Doctors Without Borders Slideshows

[Slideshow] India: Treating Kala Azar�a Complex and Deadly Disease

Wed, 09 Nov 2011 23:00:00 GMT

Bihar State, in northeastern India, is a major epicenter of the parasitic disease visceral leishmaniasis—also known as kala azar. Doctors Without Borders/Médecins Sans Frontières (MSF) works in Bihar’s Vaishali district to treat this complicated and deadly disease.

Photos by Anna Surinyach/MSF

India 2011 © Anna Surinyach/MSF

Bihar State is one of the poorest and least developed areas of India. Agriculture is the main economic engine, but most people don't own land and must work long hours for little money.

India 2011 © Anna Surinyach/MSF

Bihar is an epicenter for kala azar - a parasitic disease that is nearly always fatal when left untreated.

India 2011 © Anna Surinyach/MSF

MSF opened a kala azar project in Vaishali district, in central Bihar, in July 2007. Hajipur, the district capital, where the project is based, has a population of about 700,000. Over four years, around 8,000 people have been successfully treated.

India 2011 © Anna Surinyach/MSF

MSF runs the the kala azar diagnostic and treatment unit on the second floor of Sadar Hospital, the district's main referral facility. At any given time, most of the unit's 40 beds are occupied.

India 2011 © Anna Surinyach/MSF

This 27-year-old patient, a woman named Baby, had a fever for several weeks. When she came to Sadar Hospital, she was referred to the second floor for a rapid kala azar diagnostic test.

India 2011 © Anna Surinyach/MSF

Symptoms of kala azar include fever, loss of appetite, enlarged spleen and liver, and anemia. Infection occurs when the kala azar parasite is transmitted through the bite of a sand fly. Symptoms usually appear around two weeks after the bite.

India 2011 © Anna Surinyach/MSF

The rapid test known as rK39 shows within 15 minutes whether or not the patient has been infected. Doctors use the test results and clinical symptoms to diagnose the patient.

India 2011 © Anna Surinyach/MSF

Taking symptoms into account is important because the rapid test can sometimes show a false negative. This is particularly common in HIV patients who have also contracted kala azar. In such cases, doctors must remove and examine fluid from the spleen and examine in order to confirm whether or not the patient has kala azar.

India 2011 © Anna Surinyach/MSF

Most people affected by the disease are poor, and there is not much research being done to find more effective and simple diagnostic methods and treatment.

India 2011 © Anna Surinyach/MSF

Complicated kala azar cases are treated at the hospital, including patients suffering from severe anemia, HIV, and severe acute malnutrition, as well as pregnant women, infants, and the elderly. Simple cases are treated on an outpatient basis. Patients receive four intravenous doses of the drug liposomal amphotericin B (LAmB).

India 2011 © Anna Surinyach/MSF

Previously, kala azar patients were given the drug SSG, which required a long and toxic treatment. Many people in India and Bangladesh developed resistance to SSG. The current drug used to treat the disease is effective, requires a short course of treatment, and has fewer side effects. The initial cure rate at MSF's project in Sadar Hospital is 98 percent.

India 2011 © Anna Surinyach/MSF

After 50-year-old Kamli Devi received her second course of treatment, she began to walk again. Devi is treated as an outpatient at one of the five health centers MSF supports in the district.

India 2011 © Anna Surinyach/MSF

A 30-year-old patient receives treatment for post-kala azar dermal leishmanisasis (PKDL), an infection some patients contract after being treated for kala azar, mainly in India and Bangladesh. Although PKDL is relatively painless, it is a reservoir for the kala azar parasite and it must be treated to prevent the disease from spreading.

India 2011 © Anna Surinyach/MSF

PKDL patients can develop skin lesions that can have an impact on their quality of life. Patients must be admitted to the hospital and are given three courses of treatment over 20 days.

India 2011 © Anna Surinyach/MSF

When kala azar patients also have HIV, the two diseases form a vicious circle that is difficult to break. HIV-positive patients have fewer defenses to fight the kala azar parasite, so treatment failure is more common. At the same time, kala azar further weakens the defenses of HIV patients, increasing their risk of contracting opportunistic infections.

India 2011 © Anna Surinyach/MSF

Mukesh, 18, smiled when the doctor told him he would be discharged tomorrow. “If someone I know has kala azar in the future," he said, "I will advise him to come and get treatment at Sadar Hospital. It is the best treatment one can find and totally free of charge.” Mukesh said he plans to rest for a few weeks and then return to Delhi to work as he used to before he became sick.

[Slideshow] My Life with HIV: Siama Musine

Wed, 09 Nov 2011 23:00:00 GMT

Siama Musine lives and works in the Nairobi slum of Kibera. She is living with HIV and has been on antiretrovirals (ARVs) for six years. In 2005, MSF gave her and five other Kenyan HIV patients disposable cameras so they could document their lives. The resulting photo project, “My Life with HIV,” can be seen on doctorswithoutborders.org.

This past June, MSF checked back with Musine and the others to see how they’ve proven it possible to live an active life, with HIV, once treatment has been initiated.

Photos by Sven Torfinn

Kenya 2011 © Sven Torfinn

“People really want to know exactly how I’m living, what I’m doing. I’m a community role model. It has made me to be more proactive and to be more assertive on how I am expressing myself. It has really changed me.”

Kenya 2011 © Sven Torfinn

Siama Musine holds a photo taken before she began ARV treatment. “Sometimes if I talk to people about my status, and they look at me, they are just like, ‘Siama, you are lying to us. You look very healthy. You just look very beautiful."

Kenya 2011 © Sven Torfinn

She plans to soon move to a place she has built outside Nairobi, where she will keep goats. “When I was ill … my mother, she really didn’t want me to be part of the family. But nowadays we work together.”

Kenya 2011 © Sven Torfinn

Currently, she works as a health promotion assistant in a medical facility, providing support to people who text positive for HIV. "I remember when I was tested, the counselor who was there just told me to prepare myself for death. At that time, there was no education."

Kenya 2011 © Sven Torfinn

When she can, Musine goes swimming to build strength and be with other people.

[Slideshow] Mogadishu: Displaced People At Risk

Wed, 09 Nov 2011 23:00:00 GMT

Huge numbers of Somalis have left the country’s central regions to seek refuge in the capital, Mogadishu, since July. They have had to leave due to poor agricultural production, loss of livestock because of drought, increasing prices, and perpetual insecurity. Once they reach Mogadishu, however, they are vulnerable to a host of health problems.

Photos by Yann Libessart/MSF

Somalia 2011 © Yann Libessart/MSF

Somalia’s capital, Mogadishu, is filled with waste. The country has suffered 20 years of civil war with no real central administration, including waste management.#

Somalia 2011 © Yann Libessart/MSF

The water sold from donkey carts in Mogadishu’s streets is often unsafe and brackish; but there is no functioning water system in the city.#

Somalia 2011 © Yann Libessart/MSF

More than 150,000 newly displaced people arrived in Mogadishu from drought-affected central regions of Somalia between July and October 2011. Most of them settled in makeshift camps such Rajo camp, located on a city beach.#

Somalia 2011 © Yann Libessart/MSF

The lack of hygiene in the camps leaves people highly vulnerable to infectious diseases such as cholera, measles, and pneumonia. #

Somalia 2011 © Yann Libessart/MSF

Finding food and water is a daily challenge for displaced people. #

Somalia 2011 © Yann Libessart/MSF

Regular food distributions are conducted by local and international non-governmental organizations. #

Somalia 2011 © Yann Libessart/MSF

MSF distributes ready-to-use therapeutic food (RUTF) to families with young children every week to prevent malnutrition.#

Somalia 2011 © Yann Libessart/MSF

MSF staff screen a child for malnutrition in one of the health posts the organization runs in the makeshift camps.#

Somalia 2011 © Yann Libessart/MSF

A sick child is treated in one of four MSF intensive therapeutic feeding centers (ITFCs) in Mogadishu. Children are kept in the ITFCs when they have health complications in addition to severe malnutrition, which can put them at risk of dying.#

Somalia 2011 © Yann Libessart/MSF

Mothers are also given food in the ITFCs. Proper nutrition increases their ability to breastfeed. #

Somalia 2011 © Yann Libessart/MSF

Newly displaced people often suffer from high levels of exhaustion and dehydration.#

Somalia 2011 © Yann Libessart/MSF

Displaced children in Somalia have rarely been immunized against measles. The health system there has deteriorated for decades. Outbreaks of the disease are frequent and deadly.#

Somalia 2011 © Yann Libessart/MSF

There are few international staff working inside Mogadishu due to security threats. MSF relies largely on its Somali staff.#

Somalia 2011 © Yann Libessart/MSF

After several interruptions in medical activities due to security incidents, MSF made a rare exception to its rule of having no armed protection, and in July 1991 began hiring private armed guards. #

Somalia 2011 © Yann Libessart/MSF

Somali staff compose 95 percent of MSF teams in the country.#

Somalia 2011 © Yann Libessart/MSF

Staff collect testimonies from displaced patients to better understand the humanitarian situation in the areas where they come from and that MSF cannot access. #

[Slideshow] Galcayo: A Town Divided, A Population Trying to Endure

Wed, 09 Nov 2011 23:00:00 GMT

Photographer Sven Torfinn recently visited MSF facilities in the town of Galcayo, in south-central Somalia, where MSF is working in hospitals on both sides of a divided town—which is to say in both Galcayo North and Galcayo South, areas separated by a shifting but constant frontline. The local population suffers from a now familiar litany of afflictions, including conflict, drought, malnutrition, and a severe lack of health care services, all of which are exacerbated and enabled by armed groups that have been battling each other for years. Below are images of a town divided, and a people trying to endure.

Somalia 2011 © Sven Torfinn

The people of Galcayo, in south-central Somalia, have endured war for many years. The town is now divided by a "green line," with warring factions on either side. #

Somalia 2011 © Sven Torfinn

Twenty years of violence have destroyed basic state services and the health care system. Malnutrition, which has afflicted people in the region for a long time, has worsened significantly in the past 12 months. Doctors Without Borders/Médecins Sans Frontières (MSF) is the only provider of free health care services for hundreds of kilometers. #

Somalia 2011 © Sven Torfinn

MSF works in the outpatient department and in a recently-opened pediatric inpatient department at Galcayo North's hospital and provides an extensive package of health care services, including surgery, in Galcayo South. Here, women stand in front of an MSF's therapeutic feeding center. Women and children are particularly vulnerable in Galcayo; one in 12 women dies during childbirth, and one in seven children dies before his or her first birthday. #

Somalia 2011 © Sven Torfinn

Malnourished children who have other medical complications and are at risk of death are admitted into the inpatient therapeutic feeding center. #

Somalia 2011 © Sven Torfinn

Nurses check the weight and height of each child. Those who are stable are treated as outpatients in the ambulatory therapeutic feeding program. #

Somalia 2011 © Sven Torfinn

Hibo Osman, center, sits outside the tents of the MSF therapeutic feeding center, holding her daughter, Asho, who is malnourished and has diarrhea. When Hibo was pregnant with Asho her husband was shot in a firefight. She earns money by selling second-hand clothes in the market. #

Somalia 2011 © Sven Torfinn

Inside the feeding center, MSF nurses insert an IV line into a severely malnourished child. MSF Head of Mission Karin Fischer assists. #

Somalia 2011 © Sven Torfinn

A nurse makes his rounds in the feeding center. A team of 144 Somali staff work in MSF’s hospital in Galcayo South, providing a comprehensive range of services. #

Somalia 2011 © Sven Torfinn

Women wait in front of hospital's pharmacy. #

Somalia 2011 © Sven Torfinn

A 19-year-old man is brought to the MSF hospital in Galcayo two days after he was shot during a clash. The surgeon located the bullet in the man's abdomen using an X-ray and spent many hours finding and closing small holes in the intestines. #

Somalia 2011 © Sven Torfinn

The next day, the injured man's operation seemed to be successful. #

Somalia 2011 © Sven Torfinn

A family member of the man who was shot asked to receive the bullet. #

Somalia 2011 © Sven Torfinn

Habiba Dahir Muse sits outside the MSF hospital in Galcayo with her sons Shafeer, left, and Abdikayr. Muse has already lost two daughters. Her nomadic community in Galgaduud, about 99 miles away, collected money for her to bring her surviving children to Galcayo for treatment. #

Somalia 2011 © Sven Torfinn

Six-year-old Yurub was suffering from measles and then became malnourished. MSF treated her for both and she is now recovering. #

[Slideshow] Dadaab, Kenya: Somalis Fighting For Survival

Wed, 09 Nov 2011 23:00:00 GMT

Somali refugees continue to arrive at the overcrowded camp complex in Dadaab, northeastern Kenya, every day. They are fleeing the violent conflict in Somalia and the devastating effects of ongoing drought and lack of food. The third week of July alone brought 5,117 new refugees, pushing the total number of people in and around the Dadaab camp to 387,893. The three camp sites—Ifo, Hagadera and Dagahaley—were originally built to hold a combined 90,000 people.

Most of the new arrivals must remain on the outskirts of the overcrowded camp, where they are not receiving adequate assistance and must contend with delays in registration and access to food, water, and shelter. Doctors Without Borders/Médecins Sans Frontières (MSF) is responding to medical needs, including treatment of around 10,000 malnourished people in and around the Dadaab camp.

All photos by Brendan Bannon.

Kenya 2011 © Brendan Bannon

Somali refugees who have fled drought and violence and come to an overcrowded refugee camp in Dadaab, Kenya, carry their sick and malnourished children to an MSF feeding center on the outskirts of one of the camps. There were around 10,000 people enrolled in MSF's feeding program in Dadaab as of July 21. #

Kenya 2011 © Brendan Bannon

Refugees wait at the reception center in Dagahaley, one of three sites in the Dadaab refugee camp complex in northern Kenya. Currently, it takes two months for new arrivals at the camp to be registered, which means delays in receiving direly needed food rations. #

Kenya 2011 © Brendan Bannon

A refugee uses twigs and scraps of material to build a shelter for her family. There is no room for most new arrivals in the Dadaab camps, so the thousands of people who arrive every week must carve out a place for themselves in the surrounding desert. MSF estimates that by the end of 2011, there will be 500,000 people living in and around the camps, which were originally built to accommodate 90,000. #

Kenya 2011 © Brendan Bannon

Somali refugees wait to be officially registered and to receive a ration card for food. Since it can be two months before they get their first food ration, many refugees already settled in the camp share their food with new arrivals. #

Kenya 2011 © Brendan Bannon

Dr. Luana Lima works with patients at the MSF hospital in Dagahaley. MSF staff are seeing high numbers of malnourished children, especially those living on the outskirts of the camp. #

Kenya 2011 © Brendan Bannon

This mother of six traveled by foot from Somalia to Dadaab. Her youngest child is malnourished and is being treated at MSF’s hospital in Dagahaley. MSF medical staff are seeing not only children who have arrived at the camp malnourished, but also those who have become malnourished while staying at the camp. #

Kenya 2011 © Brendan Bannon

A malnourished child rests with her mother at MSF’s hospital in Dagahaley. The tens of thousands of Somali refugees who have come to the overcrowded camp are fleeing the ongoing violence in their country and an ongoing, devastating drought that has made food scarce and too expensive. Many people, especially children, arrive malnourished. #

Kenya 2011 © Brendan Bannon

This little boy’s arm was broken by a bullet when he was caught in an exchange of gunfire in Somalia. Before his family fled to Kenya, he was treated by doctors in MSF’s hospital in Marere, in Somalia’s Lower Juba region—the only hospital in the area. #

Kenya 2011 © Brendan Bannon

An MSF doctor examines the mother of a malnourished child in MSF’s therapeutic feeding center at the Dadaab refugee camp complex. MSF is currently treating more than 2,400 acutely malnourished children in its outpatient therapeutic feeding program, 130 who are at risk of death in its inpatient therapeutic feeding center, and 5,047 moderately malnourished in its supplementary feeding program. #

Kenya 2011 © Brendan Bannon

Young Somali refugees wait to receive vaccinations from MSF health workers. #

Kenya 2011 © Brendan Bannon

A severely malnourished child is fed through his nose at MSF’s hospital in the Dagahaley camp in Dadaab. When MSF conducted a nutrition screening on the outskirts of one of the camps, staff found that 37.7 percent of children between six months and five years old were suffering from acute malnutrition; 43.3 percent of children between five and 10 years old were malnourished. #

Kenya 2011 © Brendan Bannon

An MSF ambulance arrives at the reception center at Dadaab to pick up patients in urgent need of medical attention. Many Somali refugees, especially children, arrive at the camp dangerously malnourished; some do not survive the journey. #

Kenya 2011 © Brendan Bannon

Men dig a grave for a 35-year-old mother of five from Somalia. She had arrived at Dadaab camp in Kenya two months earlier, after a 290-km [180-mile] journey from Sakow district, southern Somalia. Her children all survived. #

Kenya 2011 © Brendan Bannon

Fresh graves in Dagahaley, part of Dadaab refugee camp. Many people arrive at the camp malnourished and weak after a perilous journey out of drought and conflict; some do not survive. #

Kenya 2011 © Brendan Bannon

A mother and child have taken shelter on the outskirts of the Dadaab camps. #

Kenya 2011 © Brendan Bannon

A young Somali refugee stands outside her family’s shelter made of twigs and whatever material they can find on the edge of the official Dadaab camp. Being located outside of the camp makes it more difficult to access food and adequate clean water. #

Kenya 2011 © Brendan Bannon

A crowd of recently arrived Somali refugees wait at the official reception center in the Dadaab refugee camp. While thousands of people come to Dadaab every week from Somalia due to the food crisis, still others flee into Somalia’s capital, Mogadishu, and into Ethiopia in search of assistance. #

Kenya 2011 © Brendan Bannon

A bone-thin cow passes by a shelter in the Dadaab refugee camp. The drought has killed off many people’s livestock in the Horn of Africa, leaving them with no source of food and no wealth. #

Kenya 2011 © Brendan Bannon

Somali refugees take shelter on the outskirts of the Dadaab camp. Thousands more arrive every week and must settle at the edge of the official camp, where they are not receiving adequate assistance and are being forced to contend with delays in registration and access to food, water, and shelter. #

[Slideshow] DRC: Trying To Contain A Cholera Epidemic

Wed, 09 Nov 2011 23:00:00 GMT

A cholera epidemic is rapidly spreading along the Congo River in western Democratic Republic of Congo. The disease is affecting towns and villages along the waterway, which is the population's main mode of transportation. More than 250 people had died as a result of the disease by July 21, and the epidemic is expected to soon reach the country's crowded capital, Kinshasa.

Doctors Without Borders/Médecins Sans Frontières (MSF) emergency medical teams are running a free cholera treatment center (CTC) in the city of Mbandaka that has been receiving around 20 new patients a day.

Photos by Robin Meldrum/MSF

DRC 2011 © Robin Meldrum/MSF

Mbandaka, the capital of Equateur Province, is a major port city on the Congo River; its population has been hit by a regional cholera epidemic. #

DRC 2011 © Robin Meldrum/MSF

A team of MSF emergency logisticians set up a cholera treatment center (CTC) in Mbandaka in just 48 hours.#

DRC 2011 © Robin Meldrum/MSF

As cholera is extremely infectious, the CTC is enclosed by a high fence made of plastic sheeting. There are slits at regular intervals in the sheets to allow wind to pass through and passers-by to look in.#

DRC 2011 © Robin Meldrum/MSF

Infection control is essential in the CTC. Regularly washing hands and spraying feet with a chlorine solution helps to prevent the spread of the disease. #

DRC 2011 © Robin Meldrum/MSF

Jonathan Mbosenge, 10, was brought to the the MSF CTC by his mother because he had the main symptoms of the disease—profuse diarrhea and vomiting. #

DRC 2011 © Robin Meldrum/MSF

Mbosenge was in a state of severe dehydration with the weak pulse and sunken eyes typical of a seriously ill cholera patient. MSF staff gave him an intravenous drip of Ringers lactate solution that rehydrated him and helped rebalance the essential electrolytes in his body.#

DRC 2011 © Robin Meldrum/MSF

Twenty-four hours later, Mbosenge had regained much of his strength and was alert. He was still ill, but his mother was much less worried. #

DRC 2011 © Robin Meldrum/MSF

Seven-year-old Eliezer Wetchi was brought by his father to MSF’s CTC. “We spent all night traveling down the Congo River to get here,” Wetchi’s father said. “I had no choice. My youngest son Eliezer was going out like a candle.”#

DRC 2011 © Robin Meldrum/MSF

“Late in the evening I held Eliezer in my arms and and we got a place on the last boat to Mbandaka," his father said. "I watched over him all night—I didn’t dare close my eyes for a second. As soon as we got here they started treating him and now he’s much better—they say he can go home soon.”#

DRC 2011 © Robin Meldrum/MSF

Dieudonne Bokwala is an MSF health promotion specialist. Every day, he goes to cholera-afflicted neighborhoods to spread the word about what cholera is, how to avoid catching it, and what to do if someone shows the symptoms. #

DRC 2011 © Robin Meldrum/MSF

The riverside near the port is a busy area. The river is also believed to be the the main mode of transportation for the epidemic, as people travel from village to town, carrying the disease with them. #

DRC 2011 © Robin Meldrum/MSF

People are generally very interested to hear the messages and learn how to avoid catching cholera. #

DRC 2011 © Robin Meldrum/MSF

Nurse Joel NyimiNyimi is in charge of the CTC’s medical operations. He has come to check on the night shift, which starts at 3 a.m., and to assist staff from the Ministry of Health, who have less experience treating cholera, with potentially difficult cases. #

DRC 2011 © Robin Meldrum/MSF

An extremely dehydrated child has just been admitted, and it is hard to for the medical staff to find a vein and start an IV drip, especially with such little light.#

DRC 2011 © Robin Meldrum/MSF

A staff member uses a flashlight built into his cellphone to help him find a vein.#

DRC 2011 © Robin Meldrum/MSF

Cholera can be deadly if left untreated, but treatment is straightforward if patients seek it early enough. Seven-year-old Ebengo was in the recovery ward with his mother after 24 hours of treatment. ”Ebengo loves playing—he is always trying to sneak away to meet up with his friends,” his mother said. “So when I got back from the market, I was surprised to find him already in bed at 5 p.m.”#

DRC 2011 © Robin Meldrum/MSF

”Just as I approached the bed, he started violently throwing up. His eyes were sunken and he was pale and weak. I got very frightened and I started crying and praying. I started thinking he might die. I had lost control of the situation.

I heard the radio messages about cholera, so I came immediately to the center. I think that if I had waited half a day more at home, my son would now be dead. All it took was a day of treatment and Ebengo is back to himself.” #

[Slideshow] South Sudan: State of Emergency

Wed, 09 Nov 2011 23:00:00 GMT

South Sudan is set to be officially recognized as an independent nation on July 9, 2011. But hundreds of thousands of newly displaced people in the world’s newest country are facing emergency needs.

In May, violence between northern Sudan and South Sudan forces in the contested border region of Abyei pushed some 100,000 people from their homes. Many saw family members killed during heavy bombardments and military ambushes. Some people, terrified of the violence, traveled as far as 10 days from home seeking safety.

Photos by Gaël Turine/VU.