Doctors Without Borders

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

Fri, 06 Nov 2009 21:48:00 GMT

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

Fri, 06 Nov 2009 21:48:00 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.

[Special Report] HIV/AIDS: Punishing Success?

Fri, 06 Nov 2009 21:48:00 GMT

South Africa 2003 © Francesco Zizola / Noor

A young man receives treatment for HIV at MSF's project in Khayelitsha.

Special Report

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Over the past decade, enormous resources have been mobilized globally to address the HIV/AIDS crisis on a large scale. Doctors Without Borders/Médecins Sans Frontières (MSF) has seen first-hand the achievements, as well as some of the
shortcomings, of these efforts in the course of providing care and treatment in more than 30 countries.

Today, the good news is that four million HIV-positive people are alive on antiretroviral therapy (ART). The bad news is that MSF teams working to treat HIV/AIDS are witnessing worrying signs of waning international support to combat HIV/AIDS. In some high-burden countries, patients are being turned away from clinics, and clinicians are once again being forced into the unacceptable position of rationing life-saving treatment. At the same time, more robust and better-tolerated treatments–widely prescribed in wealthy countries–are not reaching patients.

There are signs of a decreasing political commitment to HIV/AIDS, the loudest being a major funding deficit. Critical funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria and the US President’s Emergency Plan for AIDS Relief (PEPFAR) are in peril.

Meanwhile, a dangerous trend is under way in the global health policy arena. There
are increasing calls for a diversion of foreign aid away from HIV/AIDS and towards other health priorities. While there is clearly a need to give urgent and additional
resources to an array of global health priorities, not least maternal and child health, cutting HIV/AIDS funding is not the answer. Reducing funding at this juncture would not only undermine the goal of reducing maternal and child mortality, but it could also lead to the interruption of treatment for people with HIV/AIDS already on ART, and leave those still in need of access to treatment to die premature, avoidable deaths.

This killer disease is an ongoing emergency that requires dedicated resources at the national and international levels. A strengthened commitment to other global health priorities must happen–but it must happen in addition to, not instead of, a continued and increasing commitment to HIV/AIDS.

[Press Release] Punishing Success in Tackling AIDS

Fri, 06 Nov 2009 21:48:00 GMT

Special Report

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Johannesburg/New York, November 5, 2009 — A retreat from international funding commitments for AIDS threatens to undermine the dramatic gains made in reducing AIDS-related illness and death in recent years, according to a new report released today by the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF).

International support to combat HIV/AIDS is faltering, as reflected in significant shortfalls among two of the world’s main funding mechanisms for HIV/AIDS. The board of directors of the Global Fund, a key financer of AIDS programs in poor countries, is unable to respond to countries’ needs. The board will vote next week in Addis Ababa whether or not to suspend all new funding proposals in 2010. The US President's Emergency Plan for Aids Relief (PEPFAR), the American government’s AIDS program, is capping funding for two more years. This means that new patients will be turned away for treatment.

Report: Punishing Success: Early Signs of a Retreat from Commitment to HIV Care and Treatment.

The MSF report highlights how expanding access to HIV treatment has not only saved the lives of people living with AIDS but has been central to reducing overall mortality in a number of high HIV burden countries in southern Africa in recent years.

In Malawi and South Africa, MSF observed significant decreases in overall mortality in areas with high antiretroviral therapy (ART) coverage. Increased treatment coverage has also had an impact on the burden of other diseases. For example, tuberculosis cases have been significantly reduced in Thyolo, Malawi and Western Cape Province, South Africa.

“After almost a decade of progress in rolling out AIDS treatment we have seen substantial improvements, both for patients and public health,” said Dr. Tido von Schoen-Angerer, director of MSF’s Access to Essential Medicines Campaign. "Recent funding cuts mean doctors and nurses are being forced to turn HIV patients away from clinics, as if we were back in the 1990s before treatment was available.”

“The Global Fund must not cover up the deficit caused by its funders,” said von Schoen-Angerer. “The proposed cancellation of the 2010 funding round and other measures to slow the pace of treatment scale-up are punishing the successes of the past years and preventing countries from saving more lives.”

PEPFAR has had a huge impact on increasing the number of people on AIDS care and treatment in poor countries since 2003, supporting more than two million people on treatment with a commitment to increase treatment to at least three million by 2013. But U.S. government HIV/AIDS funding has remained the same for 2009 and 2010 and early signs indicate there will be no increase in funds for 2011 either. The proportion of PEPFAR’s budged dedicated to treatment has actually decreased. Only a handful of countries will be able to increase the number of new patients at a pace similar to what PEPFAR has supported in the past.

In 2005, world leaders promised to support universal AIDS coverage by 2010, a promise that encouraged many African governments to launch ambitious treatment programs.

"What about the promise made to people with AIDS?” said Olesi Ellemani Pasulani, MSF clinical officer in Thyolo District Hospital in Malawi. “We gave them hope and life. We have to be there for them. We all knew from the beginning that this treatment was for life. Passing on the bill for treating AIDS to very poor countries would be a colossal betrayal.”

Reducing funding at this time will leave people in urgent need of treatment to die prematurely, and can lead to dangerous interruption of treatment.

In Uganda, cuts have already begun to hit home, with some facilities forced to stop treating new patients with HIV. Other countries are backing away from their earlier treatment coverage targets. In Free State, South Africa, past funding problems—since resolved—led to disruption of treatment and a moratorium on treating new patients, which resulted in an estimated 3,000 deaths.

The report provides evidence that treating AIDS, particularly in high prevalence settings, has a positive impact on other important health goals, in particular maternal and child health.

“A stronger commitment to other health priorities must happen, but this should be in addition to, not instead of, continued, increased commitment to HIV/AIDS,” said von Schoen-Angerer.

At present, over four million people living with HIV/AIDS in the developing world receive antiretroviral therapy. An estimated six million people who are in need of life-saving treatment are still waiting for access. MSF operates HIV/AIDS programs in approximately 30 countries and provides antiretroviral treatment to more than 140,000 HIV-positive adults and children.

Southern Sudan: MSF Responds to Kala Azar Outbreak

Fri, 06 Nov 2009 21:48:00 GMT

Sudan 2007 © Susan Sandars/MSF

MSF teams walk to health posts to provide medical care in Jonglei State. During the rainy season, which continues through the Fall, reaching many of these sites requires wading through water or using boats.

Doctors Without Borders/Médecins Sans Frontières (MSF) is responding to outbreaks of kala azar—a severe parasitic disease—in Southern Sudan. The emergency is in several locations across the eastern part of the region and MSF is treating patients in its clinics in Pibor and Lankien, both in Jonglei State, and using mobile teams in Rom, in Upper Nile State, to actively trace patients.

"Without treatment, those infected with kala azar become skeletal and can die within weeks if their immune system is already weakened,” said Dr. David Kidinda, MSF medical coordinator. “In Southern Sudan, where almost three-quarters of the population have no access to even the most basic health care, it’s a race against time to reach patients.”

Kala azar, or visceral leishmaniasis, is a neglected tropical disease, endemic in some parts of Southern Sudan. It spreads quickly and easily during an outbreak and thrives in poor, remote, and unstable areas where there is extremely limited access to health care. Kala azar is contracted through the bite of a sandfly that carries the parasite. The parasite then multiplies inside the body, attacking the immune system. Symptoms include an enlarged spleen, fever, weakness, and wasting. It demands quick diagnosis and treatment, and, if left untreated, it is fatal in almost 100 percent of cases within one to four months. However, if patients access treatment on time, there is a success rate of up to 95 percent.

“We suspect that the numbers of kala azar patients reaching clinics in some areas are just the tip of the iceberg,” said Dr. Kidinda. “With all the barriers facing people here—the severe lack of infrastructure, few proper roads, crippling absence of healthcare staff and structures and the current increase in violence and insecurity in the region—survival becomes a cruel obstacle course for those in need of lifesaving treatment.”

Jonglei State is the most affected area, with reports of 275 kala azar patients being treated by a local non-governmental organization (NGO) in Old Fangak clinic in the northwest. In its remote health center in Pibor, MSF has admitted 24 kala azar patients, two of whom died, having accessed health care too late. The patients in Pibor clinic were infected in the cattle camps in the north of the state before moving back to their villages around Lekwongole, in the northwest of Pibor County. Patients must make their way to MSF’s outreach health post in Lekwongole, as MSF teams are currently unable to access these villages due to insecurity and road inaccessibility. MSF then transports the patients to Pibor by boat, as roads have become rivers.

MSF has admitted an additional 46 kala azar patients to its clinic in Lankien. Further north, in neighboring Upper Nile State, MSF has deployed an outbreak response team to screen people across Rom, where 37 patients are being treated.

MSF is not only providing direct treatment for the disease, which involves one injection per day for 30 days, but is also giving supportive treatment for dehydration and anemia, and for other diseases affecting some kala azar patients, such as malaria. In addition, MSF is providing food to patients and distributing mosquito nets and soap, and is starting health promotion activities in Jonglei State to raise awareness of the disease and encourage more people to seek treatment.

MSF has been working in Sudan since 1979. Currently, MSF has projects across Southern Sudan, and in Abyei, Southern Kordofan, and Red Sea states, and in North Darfur. MSF is an independent and neutral organization that provides medical aid to all people, regardless of race, or political and religious affiliation.

Philippines: Second Typhoon in a Month Makes Landfall

Fri, 06 Nov 2009 21:48:00 GMT

Philippines 2009 © Tony Marchant /MSF

Over the last 40 days, the Philippines has been hit by two violent typhoons and a tropical storm, which have all caused severe flooding and prompted people to assemble in evacuation centers like this one in Santa Cruz.

Typhoon Mirinae hit the east coast of Quezon province in the Philippines on October 30, packing winds of 93 mph with gusts of up to 115 mph. Mirinae, also called Santi, brought heavy rain and floods to the area before weakening into a tropical storm and veering towards Vietnam. The Philippines has been hit hard this season, with Tropical Storm Ketsana and Typhoon Parma first causing havoc about a month ago.

Typhoon Mirinae has affected the capital Manila where at least 19 people have been killed and several others are missing. More than 15,000 people have been relocated to various evacuation centers and around 300,000 people have been affected in 14 provinces.

"This new ordeal will no doubt make [people] more vulnerable to waterborne diseases."

—Pierre Luigi Testa, MSF emergency coordinator

"In some areas, the water has come up to waist height. People were still trying to cope with the aftermath of Ketsana and have already spent weeks in stagnant water,"says MSF emergency coordinator Pierre Luigi Testa. "This new ordeal will no doubt make them more vulnerable to waterborne diseases."

Assisting in newly affected areas

MSF, which has been providing assistance to victims in all affected areas of Laguna Bay and in the east of Manila since last month, has been assessing the newly flooded areas, especially in the coastal and southern areas of Laguna and in Santa Cruz, where 80 percent of the town has been submerged.

In the province of Tarlac and the urban municipalities of Los Baños, Cabuyao, Santa Cruz, and Calamba, MSF has identified the need for additional distributions of hygiene kits and plastic sheeting and further water and sanitation activities. New latrines need to be built and clean water needs to be provided. Five primary health posts have been flooded after the typhoon and MSF will launch new mobile clinics in the area.

Continuing the intervention

MSF runs regular mobile clinics in the Laguna province, southeast of Manila, both in the evacuation centers and in the flooded communities, and continues to monitor the health situation. More than 1,500 consultations have been conducted since the beginning of the intervention a month ago.

In collaboration with the Philippine ministry of health, MSF also works on the control and surveillance of cases of diarrhea and leptospirosis—a bacterial infection caused by exposure to water contaminated by animal waste.

MSF has been distributing relief kits with jerry cans, cooking utensils, blankets, soap, and materials for building shelters for an estimated 18,000 families in the affected areas. Water and sanitation activities are also underway with the construction of latrines and distribution of sanitation kits with chlorine and brushes in several evacuation centers.

After an initial intervention in the northern island of Luzon, in Cagayan and Illocos Norte provinces, which were severely hit last month, MSF has been providing assistance to flood victims in Pangasinan, Tarlac, and Benguet where 12,000 hygiene and constructions kits have been distributed. In these areas, MSF has conducted over 2,500 consultations and continues to monitor the health situation in order to control and prevent possible disease outbreaks. MSF has also built temporary latrines in Rosales, Pangasinan and has distributed water purification tablets to over 9,000 households.

Sudan: MSF Responds to Violence and Displacements in Shangil Tobaya, Darfur

Fri, 06 Nov 2009 21:48:00 GMT

Violent clashes over water sources near Shangil Tobaya, a town in North Darfur, Sudan, have caused a number of casualties and the displacement of more than 3,000 people. Since October 20, Doctors Without Borders/Medecins Sans Frontieres (MSF) has provided medical care to 12 wounded people and referred nine to the Al-Fashir Teaching Hospital. All nine patients are in stable condition.

MSF has also distributed relief items to about 3,300 affected people who have sought refuge in the towns of Um Dressaya and Shangil Tobaya. However, additional distributions of relief items is necessary due to new arrivals.

"Some people had to flee with very few belongings and food, and they are scared so MSF has sent a team for immediate assistance," says Christine Buesser, MSF deputy head of mission in Sudan. Basic household items, such as plastic sheeting, blankets, mats, soap, and jerry cans, will help people cope with the situation while additional needs are being addressed by other organizations in the area.

To follow up on the displaced people’s general health and to conduct rapid nutritional screenings on children, MSF has also sent a team of medical personnel and community health workers. The children will be included in the on-going polio vaccination campaign, which is sponsored by the Sudanese ministry of health and supported by MSF.

MSF is also liaising with other aid organizations to provide assistance where smaller groups of displaced people have fled.

[Slideshow] Indonesia: One Month After the Earthquake

Fri, 06 Nov 2009 21:48:00 GMT

[Video] Southern Asia and the South Pacific

Fri, 06 Nov 2009 21:48:00 GMT

[Video] Iraq: MSF Authorized to Continue Its Activities

Fri, 06 Nov 2009 21:48:00 GMT

[Video] Papua New Guinea: Cholera Epidemic

Fri, 06 Nov 2009 21:48:00 GMT

[Video] Central African Republic: Nutritional Emergency in the Southwest

Fri, 06 Nov 2009 21:48:00 GMT

[Video] DRC: Violence Continues Against Civilians

Fri, 06 Nov 2009 21:48:00 GMT

[Voice from the Field] Indonesia: "Most of the people are still afraid of another earthquake"

Fri, 06 Nov 2009 21:48:00 GMT

Indonesia 2009 © Alan Cheung / MSF

Daisy Plana, a Philippine mental health officer working for MSF, is providing mental health care in the rural areas surrounding the city of Pariaman.

Slideshow

Indonesia: One Month After the Earthquake

Patient stories

Millions were affected by the earthquake that hit Sumatra on September 30 as massive landslides burried entire villages. Here is some of the stories told by MSF patients:

“I was very upset, because I lost everything, my house and my family members.”

- Zaidir, 37, was living in Kampung Panas, a village close to Pariaman, when a landslide caused by the earthquake killed seven of his family members. He does not want to go back to his village again.

“I was praying in my home alone. When the earthquake happened, I ran out and a coconut tree fell on me and I was buried under the soil. I could only feel pain in my leg. I prayed all night.

My mother cries every day. Once I see her crying, I also cry. I want to resume my normal life and work again with my mother and family.”

- Ismael, 23, was living in Lubuk Laweh village near Pariaman with four family members, when a landslide destroyed his village.

“I was sleeping in my house. When the earthquake happened, I ran outside and I was under the soil in 10 seconds.

I heard many people calling for help, but after a while, it fell silent and I knew that I was the only one alive."

- Dedi Hendra, 18, from Lubuk Laweh village near Pariaman, was trapped under a landslide but managed to dig his way out.

“I can sleep at night, but I still feel sad. I do not tell other people but keep it in my heart. At first I was afraid to go back into the house, because I worried that another earthquake would come. But my parents told me not to be afraid, so I went with my father.”

- Alvin, 10, lived with his family in Bari village near Padang. His family lost their house in the earthquake but Alvin and his brother helped their father rebuild it.

Daisy Plana, a Philippine psychologist working for Doctors Without Borders/Médecins Sans Frontières (MSF), has been providing mental health support to victims of the violent earthquake that hit Sumatra, Indonesia, on September 30, 2009, in the rural areas around the coastal city of Pariaman.

What is the extend of the need for mental health support in the villages?

There is a huge need. The people are still frightened and find it difficult to sleep. Some, who have lost members of their family are getting better, but they still have difficulties living from day to day.

Because most of the people are still afraid of another earthquake, the most important issue we are dealing with is helping them prepare for another emergency.

Not many of the villages that I visit are affected by the landslides, so there are only some specific areas where we need to focus on providing deeper psychological support. We are trying to reach these villages to help the people to stabilize and show them how to handle stress.

What kind of activities is MSF providing?

We are helping both adults and children prepare for earthquakes and other natural disasters. We are also giving educational mental health sessions on how to handle different stressors. We help them stabilize by showing them that all the psychological reactions they have experienced are normal. If they feel that they need more psychological support, we offer further group or individual counseling.

"Their culture makes it very difficult for people to talk about their feelings and what they are thinking."

—Daisy Plana, MSF mental health officer

If we have time, we organize playing and sporting sessions with the community as a form of therapy and release. We are donating sports equipment to help motivate people to return to the activities that they used to do before the earthquake. We are getting the children to sing, draw and play with other children again.

What challenges do you face when providing mental health support?

The first is language. In most of the villages where we are working, people speak Bahasa Indonesia which is the language our field workers speak. But in villages, where people only speak Bahasa Minangkabau, we need interpreters and if a lot of people, say 100, join our sessions we find it difficult to deal with everybody, especially the elderly.

Also, when we translate—sentence by sentence—people become bored and leave the activity one by one. So, it is better if we have someone who can speak Bahasa Minangkabau.

The second challenge is culture. We need time to build up trust with people because it seems that mental health and psychological support is very new to the villagers. Community leaders are reluctant to have mental health assistance in their communities so we spend more time with the people talking to them and implementing big group activities to help them understand how important mental health is and why we need to support them.

Their culture makes it very difficult for people to talk about their feelings and what they are thinking. Sometimes, in the middle of an individual consultation, they will run away from the counselor because they are unwilling to speak their mind.

Indonesia: One Month After Earthquake, Focus is on Mental Health

Fri, 06 Nov 2009 21:48:00 GMT

Indonesia 2009 © Alan Cheung /MSF

Nearly one month after the earthquake, MSF is focusing on providing mental health training and conducting epidemiological surveillance of communicable diseases, including measles and tetanus, in villages near Padang and Pariaman.

Slideshow

Indonesia: One Month After the Earthquake

On September 30, a massive earthquake hit the Indonesian island of Sumatra, causing widespread destruction and triggering landslides that wiped out entire villages. According to the United Nations, an estimated 2.5 million people have been affected by the 7.6 magnitude quake, which killed 1,117 people in addition to injuring 1,214. One month later, Doctors Without Borders/Médecins Sans Frontières (MSF) is still operating mobile clinics, giving mental health support to the survivors, monitoring epidemics, distributing relief items, as well as providing water and sanitation support.

MSF is focusing on the most affected areas—the villages near Padang and Pariaman, both located on the west coast of Sumatra. A major part of MSF’s reconstruction effort is to provide mental health support to people traumatized by the earthquake. Currently group and individual consultations are carried out for both adults and children. MSF is running therapeutic community activities aimed specifically at children, such as playing sports, and is also providing training to mental health officers from the Indonesian Ministry of Health.

"I worried a lot and had difficulty sleeping during the first two weeks after the earthquake, but I am getting better after a psychological consultation with MSF," says Novaldi, 29, from Lubuk Laweh near Pariaman. He lost six family members in the earthquake.

Besides the mental health activities, MSF continues to provide medical consultations from mobile clinics in the area around Pariaman where people have received little assistance. A few villages are still cut off by landslides and MSF can only reach them by walking or by using motor bikes. More than 1,000 consultations have been carried out by MSF in the area since the earthquake struck.

"In an emergency, we need to be flexible and re-adapt our strategy to focus on the needs of population"

—Elisabetta Maria Faga, MSF Emergency Coordinator in Padang

On the positive side, MSF has been able to close the mobile clinic in Painan, further near Padang, because the medical needs related to the earthquake have been covered. "In an emergency, we need to be flexible and re-adapt our strategy to focus on the needs of population," says Elisabetta Maria Faga, MSF Emergency Coordinator in Padang. At the moment, MSF has sent several teams to villages near Padang and Pariaman to follow the vaccination programs that are being conducted by the local health authority and supported by the World Health Organization. The MSF teams will be assessing whether there is any need to have MSF’s support. MSF is also focusing on epidemiological surveillance and closely monitoring the number of communicable diseases, including measles and tetanus.

"Although the response of the government is high, the needs of the population are still huge," says Loreto Barcelo, MSF Emergency Coordinator in Pariaman. MSF teams plan to have distributed relief items—tarpaulins, blankets, mats, hygiene kits, kitchen kits and tool kits—to 16,000 families in villages close to Padang and to 10,000 families in villages near Pariaman by mid-November.

MSF has provided water and sanitation support to the villages near Pariaman, and set up a camp with waterproof shelter for 90 families in the village of Kampung Panas, where there was a landslide.

MSF has more than 70 international and national staff working in Padang and Pariaman. The teams include doctors, nurses, psychologists, water and sanitation specialists and logisticians.

[Podcast] MSF Frontline Reports

Fri, 06 Nov 2009 21:48:00 GMT

This month we bring you a story about malnutrition in a land rich for cultivation: in the Democratic Republic of Congo, many children suffer from severe malnutrition even though food is abundant where they live. And in Uganda, a community-based movement of HIV-positive patients helps MSF provide care. Plus, this month's Emergency Updates.

[Video] HIV-TB: A Double Epidemic in Southern Africa

Fri, 06 Nov 2009 21:48:00 GMT

[Voice from the Field] Patient Story: �This painful treatment is my only way out of drug-resistant TB�

Fri, 06 Nov 2009 21:48:00 GMT

Nonkululeko Mamba

Nonkululeko Mamba, 25, sits listening quietly to one of the speakers attending the International Consultative Workshop convened by Doctors Without Borders/Médecins Sans Frontières (MSF) and the Ministry of Health of Swaziland. She sits among the group of international health experts who have come to discuss the situation she and hundreds of thousands of people find themselves in. Her friend approachs me and says that Nonkululeko wants to share her story. When I scan the crowd to find her, I see this stunning woman in a bright yellow top and neat black skirt. Who would ever think that she could be HIV-positive and have drug-resistant tuberculosis (TB)?
This is Nonkululeko’s story.

“I help patients waiting for their treatment for HIV and TB. I don’t want them to suffer the way I did,” she says, explaining her job at the Hlatikulu hospital run by MSF and the ministry of health.

Nonkululeko, speaking in a soft voice and with surprising shyness, journeys to the Hlatikulu hospital, a 30-minute drive from her home, to help other patients by teaching them about the importance of taking their drugs, and offering counselling and encouragement. She enjoys her new role because she can support people who feel alone and motivate them to fight their TB.

“I understand what other patients are going through because, after all, I am also a patient. I take a minimum of 15 pills each day just to fight against drug-resistant TB. These drugs are of different sizes. Some are the size of wheat grains or even bigger than that, the size of a big bean. It is difficult, but I don’t have a choice because I want to live a normal life. After three years, I finally got used to taking a lot of drugs. But it would be better if all the drugs could be combined into one. It would be easier and less burdensome. In the first phase of my treatment, I had to walk to the clinic every day for eight months to get an injection. When I was very weak, I used to take a mini-bus.”

Nonkululeko tested positive for HIV in 2006. After two months, she started coughing and developed an incessant fever. She went to the nearest hospital which was in the capital city, Mbabane, in order to get tested. The results showed she also had TB.

“My world shattered. I cried and cried, until my eyes had no more tears to shed. I am shy. I didn’t have any friends. I was so weak. I just waited for my mother to serve my food. I couldn’t do anything. I asked God why he had let this happen,” she says.

After six months of treatment, her doctor informed her that her treatment was failing to fight the disease. “ ‘You are resistant to the drugs,’ the doctor told me. I asked what it meant, but she didn’t explain anything. I didn’t know what was happening. They referred me to Hlatikulu hospital in the Shiselweni region. There, they explained to me that drug-resistant TB is more expensive to treat than the ordinary one. It also means taking more drugs, treatment lasting minimum of two years, and painful injections too.”

The side effects for drug-resistant TB treatment can be very severe. “My feet are painful most of the time. It is difficult to walk. I always have a fever. And every morning when I take all these drugs I feel so sick. It is too much. But do I have an option? I want to live a positive life and this is my way out.”

Today, Nonkululeko has managed to become a strong and confident woman. She mingles easily with others, and she is happy. She still faces stigma from others who recoil from her or whisper about her as she passes them on her way home. But she has learned to cope. She has many friends now. “When I am in the clinic, I feel that everybody needs me. My co-patients need me. They all come to me and they feel sad when I am not around. Helping others who are also like me brings me the greatest of happiness.”

Swaziland: An MSF Doctors Explains HIV-TB Co-Infection

Fri, 06 Nov 2009 21:48:00 GMT

MSF medical staff examines a patient at an HIV- TB treatment center in Shiselweni region.

Doctors Without Borders/Médecins Sans Frontières (MSF) doctor Hermann Reuter works in a tuberculosis (TB) project in a rural district of Swaziland called Shiselweni. MSF is present in 17 clinics and three health centers here and Dr. Reuter rotates between the health centers, where most of TB patients are managed. Here, he explains the situation on the ground.

What do you see at the health centers?

On a daily basis, nurses manage the TB patients and refer the most severely ill to me. The cases I see are usually infected with multi-drug resistant TB, which means they would have already been treated with standard TB drugs without success. Other patients I treat have HIV/AIDS-related complications.

What are the main obstacles facing people with TB or HIV/AIDS here?

As Shiselweni is a rural district, distance is always a huge problem. Patients live on farms away from towns, many of them have to travel for hours to get to a health facility and they can spend their whole monthly earning on just one trip. This is unsustainable for them.

A patient needs multiple visits just to be diagnosed, and then they undertake a treatment regimen of 6 to 8 months for drug-sensitive TB or up to two years treatment for drug-resistant TB. MSF's strategy, which is to provide decentralized care, is not rocket science. It is based on what many other countries do to manage TB and HIV. We focus on providing treatment and follow-up in local health clinics, as close as possible to the patient's home.

In addition to the challenge of treating patients in a rural community, there is also a significant shortage of doctors. At the moment in this country the HIV/AIDS protocol demands that a doctor initiates patients on antiretroviral (ARV) treatment. MSF believes that the initiation of treatment could easily be managed by an appropriately trained nurse.

We need to work with the authorities to try and adopt a protocol that allows nurses to start ART for HIV positive patients.

How have HIV/AIDS and TB combined into what is being called a dual epidemic here?

About 83 percent of TB patients in Swaziland are co-infected with HIV. The country has the highest level of HIV infection in the world, affecting one out of four adults. This complicates the clinical picture of TB—diagnosis becomes more difficult and there are more severe side effects to the drugs.

Why is MSF calling for an emergency response to this crisis?

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.

One out of four sexually active adults has HIV/AIDS and life expectancy has fallen to 32 years of age. Currently, 18 percent of people infected with TB will die in this country. This is an extremely high figure.

Most of the patients die in the first two months, because they are also infected with HIV and were not put on ARV treatment fast enough or because they are infected with drug-resistant TB and were not diagnosed early enough.

[Special Report] HIV-TB in Swaziland: A Deadly Co-Infection Epidemic

Fri, 06 Nov 2009 21:48:00 GMT

An MSF medical staff looks at a patient's X-ray at a HIV-TB treatment center in Shiselweni region.

The small kingdom of Swaziland in Southern Africa is on the brink of a major health crisis due to the killer twin epidemic of HIV-AIDS and tuberculosis (TB). Swaziland has one of the highest AIDS death rates in the world today; HIV-TB co-infection is decimating the population.

One in four sexually active adults in Swaziland has HIV-AIDS and an enormous 80 percent of the tens of thousands of people who have TB are also infected with HIV. Each year there are roughly 14,000 new TB cases diagnosed among this small population of just over 1.1 million people.

This double epidemic of HIV/AIDS and TB means that life expectancy has fallen to under 32 years, and Swaziland’s already fragile health system is struggling to cope with this public health crisis.

In a country where 80 percent of the population live in impoverished rural areas, where settlements are a long way from the main communication and road networks, getting healthcare services to families is extremely difficult. Add to this the fact that Swaziland has very few doctors and no medical school to train doctors, and the situation looks even more dire.

Doctors Without Borders/Médecins Sans Frontières (MSF) has been working in Swaziland since November 2007. MSF is treating those suffering from TB, with a particular emphasis on the deadly drug-resistant and extensively drug-resistant TB that has begun to spread.

Prompted by the growing epidemic MSF decided to organize with the Swaziland Ministry of Health an international consultative workshop from October 28 to 30, 2009, to discuss the problem of HIV-TB co-infection in Southern Africa.

The main objective of the workshop is to discuss innovative ways to provide appropriate treatment and support for patients infected with HIV and TB. Given the lack of healthcare professionals in the region, the workshop participants will seek ways to establish a health system that will provide care to patients at a community level.

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What do you see at the health centers?

What are the main obstacles facing people with TB or HIV/AIDS here?

How have HIV/AIDS and TB combined into what is being called a dual epidemic here?

Why is MSF calling for an emergency response to this crisis?

[Special Report] HIV-TB in Swaziland: A Deadly Co-Infection Epidemic

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