and deadly disease that affects 36 countries in sub-Saharan Africa. Transmitted through the bite of tsetse flies, which harbor the parasite for the disease, sleeping sickness, if left untreated, can infect the central nervous system and lead to confusion and violent behavior or convulsions, ending finally in coma and death. In 2009, NECT (Nifurtimox-Eflornithine Combination Therapy), a new and highly effective treatment became available and was added to the World Health Organization’s (WHO) list of essential medicines.

Sleeping sickness affects between 50,000 and 70,000 people per year, according to WHO.

I knew nothing about this country before I came here. But now that I am here, I am finding many things fit exactly what I was looking for and at the same time I am discovering joy in things that I didn’t realize I was looking for. The people here are so physically and emotionally strong. I am lucky to share some of their most personal moments, like birth, sickness, and healing. The local language in this region is called Mbai. I made a short song in Mbai because the patients in Maitikoulou love singing, and the local people here are never too shy to perform.

Each night, I ask the patients to hang their bed nets because some of our malnourished children, who didn’t already have malaria, were catching it in our ward. To encourage the mothers to use the bed nets, I started to tell them, “Mosquitoes will give your children malaria.” I repeated that constantly, and then as a joke one day, one patient sang it back to me, put it to a little church tune, and then we kept adding more verses.

Public health is more effective when it is also a little bit fun, so we have created verses that help capture this sentiment. The first line is, “Mosquitoes will give your children malaria.” Another line is “Sleeping sickness is caused by the bite of the fly. Trypano is serious and without treatment people will die.” And the last line is, “Maitikoulou wishes you to do well. Médecins Sans Frontières wants you to have good health.”

I teach this song to people whenever we do community outreach activities, like the village-based screening for sleeping sickness, where we also screen for malnutrition, and do vaccination registration. People line up and wait several hours to get the rapid screening test. Those who are positive take the illness very seriously; they come to our center from far away, then they stay for one to two weeks to complete their treatment.

Community outreach is definitely my favorite part of the job. The national staff team also has a lot of fun—they are so proud of their work, their knowledge, and the fact that they are helping their brothers and sisters. The village visits are also a great opportunity to see some of our former patients again.

Just recently, we were able to play and spend the day with a little boy who had severe, neurological sleeping sickness in June. We all remember him well because he was so sick. He had trouble walking, his speech was totally disordered, he slept all day, and he screamed all night. The patients in the beds next to him complained about him, so during the night his father would hold him and walk up and down the dirt road so that the other patients could get some sleep. But now he is cured. The team and I got to watch him running around and playing with the other children. His father was really happy and said that he has returned to being a normal little boy.

By the end of the day he and the other village children had memorized my entire public health song. Whenever I hear children sing it, it never fails to lift my spirits and to remind me that it is all worthwhile.

[Press Release] Fears For Migrants Forced Back to Africa

Thu, 19 Nov 2009 21:38:00 GMT

Rome, November 19, 2009 -- New Italian government policies to curb the influx of migrants have led to a sharp decrease in the number of migrants and refugees arriving by boat to Lampedusa, Italy. As a result, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) is withdrawing its team from the island. Between May and October 2008, more than 21,000 migrants and refugees landed on Lampedusa after a perilous journey across the Mediterranean, according to MSF. During the same period this year, MSF teams saw fewer than 200 migrants. MSF is extremely concerned for the fate of migrants reportedly intercepted at sea and prevented from arriving in Italy.

Since the new government policies were implemented earlier this year, many boats carrying migrants have reportedly been intercepted at sea and forced back to Libya. The first official forced return announced by the Italian government took place in May of this year. Migrants are being denied the opportunity to land in Europe and receive much-needed humanitarian assistance. They are also exposed once again to the violence and abuse endured while trying to reach Italy.

“We often hear horrific stories from our patients about what they endure during the journey,” said Antonio Virgilio, MSF head of mission in Italy and Malta. “They have crossed the desert, been locked up in prisons where they have been given no food or water, they have been mistreated, beaten up, women have been raped. They go through hell before they finally manage to get on a boat to Italy or Malta. And now they are being sent back to relive this nightmare all over again. This is a huge threat to their health and even their lives.”

For years Lampedusa has been a regular point of entry for migrants and refugees who cross the Mediterranean Sea to Europe. Since 2002, MSF has provided medical care to those who land on the island. Migrants and refugees arrive in Lampedusa suffering from osteo-muscular complaints, burns from exposure to sun and fuel, and dehydration as a result of the dangerous sea crossing. Many are traumatized by the journey. Increasingly, children and pregnant women—who are particularly at risk—are among those making the journey. In 2008, one in 10 women seen by our teams was pregnant.

In 2008 alone, MSF provided medical care to more than 1,400 migrants and refugees who arrived on the docks of Lampedusa in need of urgent assistance. Most people seen by MSF came from sub-Saharan Africa; one third came from east African countries, including Somalia and Eritrea. They endure the long, harsh journey to escape conflict, deprivation, or widespread violations of human rights. During the journey, they are often subjected to mistreatment and violence, including rape. Since May 2009, however, MSF has assisted fewer than 160 patients.

In response to the worryingly low number of migrants who are landing, MSF is withdrawing its teams from Lampedusa.

“We have reports that some boats are also being sent to Porto Empedocle, in Sicily,” said Loris de Filippi, MSF operational coordinator. “We have tried to assess migrants’ conditions upon landing and provide assistance, but we have not been granted authorization by the local authorities.”

MSF continues to provide humanitarian assistance to vulnerable migrants and refugees facing increasingly restrictive policies in mainland Italy.

MSF has been providing healthcare to migrants and refugees in Italy since 1999. MSF also provides humanitarian assistance to migrants in Malta, Greece, France, Morocco, Yemen, South Africa and Thailand.

[Slideshow] Kyrgyzstan: Former Prisoners Struggle to Continue TB Treatment

Thu, 19 Nov 2009 21:38:00 GMT

Sierra Leone: Lives Are Lost Due to Costly Healthcare

Thu, 19 Nov 2009 21:38:00 GMT

Sierra Leone 2008 © William Daniels

All patients must pay user fees to access medical care in Sierra Leone, even though half the population lives on less than a dollar a day.

Lives that could be saved are lost every day in Sierra Leone, where user fees serve as a major obstacle to accessing vital health care. Doctors Without Borders/Médecins Sans Frontières (MSF) urges international donors and others at a conference this week in London to take the necessary steps to improve access to health care in this desperately poor country.

In Sierra Leone, one in five children will die before their first birthday. The country is consistently rock-bottom on many international health indicators—its maternal and child mortality rates are among the highest in the world.

Nevertheless, all patients in Sierra Leone are required to pay user fees when seeking treatment in the national health system. Even though these user fees are rather low, they present enormous difficulties for people living in extreme poverty in a country where more than half of the population are living on less than a dollar a day. When a simple consultation costs the equivalent of 25 days of income, health care will simply not reach the poorest.

"The health situation in Sierra Leone is in a state of emergency, with people dying every day because they do not have access to treatment."

—Seco Gerard, MSF advocacy advisor

"The health situation in Sierra Leone is in a state of emergency," says Seco Gerard, MSF advocacy advisor, "with people dying every day because they do not have access to treatment. Asking people to pay for health care in such a context has devastating consequences, as many simply cannot afford the fees. For example, people wait to seek treatment until their health situation has becoming critical, or buy poor-quality medicine in the local market. Many do not even seek help at all."

On November 18 and 19, international donors and government representatives will convene in London for the Sierra Leone Investment and Donor Conference. The purpose of the conference is to establish a broader base of donor support for Sierra Leone. At the conference, the Sierra Leonean government will launch a plan for a fair health care financing mechanism which includes the abolition of user fees for women and children.

"The Sierra Leone government has publicly stated its commitment to abolish user fees, and the UK government and other donors have promised to help," said Gerard. "What is crucial now is that Sierra Leone actually receives the necessary funding and technical assistance to realise this objective. It is time that words are being followed up by concrete action. If not, people who could otherwise be saved will continue to die needlessly every day."

MSF has worked in Sierra Leone since 1986. MSF supports a referral hospital near Bo, the country’s second largest city, and supports the operation of 30 rural health posts. MSF offers inpatient services for women and children, malaria treatment, as well as a therapeutic feeding program. In total, over 417,000 consultations were carried out during 2008.

[Video] Sierra Leone: Patient Fees Put Lifesaving Medical Care Out of Reach

Thu, 19 Nov 2009 21:38:00 GMT

Kyrgyzstan: MSF Treats Prisoners Struggling with Drug-Resistant TB

Thu, 19 Nov 2009 21:38:00 GMT

Kyrgyzstan 2009 © Alexander Glyadyelov

In Kyrgyzstan, a team of MSF community workers and a network of volunteers assist former prisoners with tuberculosis to complete their treatment regimes for the deadly disease.

Multidrug-resistant tuberculosis (MDR-TB) is on the rise worldwide and kills around 120,000 each year. The treatment of MDR-TB is very time-consuming and has prohibitively negative side effects. Many patients have difficulties remaining in treatment for up to two years and must at the same time endure the social stigma that comes with being infected by the deadly disease.

He is a free man now, but Ruslan has gone back to Colony 31, a special penal colony in Kyrgyzstan for prisoners suffering from TB , to celebrate with his doctors the completion of his long, arduous, and painful treatment for MDR-TB.

"It was like a nightmare, you can’t imagine how difficult it was to take those drugs."

—Ruslan, Kyrgyz TB patient

"It was like a nightmare, you can’t imagine how difficult it was to take those drugs," Ruslan says. "You want to sleep but you can’t, you feel dizzy, you feel nauseous, you vomit, but you don’t feel any better. I took the drugs even though I felt awful but my former cellmate couldn’t keep going. For him the side effects were too much."

Every year, 120,000 people die from MDR-TB and nearly half a million new cases are identified. The number of patients suffering from strains of the disease that are resistant to one or more drugs is growing—the World Health Organization estimates two million cases worldwide. Most patients develop MDR-TB because they are not treated properly, but people are increasingly contracting MDR-TB the first time they are infected.

Treatment for MDR-TB is costly and complex. The drug regimen duration is up to two years with severe side effects and a cure cannot be guaranteed. Side effects range from unpleasant to unbearable and even dangerous. Several MDR-TB medications have terrible gastric effects, trigger nausea, and cause the kidneys and liver to malfunction. To counter such side effects, the only solution is to add more tablets to the already high daily pill count.

Kyrgyzstan 2009 © MSF

Ruslan, a former prisoner from Kyrgyzstan, who has been cured of his multidrug-resistant tuberculosis and went back to his former prison to celebrate with doctors and other medical staff.

In Kyrgyzstan, a landlocked and mountainous country in Central Asia, Doctors Without Borders/Médecins Sans Frontières (MSF) has been operating a TB treatment project since 2006 in collaboration with the International Committee of the Red Cross. The project is based at two sites—Colony No. 31, a penal institution, and SIZO No. 1, a pre-trial detention center—both located near Kyrgyzstan’s capital, Bishkek.

One in three prisoners with TB is released before the completion of treatment and faces enormous obstacles once outside the penitentiary system. Since they struggle with little help for the basic necessities of life and some deal with alcohol or drug addictions, many ex-prisoners do not see their treatment as a high priority. Some may not even have the money to reach the nearest TB facility. If they do come, they may not be accepted because they don’t have the proper documents or because medical staff are unwilling to treat former prisoners.

"I was released in May 2008, right in the middle of my treatment," Ruslan says. "While I was in the colony the community workers explained to me how I could continue treatment in the civilian sector. But when I got to the hospital, the doctors looked at me with suspicion. ‘Ex-prisoner…..criminal’ they said. But after a while, because of my good behavior, their attitude towards me changed."

"Our patients face the double stigma of not only having TB but also having been in prison. In addition, they may be homeless, unemployed, be dependent on alcohol or drugs and without identity papers."

—Umutai Dauletova, MSF social support coordinator

Umutai Dauletova, MSF’s social support coordinator affirms that it can be difficult for ex-prisoners with TB to be admitted to public hospitals. "Our patients face the double stigma of not only having TB but also having been in prison," Dauletova says. "In addition, they may be homeless, unemployed, be dependent on alcohol or drugs and without identity papers."

Today, around 70 former patients are being supported by a team of MSF social workers and a network of volunteers to complete their TB treatment. Support includes counseling, information and education, food parcels and money for transport.

"We are trying to implement a case-management system now," says Dauletova. "It’s a community approach where volunteers help patients adhere to their treatment."

Ruslan works as a volunteer case manager and offers support to some TB patients who are on treatment in the hospital near where he lives. "With the help of the MSF social team I try to cope with my responsibilities as a case manger. My message to the people I support is 'Patience, patience, patience and don’t lose hope!' "

From 2006 to 2009 MSF has supported 2,270 TB cases, including 200 MDR-TB cases in Colony No. 31 and Sizo No. 1. MSF’s TB project includes the provision of training, drugs, the equipping of laboratories and the rehabilitation of the prison hospitals and living quarters for TB patients. MSF has overseen the introduction of internationally adapted treatment protocols in the penitentiary system and has assisted the Justice Department and the Ministry of Health to improve the medical care of TB patients in prison. In 2007 an MSF office of social support was opened in Osh, the largest city in the south of Kyrgyzstan, to help former inmates to continue their treatment.

World Food Summit Fails to Address Childhood Malnutrition

Thu, 19 Nov 2009 21:38:00 GMT

As the World Food Summit draws to a close, the international community once again provides no commitments on tackling childhood malnutrition. World leaders have also failed to commit funds to directly target the malnutrition problem, despite pledges of US $20 billion to support food security made at the l’Aquila G8 meeting earlier this year.

The neglect of 3.5 to 5 million children under the age of five who die from malnutrition each year means that the summit has conspicuously failed to protect those most in need.

In 2008, Doctors Without Borders/Médecins Sans Frontières (MSF) treated more than 300,000 malnourished children worldwide. MSF teams have witnessed the damage caused by ineffective food assistance that continues in spite of the existence of scientific consensus on preventing malnutrition.

A report released last week by MSF revealed that of the billions of Organization for Economic Cooperation and Development (OECD) country funds allocated to international food aid and food security, only 1.7 percent directly target childhood malnutrition. Part of existing funds must be reallocated so that aid targets malnutrition directly.

Ensuring that food assistance prevents childhood malnutrition is an urgent need; designing programs to meet the food needs of young children should be a priority. In reality, current food aid funded by international donors such as the OECD countries does not contain the nutrients a young child needs for growth and development.

G8 leaders were absent from the World Food Summit. This is no excuse for inaction on childhood malnutrition, particularly when it comes to allocation of funds pledged at the G8 meeting in L’Aquila.

[Voice from the Field] Somalia: "I did not choose this career at the beginning"

Thu, 19 Nov 2009 21:38:00 GMT

Somalia 2009 © MSF

In the South Galcayo hospital, 144 Somali MSF staff are working to keep surgical activities running in an insecure area where violent clashes occurs often.

In the central Somali city of Galkayo, Dr. Abdullahi Adan Mohamoud is working for Doctors Without Borders/Médecins Sans Frontières (MSF) to provide health care to a vulnerable population trapped in a conflict-ridden and divided city. In this interview, he discusses the medical needs in Galkayo and his experience working as a surgeon in Somalia.

Why is MSF’s surgical facility in South Galkayo Hospital so important?
The MSF surgical facility in Galkayo is very important because it is the only free surgical facility in a region affected by frequent violent clashes. It caters for many people, in towns and villages as far away as Dhusa Mareeb (150 miles). The people in this region are too poor to afford private surgery, which costs a fortune. Furthermore, there are very few surgeons working in Somalia as a whole. The majority are concentrated in Mogadishu, which is far away from Galkayo (about 450 miles).

What kinds of surgeries do you perform?
We perform all types of surgery, however, war-wounded patients make up roughly half of the patients we operate on. This is sporadic and very unpredictable, like the clashes. We also carry out pathological surgeries for things like intestinal obstructions, appendicitis, ulcers and C-sections in the maternity unit—assisting with the safe delivery of babies when there is a difficulty.

How long has MSF been providing surgery in Galkayo?
The MSF surgical facility in Galkayo has been operating for five years. I took up my position here four months ago. Before I arrived, MSF had been forced to stop surgical activities for around 10 months due to lack of human resources. It is very good that we can now offer the service again.

"The explosion took place after midnight and the hospital was flooded with wounded"

—Dr. Abdullahi Adan Mohamoud, MSF surgeon

Can you tell us about any recent incidents that illustrate your work?
In late October and early November, Galkayo experienced a number of heavy clashes, including an explosion. As a result, the hospital received around 45 injured people, in this instance, predominantly men.

The explosion took place after midnight and the hospital was flooded with wounded. Unfortunately, there were two patients with very heavy injuries who died at the triage before even reaching the operational theatre.

People had all kinds of injuries, ranging from minor injuries to major abdominal and vascular injuries. The easier cases needed medical treatment and the major cases needed surgical intervention. We managed to save every single patient we treated and now all of them are conscious and some are even discharged.

One case in particular stands out, as the man was very confused. He had come from the north of Galkayo, which is a difficult journey due to the division of the city. He had multiple injuries and needed surgical treatment. However, his condition made it difficult to get the necessary consent. Thankfully, we could eventually treat the man, thanks to support from the elders. He is now much better.

How did you get into surgery?
Actually, I did not choose this career at the beginning. I was thinking of fleeing the country as the violence was becoming intolerable. However, my brother encouraged me to go to university and study. I took his advice and studied hard at Benadir University in Mogadishu. In 2008, I graduated, among the first group of doctors to graduate in Somalia since the fall of Siad Barre. After graduation I went to Medina hospital to gain specialist training in surgery, facilitated by MSF.

How do you feel about your job?
I enjoy doing this job. It is the best thing that ever happened to me. The part I enjoy the most is seeing my patients coming back to the hospital after treatment and thanking me and encouraging me. This gives me feeling of accomplishment and fulfillment.

Somalia: Round-the-Clock Care Saves Countless Lives in South Galkayo Hospital

Thu, 19 Nov 2009 21:38:00 GMT

Somalia 2009 © MSF

Despite the forced evacuation of international staff in early 2008, MSF services in the war-torn city of Galkayo has continued, thanks to hard work by the Somali medical staff.

Located in bone-dry central Somalia, the city of Galkayo is divided in half by warring militias and separatist regional governments that continuously clash in armed confrontations. Since Doctors Without Borders/Medecins Sans Frontieres (MSF) was forced to evacuate its international staff in 2008 due to insecurity, MSF’s Somali staff has carried on the work of providing medical care to people trapped in a conflict with nowhere else to turn.

Quickly changing into his green gown, Dr. Maslah hurried to the operating theatre in South Galkayo hospital to perform an emergency operation on a young man who has been stabbed. "The call came at 8 p.m.," he said. "By 10 p.m. we were in theatre and by 11 p.m. we had managed to stabilize the patient."

The following morning, relatives of the patient gathered in the hospital chatting, and sometimes even laughing loudly, as they receive news that the young man is going to be fine. They reassure friends and other relatives who arrive, having rushed to the hospital fearing the worst.

As one of the 144 Somali staff working for MSF in South Galkayo hospital, Dr. Maslah has played a crucial part in keeping the surgical activities running. In early 2008, at a time when the conflict in Somalia was intensifying and medical needs were increasing, MSF was forced to evacuate its international staff from the country. Since then, MSF’s projects have been run by Somali staff, supported and supervised by management teams based in Nairobi who visit whenever security allows. Without the work of Dr. Maslah and the hundreds of other Somali staff working for MSF throughout the war-torn country, thousands of people would have been left without free lifesaving medical care.

"Every month I’ll perform around 40 operations on people with abdominal injuries, gunshot and stab wounds, injuries of the colon, and people who’ve been in car accidents."

—Dr. Maslah, Somali MSF surgeon

Nightime phone calls for urgent operations are a routine part of Dr. Maslah’s work, as South Galkayo hospital is the only one to provide free emergency surgery in the area. "Every month I’ll perform around 40 operations on people with abdominal injuries, gunshot and stab wounds, injuries of the colon, and people who’ve been in car accidents," says Dr. Maslah.

Surgery is just one of the services MSF provides in South Galkayo hospital, where some patients come from as far away as Ethiopia to receive care. MSF also operates an outpatient department, an inpatient department, a busy maternity ward and tuberculosis center. Every month MSF gives almost 4,000 outpatient consultations, admitting around 120 people for inpatient care and delivering more than 100 babies.

Prolonged drought, coupled with fighting and high food prices means the therapeutic feeding center is often packed to capacity. Pointing to a queue of frustrated women holding weak, dehydrated babies waiting to be admitted, nutritional supervisor Jibril explains: "Every month we admit several cases of diarrhea, measles, dehydration, and sometimes meningitis. But now severe acute malnutrition is becoming the most common problem. We are currently treating 90 patients in a space meant for only 60."

The exhaustion on the mothers’ faces reveals the long and costly journey that most have made to reach the hospital. As one mother says, "Many in the village know that there is free treatment here, but the biggest problem is the journey. It can take many days and is often very expensive, costing around 500,000 Somali shillings (about US$10). A lot of people can’t afford it, so they stay at home and some of them die in the village."

The burn marks on the bodies of a number of the young babies in the feeding center shows that many of the mothers first turned to traditional healers for treatment and only come to the hospital as a last resort.

In sharp contrast to the group is a woman with a big smile standing at the door of the feeding center. In one arm she carries a healthy baby and in the other she holds a bag containing the family food ration she has been given by MSF to take home. She raises her voice above the deafening noise of the crying children to thank one of the staff. "She has been here for quite some time and today she is returning home with a healthy baby," says Jibril.

MSF staff like Jibril and Dr. Maslah work around the clock at South Galkayo hospital with many other committed Somali staff to provide health care to a community in dire need. "The staff at this hospital save many lives," says Dr. Maslah.

South Galcayo hospital is one of the few centers in central/south Somalia that offers surgical care—lifesaving emergency obstetric care and treatment for the many people wounded by violence. During 2008, MSF staff treated 470 victims of violent trauma and provided 43,781 medical consultations, including the treatment of more than 3,000 severely malnourished children. They delivered 936 babies and vaccinated 17,650 people. In addition, 269 patients were started on treatment for tuberculosis. The team also has the capacity to respond to outbreaks such as cholera, measles, meningitis, and nutritional crises.

El Salvador: MSF Responds in Wake of Devastating Floods

Thu, 19 Nov 2009 21:38:00 GMT

El Salvador 2009 © Xavi Punset /MSF

Floods and mudslides have taken the lives of 150 people in El Salvador. MSF teams are based in the region of La Paz, concentrating on the distribution of non-food items and giving mental health support to the victims.

During the weekend of November 6-9, a fierce storm struck El Salvador, triggering floods and mudslides that killed 150 people and displaced more than 13,000. The storm, which is unnamed, came only few days after Hurricane Ida churned along the Atlantic coast of Central America. Salvadorian authorities have declared a state of emergency in the regions affected and many communities have been isolated for days because of collapsed bridges.

Doctors Without Borders/Médecins Sans Frontières (MSF) has sent a team of nine—doctors, logisticians, a nurse, a water and sanitation expert, and a mental health officer—to help the victims of this natural disaster. The MSF Emergency Unit, based in Panama, has sent a planeload of medical and relief material, including water purification equipment and 15 days worth of medicines, surgical materials and first-aid kits.

MSF teams have been assessing the needs of the people in the two most affected regions, La Paz and San Vicente, both on the Pacific shoreline. "People tell me how they were stuck in their homes, how the water was rising and rising and they couldn’t escape," says Xavi Punset, MSF medical coordinator. The MSF mental health officers have done counseling in the shelters and have seen how, despite the sadness people experienced after losing everything, the civil society reacted quickly and immediately set up shelters for those who had been affected.

The first assessments indicate that medical needs are being covered by the government authorities and national NGOs; shelters also are in good condition. The MSF teams will be working in the region of La Paz, on the outskirts of Zacatecoluca and La Libertad, concentrating on the distribution of non-food items and giving mental health support to the victims.

"The question is: What will happen in the post-emergency phase?"

—Xavi Punset, MSF medical coordinator

MSF will continue assessing the needs in the more remote parts of the region of San Vicente and will look into setting up a mental health program for those who have lost their homes. "The question is: What will happen in the post-emergency phase?" says Punset. "Some houses have been flooded and people will be able to go back in the future. However, others have been completely destroyed, so for many people who are now in the shelters, there is nothing to go back to."

[Press Release] Efforts to Combat Global Childhood Malnutrition Woefully Underfunded

Thu, 19 Nov 2009 21:38:00 GMT

Rome/New York, November 11, 2009 – Funding by rich countries to combat malnutrition has remained flat for seven years, according to a report released today by the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF). This barely accounts for three percent of the funds needed to reduce the 3.5 to 5 million annual deaths of children under five attributed to malnutrition.

The report also reveals the enormous waste built into the food aid system. According to MSF, much of the nutrition funding gap could be filled by re-allocating existing funds towards the most vulnerable group, children under five.

The report, released in advance of the World Food Summit in Rome, analyzes how a global effort to prevent childhood malnutrition – which can lead to life-long handicaps, if not death – has simply not been funded. Rich countries only spend an annual US$350 million out of US $12.5 billion the World Bank estimates is required to adequately combat malnutrition in 36 high-burden and 32 high-prevalence countries.

“At the World Food Summit it would be a colossal mistake not to finally commit to improve and scale-up nutrition programs alongside efforts to boost local food production,” said MSF nutrition team leader Stéphane Doyon and co-author of the report. “This report documents the fact that nutrition interventions that have been proven to reduce deaths remain catastrophically underfunded.”

MSF used data from the OECD, European Commission, World Bank, Gates Foundation and UNITAID to analyze the funding flows of the main international donors. Although billions of dollars of international assistance are labelled “development food aid and food security” or “emergency food aid,” less than two percent is being spent on interventions targeted specifically at reducing childhood malnutrition. Moreover, existing funds are being wasted through inefficient practices, such as the US government policy of shipping in-kind food aid overseas, which costs an estimated US$600 million more than purchasing food aid locally.

“The lack of targeted efforts means that young children receive inappropriate food that does not have the key nutrients they need to avoid becoming dangerously malnourished,” said Doyon. “There are opportunities to partly scale-up nutrition funding simply by improving the efficiency of the existing donor government policies.”

Today the authors of the report said that governments can also improve food aid by introducing and paying for newer, more expensive, but nutritionally appropriate food for young children. International organizations, including MSF, have proven that severe malnutrition can be prevented and cured on a very large scale.

Over the past two years MSF has treated more than 300,000 malnourished children in 22 countries. Malnutrition weakens resistance and increases the risk of dying from pneumonia, diarrhoea, malaria, measles or AIDS.

The World Food Summit will be held on November 16th-18th in Rome.

Cape Verde: MSF Responds to Africa's Biggest Recorded Dengue Fever Outbreak

Thu, 19 Nov 2009 21:38:00 GMT

The Cape Verde Ministry of Health has reported 13,187 suspected cases of dengue fever in four islands within the archipelago between October 1 and November 9. The outbreak is the first ever in Cape Verde and is the biggest recorded in Africa. The number of cases increased sharply at the beginning of November, reaching 1,000 cases per day. As of November 11, 93 cases of dengue hemorrhagic fever have been reported and six people have died.

“This is the first reported epidemic of dengue fever in Cape Verde and it is huge,” said Dr. Iza Ciglenecki, MSF’s emergency coordinator in Cape Verde. “With globalization, dengue fever is appearing in places where it has previously been unknown. It is the most rapidly spreading mosquito-borne disease in the world.”

The international response to the outbreak has been positive, with public health experts and international medical teams now providing medical support, case management, surveillance, and diagnostics.

MSF has sent a team to support the hospital in Sao Filipe, the main town on the island of Fogo, where between 100 and 150 new dengue cases are being reported every day. Fogo has a population of around 40,000 people. More medical staff from MSF will arrive by the end of the week to support health centers in Praia, Cape Verde’s capital city on Santiago Island.

Dengue is a viral disease, transmitted by Aedes mosquitoes. Symptoms are similar to flu or malaria, with a high fever, headaches, and muscle pain. Most patients recover, but in a small proportion of cases the disease can progress into a more severe form.

Southern Africa: Fighting HIV-TB Crisis, MSF Contributes to New Recommendations

Thu, 19 Nov 2009 21:38:00 GMT

Participants at an International Consultative Workshop that took place at the end of October in Swaziland have come up with a series of recommendations to improve and increase the response to the alarming dual epidemic of HIV/AIDS and tuberculosis (TB) that is claiming thousands of lives every year in the Southern African region and in Swaziland in particular. The meeting was jointly organized by the Ministry of Health of the Kingdom of Swaziland and Doctors Without Borders/Médecins Sans Frontières (MSF).

From October 28 to 30, 2009, over 120 international and local experts gathered in Matsapha, Swaziland, to discuss response strategies to the dual HIV-TB epidemic and heard testimonies from civil society representatives, including patients currently on treatment. A particular focus of the workshop was on the crippling effect that the growing multi-drug-resistant tuberculosis (MDR-TB) epidemic is having on the health systems of Southern African countries. Patients suffering from MDR-TB need to be put on a two-to-three year treatment that includes painful injections for at least six months and a large number of drugs have to be taken every day. HIV-positive people are a particular concern being at a much greater risk of developing tuberculosis and its resistant forms than other people.

MDR-TB was high on the meeting’s agenda, because resistant strains of tuberculosis are the most complex to detect and cure. “I’m supposed to take injections for nine months,” says Nikiwe Mahlaba, a 30 year-old patient from Swaziland. “So far, I’ve only been injected for four months and the pain is unbearable. I get so worried when I see other patients who are also receiving the same injection, some of them going deaf due to the side effects.”

The workshop came up with a series of recommendations covering issues such as improving health systems and models of care, the clinical management of DR-TB patients, infection control, health information systems, laboratory, ethical issues, and drug supply. There was a strong call for the need to initiate and provide HIV and TB treatment more broadly—at peripheral health care facilities, closer to where patients live, thus improving access to the diagnosis and treatment, a task to be performed by qualified nurses if the medical doctors, who are often in short, are not available.

Read this report for a complete list of recommendations.

“In most of the conflicts or natural disasters where MSF intervenes around the world, the number of people dying is significantly less than what we are seeing today in Swaziland and other areas in the Southern African region,” says Hermann Reuter, an MSF doctor working in Swaziland. “Most of the TB patients die in the first two months because they are also infected with HIV and were not put on antiretroviral treatment fast enough, or because they are infected with drug-resistant TB and were not diagnosed early enough.”

The dual HIV-TB epidemic remains the highest cause of death in countries of the Southern African region and is a heavy burden on the health systems there. The meeting’s recommendations will be shared with the TB assessment team of the Southern Africa Development and Economic Community (SADEC) region when they visit Swaziland from November 16 to 20, 2009.

“This workshop was a resounding success, not only thanks to the involvement and hard work of so many experts, but also because they have come up with practical recommendations,” said Bruno Jochum, MSF's Director of Operations in Geneva. “We hope the recommendations can be endorsed quickly and implemented in a timely way by all the stakeholders fighting the HIV-TB epidemic.”

[Voice from the Field] Malawi: "How can you go back to rationing access to care?"

Thu, 19 Nov 2009 21:38:00 GMT

Malawi 2009 © MSF

Olesi Ellemani Pasulani, MSF clinical officer in Malawi, remembers what is was like treating people living with HIV/AIDS before the scale-up of ART in Malawi. "You could just take care of them, and wait for the day that they would die," he said.

The increase in availability of antiretroviral drugs (ARVs) used to treat HIV in recent years, backed by solid funding commitments, has given millions of people in poor countries a new lease on life. This is the case for tens of thousands of people living with HIV/AIDS in Malawi’s southern Thyolo district. Here, Olesi Ellemani Pasulani, clinical officer for Doctors Without Borders/Médecins Sans Frontières (MSF) at the Thyolo District Hospital, shares his perspective on how improved access to care has changed the lives of people living with HIV/AIDS and the healthcare workers who treat them.

"I can remember what the situation was like before we had ARVs in 2003," Pasulani said. "We could only offer people voluntary HIV testing and counseling. We could only promote the use of condoms and distribute them and we could treat other sexually transmitted diseases. We had a lot of patients in homes that were on palliative care due to terminally ill conditions. There were very few people that came forward to be tested for HIV, because there was not much we could do without ARVs. It was like a death sentence to test HIV positive."

Health care workers were left disheartened because they could only deliver home-based care, simply being able to offer treatment for chronic illnesses and providing end of life care to patients.

"You could just take care of them, and wait for the day that they would die," he said. "It was really hard, because you could see how people were broken down by the knowledge of being HIV positive. That era was really hard for healthcare workers and it demotivated you completely."

Thanks to a model of care developed by MSF and the Malawian Ministry of Health, the ARV scale-up in the Thyolo district in 2003 turned around thousands of lives and entire communities by providing universal access to treatment across the district. By the end of 2008 the number of people on ARVs had increased even further and now in 2009 universal access is maintained.

"Now people living with HIV/AIDS have courage—there is light at the end of the tunnel for them. There is hope among people in the villages."

—Olesi Ellemani Pasulani, MSF clinical officer in Malawi

"Now people living with HIV/AIDS have courage—there is light at the end of the tunnel for them," Pasulani said. "There is hope among people in the villages. You can see the difference that you as healthcare worker make in someone’s life thanks to ARVs. We would see a patient that was bed-ridden earlier, and they would start ARVs. When you meet them again six or seven months later in the market or on the street, they are completely changed. They have joy."

The threat of the early retreat of HIV/AIDS funding and the dire impact it would have on patients’ lives across the most affected areas of sub-Saharan Africa is something that worries Pasulani and his colleagues.

"It is important to continue with ARVs and increase it even more. How can you go back to rationing access to care? It is a right to life. If treatment is threatened it will mean we go back to a situation worse than before ARVs. It will also damage the relationship of trust that communities have built with healthcare workers over the years."

[Special Report] Malnutrition: How Much is Being Spent?

Thu, 19 Nov 2009 21:38:00 GMT

Malnutrition is one of the biggest contributors to child mortality. Here, an MSF worker screens a Congolese child for malnutrition with a MUAC, a tool that measures his middle-upper arm circumference.

Download full report

Malnutrition is an urgent humanitarian emergency that contributes to the deaths of 3.5 to 5 million children under five each year. Millions more are left vulnerable to illnesses or suffering from physical or mental disabilities due to malnutrition. This in turn contributes to impediments to education and development in affected countries.

Despite the fact that malnutrition has regained the world’s attention in recent years, especially in light of the 2007-2008 surge in food prices, international donor funding falls drastically short of the enormous needs. The World Bank estimates that $12.5 billion is needed yearly from the international donor community to effectively address malnutrition. A new report by Doctors Without Borders/Médecins Sans Frontières (MSF), released in advance of the 2009 World Food Summit, reveals that the current funding for the years 2004-2007 averaged $350 million annually—30 times less than the amount need to fight malnutrition.

MSF's report "Malnutrition: How Much is Being Spent?" documents that international donor funding flows have remained flat and insufficient since 2000 and makes a plea to donors, recipient countries, and international organizations to increase their commitments considerably. In addition, the report shows only 1.7 percent of emergency food aid actually addresses nutritional needs. MSF recommends that interventions target nutrition if the scourge of malnutrition is to be reduced.

Greece: Detention Center Temporarily Closed

Thu, 19 Nov 2009 21:38:00 GMT

The Pagani detention center on the island of Levbos will be temporarily shut down for repairs. The closing has raised anticipation of a potential change in Greek immigration policy.

The Greek government has announced they will temporary close down the Pagani detention center. Doctors Without Borders/Médecins Sans Frontières (MSF) sees this as a welcome first step towards more humane treatment of undocumented migrants and asylum seekers.

In order to carry out repairs, Greek authorities have decided to temporarily close the Pagani detention center, which is located in Lesvos, an island in the eastern Aegean Sea. The center is normally home to around 1,200 migrants and asylum-seekers living in deplorable health conditions.

"MSF is pleased that the authorities have decided to close the center and take action to improve the living conditions, since it is unsuitable for human habitation"

—Christos Papaioannou, MSF field coordinator in Lesvos

"Although there are currently still a small number of people inside Pagani, as there are no boats leaving the island on a daily basis, MSF is pleased that the authorities have decided to close the center and take action to improve the living conditions, since it is unsuitable for human habitation," said Christos Papaioannou, MSF field coordinator in Lesvos, which has provided mental health care to detainees since August.

However, it is still unclear whether the detainees be transferred to the neighboring island of Chios. "There is always a big question mark about what happens to these people when they are released or transferred to other locations. We understand that migrants arriving in Lesvos are now being transferred to Chios. We therefore plan to assess the situation there and find out whether there is need to provide assistance," said Micky van Gerven, MSF head of mission in Greece.

The decision to shut down Pagani has raised anticipation of a potential change in Greek immigration policy. "We hope that instead of re-opening the facility as a detention center, the authorities proceed with a plan for open reception centers for migrants and asylum seekers. This would enable proper screening for the population and more importantly, it would mean that people, vulnerable groups especially, would not be detained," said van Gerven. "In general, we hope that the case of the detention center of Pagani signals a changing detention policy towards open centers for screening and administration purposes, humane treatment for the population, access to health care and asylum procedures. The conditions inside the two other detention centers in which MSF is currently providing mental health support remain extremely difficult for the people—it is up to the government to use Pagani as a successful example of a new approach that respects human dignity."

Lebanon: Breaking the Mental Health Taboo

Thu, 19 Nov 2009 21:38:00 GMT

Farah Malyani, MSF mental health worker

After the 2006 Israel-Hezbollah War, Doctors Without Borders/Médecins Sans Frontières (MSF) was alerted to the gap in the provision of mental health care in Lebanon. After conducting an assessment, MSF launched a mental health project on the outskirts of Beirut in December 2008 to provide care to communities that generally consider mental health a private matter with a heavy social stigma.

MSF's community mental health center is located near a large Palestinian refugee camp in Burj El Barajneh, in southern Beirut, and offers free mental health treatment, counseling and care targeting the most excluded in the community—poor Lebanese citizens as well as Palestinian and Iraqi refugees.

Patient story

Salwa is Lebanese, married to a Palestinian husband, and a mother of four. For years she suffered from inexplicable body pain, chronic fatigue, and panic attacks that made it impossible for her to lead a normal life. Currently, she is receiving treatment at MSF’s community mental health center.

"A few months ago, following the advice of a close friend, I started going to the MSF center where I heard they offered psychological help for free. I could not afford to pay.

Session after session, I began to feel better. I even started participating in the social activities at the center and I had the chance to meet other women who have similar problems to mine. I no longer felt alone and I began to feel better about myself.

My life has taken on a new meaning now. Today, I am able to talk about my psychological problems and to accept them, without being afraid of how society sees me. In the past, I used to be worried about being described as ‘crazy’ or ‘unbalanced’, but now I’m just grateful that I’ve found someone who I can talk to and who has helped me to believe in myself for the first time."

"The MSF center is situated in an area where there is a lot of suffering and poverty," said Farah Malyani, a Palestinian MSF mental health worker. "We see people who have basic needs that are not being met. They have experienced several wars and there are generations of refugees living in camps. This has created a range of mental health problems that are unique. I have worked with psychiatric patients in a hospital in Beirut, but the problems I see here are totally different."

Research in Lebanon has found that 17 percent of the population meets the criteria for having a mental health disorder.

Research in Lebanon has found that 17 percent of the population meets the criteria for having a mental health disorder. Mental health problems were found to be even more widespread amongst the large Palestinian refugee community who live in the country, without the right to work or to become a citizen. About 37 percent of women and 19 percent of men attending refugee health clinics reported feeling medium or high levels of anxiety. Most of the time, these disorders are neither diagnosed nor treated. Violence, human rights abuses, poverty, gender inequality and low levels of education all exacerbate mental health problems.

"Working here involves a mixture of feelings," Malyani said. "Sometimes, when people start talking about the difficulties of everyday living, finding something to eat, where to sleep, I am reminded that they are fighting for their basic human needs. It’s difficult not to get emotional or too involved. I meet mothers who are unable to take care of their families because of their depression. I can’t help but think if I were in her place, I would be really lost, but at the end of the day it’s my job and I have to be strong for the people I’m helping.

"At first, I was overwhelmed, I asked myself, ‘How can we help? Is simply listening and giving out medication going to be enough?' But eventually I was able to see that people are supported when they are given the space to be listened to. Also medication can help relieve their anxiety and depression. It makes a big difference. They have been able to go back to their jobs and to take care of their children. Although this is quite a new project, we have already noticed a lot of progress in our patients and it’s really wonderful to see."

"Many times, a patient will say to me: ‘I am not crazy! Don’t think I am crazy!’ I tell them that their condition is a mental illness and, like hypertension or diabetes, it can be treated."

—Farah Malyani, MSF mental health worker

Despite the high number of mental health problems, very few people in need of mental health support in Lebanon are actually receiving it. This is due to a range of factors—a lack of services and qualified staff, cost of counseling and the fact that existing services mainly target children. The largest inhibition to consult mental health professionals, however, is fear of being dishonored for having a mental disorder. For that reason, another goal of MSF's project is to increase awareness about mental health.

"As a team, we are also working on changing the perception of mental health in the community and trying to remove the stigma associated with it," Malyani said. "Many times, a patient will say to me, ‘I am not crazy! Don’t think I am crazy!’ I tell them that their condition is a mental illness and, like hypertension or diabetes, it can be treated."

[Audio Slideshow] DRC: Renewed Violence in Baraka, South Kivu

Thu, 19 Nov 2009 21:38:00 GMT

[Press Release] DR Congo: MSF Vaccination Used as Bait in Unacceptable Attack on Civilians

Thu, 19 Nov 2009 21:38:00 GMT

Kinshasa, November 6, 2009 – Last month, seven vaccination sites operated by the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) came under fire during attacks by the Congolese army against the Forces Démocratiques de Libération du Rwanda (FDLR) in North Kivu, Democratic Republic of Congo (DRC). Thousands of civilians had gathered at the sites. MSF denounces this clearly unacceptable abuse of humanitarian aid for military purposes.

MSF launched a mass vaccination campaign in Masisi district to support the Congolese ministry of health in its response to a measles epidemic. On October 17, MSF medical teams were vaccinating thousands of children in seven different sites in Ngomashi and Kimua Zones, controlled at the time by the FDLR.

All parties to the conflict had given security guarantees to MSF to vaccinate at these locations at those times. However, the Congolese national army launched attacks on each of the vaccination sites. All the people who had come to get their children vaccinated were forced to flee the heavy fighting. Scattering everywhere, they are now in unknown locations and thus cannot be vaccinated. MSF had to stop its activities in the zones and evacuate its teams to Goma, the regional capital of North Kivu.

“We feel we were used as bait,” said Luis Encinas, head of MSF programs in Central Africa. “The attacks coincided with the beginning of our vaccination and put the lives of civilians in extreme risk. Thousands of people, and the MSF teams, were trapped in the gunfire. The attack was an unacceptable abuse of humanitarian action to fulfil military objectives. How will MSF be perceived by the population now? Will our patients still feel safe enough to access medical care? We are compelled to strongly denounce this situation as such actions seriously compromise our neutrality.”

MSF is an independent medical, humanitarian organisation that delivers impartial medical aid according to the strictest principles of neutrality. It is this neutrality that makes it possible for MSF teams to vaccinate in such FDLR-controlled zones, which, until that point, had been inaccessible to Ministry of Health staff.

In addition, the last few months have seen a worrying increase in attacks against humanitarian organisations by various armed groups in North and South Kivu.

“MSF demands that all parties to a conflict respect the work of humanitarian organisations,” added Meinie Nicolai, MSF director of operations. “If not, it is the populations who pay the price. Those already overwhelmed by extreme violence and endless displacement are the ones who may end up cut off from humanitarian assistance.”

A total of 165,000 children, aged from six months to 15 years, were vaccinated against measles during the campaign in the Masisi region before and following the attacks. In Masisi town, MSF supports a hospital, a health center, runs mobile clinics, and provides vaccinations. The organization operates clinics and supports hospitals in other parts of Masisi District. MSF also brings medical care to people in Walikale, Rutshuru, and Lubero Districts, as well as in South Kivu Province. MSF has worked in North Kivu since 1992.

CAR: MSF Sees More Than 4,000 Children in Nutrition Emergency

Thu, 19 Nov 2009 21:38:00 GMT

The southwestern area of Central African Republic (CAR) continues to face a severe nutritional emergency. In September, after being alerted by local authorities, MSF medical teams opened four feeding centers in Carnot, Boda, Nola, and Gamboula. Teams also implemented a number of outpatient treatment programs. Three months later, staff have treated more than 4,000 children. Clara Delacre, MSF emergency coordinator in Boda and Nola, explains the situation on the ground.

How has the situation evolved over the last three months?

In Boda, the number of patients has been increasing progressively…so much so that 1,600 children have already been admitted to the program, half of them suffering from severe acute malnutrition and the other half from moderate malnutrition. In Nola, another 750 children have been admitted and the percentage of severely malnourished is similar to the one we have in Boda.

In our projects in Carnot, Gamboula and Pissa we are treating children who are suffering from severe acute malnutrition. In Carnot, so far we have treated 1,600 children, while 178 more were treated in Gamboula, though this has now been closed as admissions decreased. Meanwhile, a new project opened in Pissa, where 117 children were admitted within the first week. All together, we have already treated almost 4,250 children.

Throughout this time, we have conducted several evaluations across the area, and I think that right now our coverage is good and most malnourished children in the region are being treated.

Barely a month ago, the ambulatory programs in Boda suddenly increased by 400 children in two weeks. About 70 percent of these children were coming from a place called Gadtzi and its surrounding area. What was the reason for the increase, and how have you addressed the situation?

The increase was due to the message spreading far and wide by word-of-mouth that our service is here. It is resulting in our receiving mothers who have walked up to 50 kilometers (30 miles) with their children to come and see us.

We had about 200 children receive treatment in Gadzi and we were going there every two weeks, so we barely had time to see them all. In addition, we suspected that we were not reaching the entirety of the affected population, so we assessed the situation and decided to create a medical team to visit the area every week. On each visit the team stays for five days to conduct an outpatient clinic for Gadzi and two other surrounding areas.

In the past few days, we have heard that poisoning from eating bitter or under cooked cassava was the reason why people are still falling sick. What can you tell us about this?

There is a kind of cassava they call ‘bitter’ that grows very fast and whose cultivation was introduced in recent years. The problem is that it needs longer cooking time and when people are hungry or cannot spend three, four, five days cleaning it, they eat it straight away. Many times, this causes cyanide poisoning, also known as konzo, which in turn causes neurological disorders. Yet in the area where we work, we have not seen many such cases so far.

Now that the rainy season is coming to an end, is a decrease in new patients expected?

Perhaps, when the malaria incidence rate decreases, the number of patients will also decrease, as this is one of the factors contributing to the situation. Yet, on the other hand, the results of the next harvest remain to be seen that could have an impact on food availability during the dry season. Now is also the time when people start coming back from the bush to the towns, so we will also start to see patients whom we had not had access to before.

What other underlying problems need to be addressed in this region?

While some local events have contributed to this current crisis by leaving many people without a source of income and reducing their buying capacity, this is compounded by the virtually non-existent access to health care in an area where up to 65 percent of patients we see suffer from malaria. Overall, this region has been rather neglected by the international community which has focused mostly on providing aid to the north of the country. Thereby, specific projects on food security, education and access to health are more than necessary across the entire region.