Dispatches (Summer 2005)

DispatchesM S F C A N A D A N E W S L E T T E R

Vol.7, Ed.2

IN THIS ISSUE

1

6

8

9

10

13

14

15

1999 Nobel Peace Prize Laureate

Northern Uganda:A struggle with disease and insecurity

Children of Somalia

Patient power inZambia

The dream of accessto medicines for all

Chagas disease

New drug simplifiesmalaria treatment

Goodbye and thank you

Confronting humanityin Angola

When I got the call from the MSF officetelling me that I would be going to

Uganda for my first mission, I had to search tofind information about this country and theissues I might be facing. This is because thestrife in northern Uganda is one of the top 10most underreported humanitarian stories,receiving very little media coverage.

Though in the eyes of the international commu-nity Uganda has enjoyed relative stability sinceYoweri Kaguta Museveni came to power in

1986, this has not been the case in the war-ravaged north. For 18 years the people ofnorthern Uganda have endured a brutal conflictthat has received minimal attention from theoutside world.

Since 1986, the Lord’s Resistance Army (LRA)has terrorized the region with the declared intentto remove Museveni as president. LRA leaderJoseph Kony wages his campaign only in thenorth, attacking the very civilians he hopes to“liberate” from Museveni’s rule.

NORTHERN UGANDAA struggle with disease and insecurity

MSF PROVIDES CAMPS IN

NORTHERN UGANDA WITH BASIC

MEDICAL CARE, CLEAN DRINKING

WATER, LATRINES AND THERAPEUTIC

FEEDING FOR SEVERELY

MALNOURISHED CHILDREN.

(continued on page 2)

page 3Dispatches Vol.7, Ed.2

Children are particularly vulnerable to rebelattacks and the LRA has abducted tens of thou-sands of children to populate their rebel forces.These children are forced into combat and sex-ual slavery.

Currently, more than 1.6 million people (80 percent of northern Uganda’s population) have beendisplaced by this conflict. They live in internallydisplaced person’s (IDP) camps where the con-ditions are deplorable. These “protected” campswere officially created in 1996 to be a tempo-rary solution to the conflict – a safe haven forthe population to seek refuge while the Ugandanarmy (UPDF) fought the rebels.

Civilians were forced to leave their homes, theirland and their daily lives for these congestedprotected villages that in reality offer little secu-rity, squalid living conditions and insufficientaccess to health care. This so-called temporarymeasure has been the reality for the past nineyears. Access to safe water in the camps is inad-equate and poor sanitation contributes to thespread of disease.

People living in the camps depend on handoutsfrom the World Food Programme to sustainthemselves, as it is unsafe for them to make thejourney to their fields for farming. Those who tryto farm run the risk of attack by the LRA orharassment by the UPDF for being possiblerebel supporters.

Though many humanitarian organizations havemade northern Uganda a priority, help is limiteddue to insecurity in the area. Many agencies onlyoffer support to the most secure camps due tofear of attack. Health stations are present butare often abandoned due to the risk of ambushalong the roads. As a result, death is a realityfrom treatable diseases such as malaria, diar-rhoea, and respiratory infections. Malnutrition isa ubiquitous issue, with the heaviest toll takenon infants and young children.

I arrived in Uganda in October 2004 at theheight of a cholera outbreak in one of the largestIDP camps in the north. MSF had many pro-grammes that required my attention, but initial-ly all I had time for was cholera. We worked non-

U g a n d a

Carrie Bernard (right) spent five months in Gulu, northern Uganda as a volunteer medical doctor for MSF. Her workincluded a night commuter shelter for children, a cholera treatment centre, and remote health centres.

CHILDREN ARE PARTICULARLY

VULNERABLE TO REBEL ATTACKS AND

THE LRA HAS ABDUCTED TENS OF

THOUSANDS OF CHILDREN TO

POPULATE THEIR REBEL FORCES.

THESE CHILDREN ARE FORCED INTO

COMBAT AND SEXUAL SLAVERY.


Children are particularly vulnerable to rebelattacks and the LRA has abducted tens of thou-sands of children to populate their rebel forces.These children are forced into combat and sex-ual slavery.

Currently, more than 1.6 million people (80 percent of northern Uganda’s population) have beendisplaced by this conflict. They live in internallydisplaced person’s (IDP) camps where the con-ditions are deplorable. These “protected” campswere officially created in 1996 to be a tempo-rary solution to the conflict – a safe haven forthe population to seek refuge while the Ugandanarmy (UPDF) fought the rebels.

Civilians were forced to leave their homes, theirland and their daily lives for these congestedprotected villages that in reality offer little secu-rity, squalid living conditions and insufficientaccess to health care. This so-called temporarymeasure has been the reality for the past nineyears. Access to safe water in the camps is inad-equate and poor sanitation contributes to thespread of disease.

People living in the camps depend on handoutsfrom the World Food Programme to sustainthemselves, as it is unsafe for them to make thejourney to their fields for farming. Those who tryto farm run the risk of attack by the LRA orharassment by the UPDF for being possiblerebel supporters.

Though many humanitarian organizations havemade northern Uganda a priority, help is limiteddue to insecurity in the area. Many agencies onlyoffer support to the most secure camps due tofear of attack. Health stations are present butare often abandoned due to the risk of ambushalong the roads. As a result, death is a realityfrom treatable diseases such as malaria, diar-rhoea, and respiratory infections. Malnutrition isa ubiquitous issue, with the heaviest toll takenon infants and young children.

I arrived in Uganda in October 2004 at theheight of a cholera outbreak in one of the largestIDP camps in the north. MSF had many pro-grammes that required my attention, but initial-ly all I had time for was cholera. We worked non-

U g a n d a

Carrie Bernard (right) spent five months in Gulu, northern Uganda as a volunteer medical doctor for MSF. Her workincluded a night commuter shelter for children, a cholera treatment centre, and remote health centres.

CHILDREN ARE PARTICULARLY

VULNERABLE TO REBEL ATTACKS AND

THE LRA HAS ABDUCTED TENS OF

THOUSANDS OF CHILDREN TO

POPULATE THEIR REBEL FORCES.

THESE CHILDREN ARE FORCED INTO

COMBAT AND SEXUAL SLAVERY.


stop for the first three weeks of the outbreak tobuild the cholera treatment centre, recruit, hire,and train national staff, and to begin the educa-tion process of the population regarding prevent-ing the spread of this potentially lethal disease.

I had expected to work hard. I had not expectedthat I would have to negotiate with the militaryto be able to treat my patients. This is the real-ity, however, in a place where people are con-fined to their huts by the army in an attempt tokeep the civilians separate from the rebels.

Our efforts were successful and the cholera out-break was contained. This allowed me to focusmy attention on our primary health centres inthe remote areas of the north. MSF runs healthcentres where the government has been unsuc-cessful in doing so due to the war. Daily we dealtwith cases of severe malaria, malnutrition, anddehydration from diarrhoea.

Though our treatments were often successful,many people died because it was not safe for usto transport them to the hospital. We wereunable to get to our health centres for days at atime due to increasing conflict, leaving nationalstaff stranded and our clinic running low onmedications. I was amazed by the strength andcommitment demonstrated by the national staffwhen faced with such adverse conditions. Theygave me the strength to go on when at times thesituation seemed hopeless.

In the evenings, it was sometimes difficult tomaintain that hope as thousands of childrenstreamed into our night commuter sheltersearching for a safe place to sleep. The childrenfear attack and abduction by the rebels so theywalk up to 10 miles every night in search ofsafety. Though I was proud of our programme(we offered security, shelter, counselling, nurs-ing care and adult supervision) it broke my heartto see up to 4,500 children (some just able towalk) leave their parent’s homes each and everynight to sleep in a crowded tent with strangers.Our shelter was just one of many as an estimat-ed 50,000 children search for protection night-ly in the north.

The needs in northern Uganda are great. Nearthe end of my mission we were beginning toimplement our sexual and gender based violenceprogrammes. Sexual violence is a growing prob-lem and MSF is there to address the need fortreatment, counselling and education. The nightcommuters are not going away, and the peoplein the remote camps are in desperate need ofhealth care. Though peace is what northernUganda needs most, MSF is there for the timebeing to provide critical assistance to the mostvulnerable.

Carrie BernardMedical doctor, Gulu, northern Uganda

CIVILIANS WERE FORCED TO LEAVE

THEIR HOMES, THEIR LAND AND THEIR

DAILY LIVES FOR THESE CONGESTED

PROTECTED VILLAGES THAT IN REALITY

OFFER LITTLE SECURITY, SQUALID

LIVING CONDITIONS AND INSUFFICIENT

ACCESS TO HEALTH CARE.


stop for the first three weeks of the outbreak tobuild the cholera treatment centre, recruit, hire,and train national staff, and to begin the educa-tion process of the population regarding prevent-ing the spread of this potentially lethal disease.

I had expected to work hard. I had not expectedthat I would have to negotiate with the militaryto be able to treat my patients. This is the real-ity, however, in a place where people are con-fined to their huts by the army in an attempt tokeep the civilians separate from the rebels.

Our efforts were successful and the cholera out-break was contained. This allowed me to focusmy attention on our primary health centres inthe remote areas of the north. MSF runs healthcentres where the government has been unsuc-cessful in doing so due to the war. Daily we dealtwith cases of severe malaria, malnutrition, anddehydration from diarrhoea.

Though our treatments were often successful,many people died because it was not safe for usto transport them to the hospital. We wereunable to get to our health centres for days at atime due to increasing conflict, leaving nationalstaff stranded and our clinic running low onmedications. I was amazed by the strength andcommitment demonstrated by the national staffwhen faced with such adverse conditions. Theygave me the strength to go on when at times thesituation seemed hopeless.

In the evenings, it was sometimes difficult tomaintain that hope as thousands of childrenstreamed into our night commuter sheltersearching for a safe place to sleep. The childrenfear attack and abduction by the rebels so theywalk up to 10 miles every night in search ofsafety. Though I was proud of our programme(we offered security, shelter, counselling, nurs-ing care and adult supervision) it broke my heartto see up to 4,500 children (some just able towalk) leave their parent’s homes each and everynight to sleep in a crowded tent with strangers.Our shelter was just one of many as an estimat-ed 50,000 children search for protection night-ly in the north.

The needs in northern Uganda are great. Nearthe end of my mission we were beginning toimplement our sexual and gender based violenceprogrammes. Sexual violence is a growing prob-lem and MSF is there to address the need fortreatment, counselling and education. The nightcommuters are not going away, and the peoplein the remote camps are in desperate need ofhealth care. Though peace is what northernUganda needs most, MSF is there for the timebeing to provide critical assistance to the mostvulnerable.

Carrie BernardMedical doctor, Gulu, northern Uganda

CIVILIANS WERE FORCED TO LEAVE

THEIR HOMES, THEIR LAND AND THEIR

DAILY LIVES FOR THESE CONGESTED

PROTECTED VILLAGES THAT IN REALITY

OFFER LITTLE SECURITY, SQUALID

LIVING CONDITIONS AND INSUFFICIENT

ACCESS TO HEALTH CARE.


Somalia, one of the poorest countriesin the world, remains virtually ignored

by the rest of the globe. Eight million peo-ple are estimated to live here in a countrywith only a fledgling government, con-stant insecurity and 20 preceding years ofcivil war.

There are high numbers of internally dis-placed persons in all areas of Somalia.These people have fled from one part ofthe country to another fearing for theirsafety because a clan to which they do notbelong controls the area in which they hadlived. These people live in great povertyand have neither food nor the necessitiesof basic living. Internally displaced per-sons are not classified as refugees by theUnited Nations and they do not receiveany international assistance. Hundreds ofthousands of such people in Somalia livewith their children in encampments on theedge of the larger towns with no employ-ment, no water, little food, overcrowding,no sanitation and all the health problemsthat come with these conditions.

There is no national health service, nosocial welfare system and much poverty.The Somali people have little access tohealth care (eight doctors for one mil-lion people was one estimate). Manyfamilies will walk hundreds of mileswith a sick child to the nearest healthfacility. There is free polio vaccinationbut not all children are able to get it andthere is only limited availability for vac-cination for whooping cough, tetanusand diphtheria.

There are many camels, many goats andmany children in this country of sun-shine and desert and most Somali peo-ple are nomadic, living in the bush. Theweather is hot and the geography desertwith few bushes and rivers which dry upin the dry season.

Large families are the norm, and somemen have more than one wife. Eachwoman has on average six children. Butone child in four will not reach the age offive, according to the most recent esti-

mates, and the infant mortality rate is oneof the highest in the world.

Many children live in the bush with theirparents in a way that has not changed forthousands of years. Animals are the fam-ily’s wealth and the family drinks the milkof the goats and the camels. Children’ssongs are often about the camels.

As soon as they are old enough childrenwill care for the animals, the goats andthe camels, and find greenery and waterfor them to eat and drink – children asyoung as five years old help with the ani-mals. There is little formal schooling forthose children and only about 45 per centof adult males and 25 per cent of adultfemales are able to read.

At the age of five or six, many little girls arestill subjected to female genital mutilationor circumcision, a practice which may beless frequent than before but which stilloccurs and causes great discomfort andsuffering to the female population.

L e t t e r f r o m t h e f i e l d

A child who pricked a foot with a thornis now in hospital fortunately recoveringfrom tetanus, which is almost unknownin Europe or North America because ofmass vaccination. The most devastatingchildhood diseases are diarrhoeal dis-ease and tuberculosis. Statistics are notavailable on the prevalence of HIV/AIDSbut it is likely lower than other sub-Saharan countries.

Children are seen with landmine injuriesand even gun shot wounds. Traffic acci-dents on roads are common. Tragically, itis not uncommon to see a child broughtfrom a distant place who dies beforetreatment can begin. The death of achild is always tragic but it is even moreso when it is from a disease that is pre-ventable and curable given adequatehealth resources.

Médecins Sans Frontières (MSF) is oneof only a few nongovernmental agen-cies actively working in Somalia to pro-vide desperately needed health care to

this impoverished country and its chil-dren. It has also taken over the man-agement of the Galkayo Hospital inPuntland, which includes paediatricand maternity wards.

In addition, MSF has established a thera-peutic feeding centre in North and SouthGalkayo in Puntland for malnourishedchildren. It is not uncommon to admitchildren who are less than 60 per cent ofthe expected weight for their height.Often they have serious diseases such asmeasles, diarrhoea and tuberculosis.They are treated and introduced back to anormal diet in a very specialized way.

The children of Somalia deserve bettereducation, better health care and a bet-ter chance to live a longer and morepeaceful life.

Irene TurpieMedical doctor, Galkayo, Somalia

THE DEATH OF A CHILD IS ALWAYS

TRAGIC BUT IT IS EVEN MORE SO

WHEN IT IS FROM A DISEASE THAT

IS PREVENTABLE AND CURABLE

GIVEN ADEQUATE HEALTH

RESOURCES.

Children of Somalia

Irene Turpie is a medical doctor from Dundas, Ontario. In 2005 she spent four monthsvolunteering with MSF inGalkayo, Somalia. The town ofGalkayo is divided in two andeach side is controlled by adifferent group. There are manyinternally displaced people inGalkayo, as is often the case inareas of civil war and unrest.


Somalia, one of the poorest countriesin the world, remains virtually ignored

by the rest of the globe. Eight million peo-ple are estimated to live here in a countrywith only a fledgling government, con-stant insecurity and 20 preceding years ofcivil war.

There are high numbers of internally dis-placed persons in all areas of Somalia.These people have fled from one part ofthe country to another fearing for theirsafety because a clan to which they do notbelong controls the area in which they hadlived. These people live in great povertyand have neither food nor the necessitiesof basic living. Internally displaced per-sons are not classified as refugees by theUnited Nations and they do not receiveany international assistance. Hundreds ofthousands of such people in Somalia livewith their children in encampments on theedge of the larger towns with no employ-ment, no water, little food, overcrowding,no sanitation and all the health problemsthat come with these conditions.

There is no national health service, nosocial welfare system and much poverty.The Somali people have little access tohealth care (eight doctors for one mil-lion people was one estimate). Manyfamilies will walk hundreds of mileswith a sick child to the nearest healthfacility. There is free polio vaccinationbut not all children are able to get it andthere is only limited availability for vac-cination for whooping cough, tetanusand diphtheria.

There are many camels, many goats andmany children in this country of sun-shine and desert and most Somali peo-ple are nomadic, living in the bush. Theweather is hot and the geography desertwith few bushes and rivers which dry upin the dry season.

Large families are the norm, and somemen have more than one wife. Eachwoman has on average six children. Butone child in four will not reach the age offive, according to the most recent esti-

mates, and the infant mortality rate is oneof the highest in the world.

Many children live in the bush with theirparents in a way that has not changed forthousands of years. Animals are the fam-ily’s wealth and the family drinks the milkof the goats and the camels. Children’ssongs are often about the camels.

As soon as they are old enough childrenwill care for the animals, the goats andthe camels, and find greenery and waterfor them to eat and drink – children asyoung as five years old help with the ani-mals. There is little formal schooling forthose children and only about 45 per centof adult males and 25 per cent of adultfemales are able to read.

At the age of five or six, many little girls arestill subjected to female genital mutilationor circumcision, a practice which may beless frequent than before but which stilloccurs and causes great discomfort andsuffering to the female population.

L e t t e r f r o m t h e f i e l d

A child who pricked a foot with a thornis now in hospital fortunately recoveringfrom tetanus, which is almost unknownin Europe or North America because ofmass vaccination. The most devastatingchildhood diseases are diarrhoeal dis-ease and tuberculosis. Statistics are notavailable on the prevalence of HIV/AIDSbut it is likely lower than other sub-Saharan countries.

Children are seen with landmine injuriesand even gun shot wounds. Traffic acci-dents on roads are common. Tragically, itis not uncommon to see a child broughtfrom a distant place who dies beforetreatment can begin. The death of achild is always tragic but it is even moreso when it is from a disease that is pre-ventable and curable given adequatehealth resources.

Médecins Sans Frontières (MSF) is oneof only a few nongovernmental agen-cies actively working in Somalia to pro-vide desperately needed health care to

this impoverished country and its chil-dren. It has also taken over the man-agement of the Galkayo Hospital inPuntland, which includes paediatricand maternity wards.

In addition, MSF has established a thera-peutic feeding centre in North and SouthGalkayo in Puntland for malnourishedchildren. It is not uncommon to admitchildren who are less than 60 per cent ofthe expected weight for their height.Often they have serious diseases such asmeasles, diarrhoea and tuberculosis.They are treated and introduced back to anormal diet in a very specialized way.

The children of Somalia deserve bettereducation, better health care and a bet-ter chance to live a longer and morepeaceful life.

Irene TurpieMedical doctor, Galkayo, Somalia

THE DEATH OF A CHILD IS ALWAYS

TRAGIC BUT IT IS EVEN MORE SO

WHEN IT IS FROM A DISEASE THAT

IS PREVENTABLE AND CURABLE

GIVEN ADEQUATE HEALTH

RESOURCES.

Children of Somalia

Irene Turpie is a medical doctor from Dundas, Ontario. In 2005 she spent four monthsvolunteering with MSF inGalkayo, Somalia. The town ofGalkayo is divided in two andeach side is controlled by adifferent group. There are manyinternally displaced people inGalkayo, as is often the case inareas of civil war and unrest.

When Jean Chrétien’s Pledge to AfricaAct finally came into force in April of

2005, Canadian companies were allowedto produce generic versions of medicinesfor export to developing countries facingpublic health crises.

As discussed in the last edition ofDispatches (Vol 7, Ed.1), Médecins SansFrontières (MSF) is placing an orderunder the legislation to see whether, inpractice, it really can bring medicines topatients in need.

Since Parliament passed the law in May2004, not one single pill has left Canada.There is, however, hope on the horizon.Apotex, a large Canadian generic compa-ny, has agreed to develop a fixed-dosecombination (three medications combinedin one pill – 3FDC) for HIV/AIDS treat-ment. Their product is now being devel-oped and the approval process with HealthCanada is underway.

The Canadian legislation (formerlynamed bills C-56, C-9 then C-29) is thefirst attempt to implement paragraph 6of the Doha Declaration. The WorldTrade Organisation (WTO) in its Aug. 30,2003 decision temporarily allowedgeneric companies to produce versionsof patented originator drugs with a com-pulsory licence provided the drugs wereonly destined for export. No-one knowshow it will work in practice or whereproblems will be.

Canadian social, political and administra-tive goodwill indispensable: Without thegoodwill and determination of peoplesuch as civil society organisations, someCanadian public servants and politicians,and UN AIDS Envoy Stephen Lewis, the18-month process to-date would likelynot have happened.

Technical hurdles: The complexities andrestrictions included in the legislation

may result in the process being unwork-able in practice.

List of medicines: A restrictive list of med-icines has no place in the legislation, andyet it exists. Half of the medicines on thelist are no longer under patent or are oldand rarely used drugs, while the other halfis severely limited. The 3FDC MSF hasasked Apotex to produce is not on the listand its inclusion could be refused orblocked or cause a delay.

Corporate goodwill required: There is noguarantee for generic companies that adrug will pass the approval process inHealth Canada and no guarantee patentholders will not litigate.

Limited financial incentives for companies:Some generic companies claim the gov-ernment should provide better financialincentives (such as tax breaks or grants)which would encourage the generic com-panies to engage in the process of pro-ducing a drug under the legislation.

WHAT NEXT?

The accessibility of just one basic first-line HIV/AIDS treatment is a success initself. The fact that it will be a Canadiandrug is a point of pride for Canadians.

But, we must look at the bigger picture.Since the Doha Declaration in 2001promoting “access to medicines forall,” no medicine has been producedunder the declaration. If this Canadiandrug reaches people in developingcountries, it will have taken five yearsto get one generic company in one WTOmember state to produce one AIDSdrug under paragraph 6. In five years,how many people have died ofHIV/AIDS? UNAIDS estimates overthree million in 2004 alone.

This pace is simply not acceptable. Andwith few countries jumping to followCanada’s lead and generic companiesin Europe clearly stating their disinter-est in the process, the hope that thisparagraph 6 style legislation willchange the direction of the AIDS crisisis fading.

So Canada can be pleased it has donesomething. But we cannot allow ourselvesto believe it is the answer. Access to med-icines for all is still a dream…and Dohastill empty words on paper.

Rachel Kiddell-MonroeAccess campaign coordinator

THE DREAM OF ACCESS

A c c e s s t o e s s e n t i a l m e d i c i n e

TO MEDICINES FOR ALL

Often, advocates for global equity inhealth preach to the hallelujahs of the

already converted. It is a facile task toconvince, for instance, the readers of thismagazine that those infected with HIVneed better access to testing and treat-ment, and that their communities needcomprehensive education to prevent fur-ther transmission. It is much more diffi-cult to reach those less inclined to appre-ciate the importance of world health,their minds necessarily on matters ofgreater individual importance. It is a chal-lenge of Medécins Sans Frontières (MSF),as it is for the likes of the WHO or the RedCross, to provide persuasive argumentsfor why health, like disease, should knowno borders.

Often MSF argues on behalf of individu-als, and their nations, whose voice is muf-fled by poverty or war. Eventually, it ishoped, these people will find words oftheir own. In Zambia, they are.

The MSF project in northern Zambia iscentred in the rural area of Nchelenge, arevised remnant of the programme thattreated the flood of refugees from thenearby Democratic Republic of Congo

(DRC). The war in DRC has moved on,and so has MSF. HIV education, testing,and counselling of Zambian people beganin 2001. The first patient received anti-retrovirals (ARVs) in January of 2004.People come from hundreds of kilometresaway to access the programme.

HIV has been part of Zambian life fordecades. But like so many other southernAfrican countries, its effects have beenseen and not heard. Most countries havenot had as much foresight as Uganda inmaking their struggle with the diseaseplain and part of an open dialoguebetween patients, their government, andthe media. Until now, a similar discoursein Zambia has been hampered by pover-ty, stigma and misinformation. With thehelp of MSF, and a growing, empoweredgroup of patients committed to living“positively,” this is changing.

In support groups in Nchelenge, alongwith their corollaries in an MSF project incentral Zambia, people are finding theirvoice. Each day, dozens of people sittogether, positive and negative, and dis-cuss their community’s struggle with HIVand how to win it. They talk about stigma,misinformation, how best to educate theirfriends and families. They talk aboutbusiness ideas that will provide for the

sickest among them. They talk aboutwhat their government needs to do forthem. The discourse is informed, andoften passionate. They leave the smallroom committed to change and armedwith ideas.

HIV in Zambia is now front page news.Nearly every day, the Lusaka dailies fea-ture a story about access, or a prominentspokesperson. Politicians, including thepresident, are harangued for not beingopenly tested. According to the head ofmission of the Nchelenge project, RiekjeElema, the visibility of the Zambian HIVcommunity is growing by the month.

With elections pending in 2006, theirs isa group that the politicians are payingclose attention to. It is suspected that thegovernment will soon announce its plan tomake ARVs freely available throughoutthe country. Together Zambian peoplehave done something that MSF could onlyaspire to. Instead of trying to convince areluctant audience that their argumentsare worth listening to, they are provingthat they cannot be ignored.

James MaskalykMedical doctor visiting MSF projects,

Zambia

Z a m b i a

power inZAMBIA

Dispatches Vol.7, Ed.2

patient

page 9

When Jean Chrétien’s Pledge to AfricaAct finally came into force in April of

2005, Canadian companies were allowedto produce generic versions of medicinesfor export to developing countries facingpublic health crises.

As discussed in the last edition ofDispatches (Vol 7, Ed.1), Médecins SansFrontières (MSF) is placing an orderunder the legislation to see whether, inpractice, it really can bring medicines topatients in need.

Since Parliament passed the law in May2004, not one single pill has left Canada.There is, however, hope on the horizon.Apotex, a large Canadian generic compa-ny, has agreed to develop a fixed-dosecombination (three medications combinedin one pill – 3FDC) for HIV/AIDS treat-ment. Their product is now being devel-oped and the approval process with HealthCanada is underway.

The Canadian legislation (formerlynamed bills C-56, C-9 then C-29) is thefirst attempt to implement paragraph 6of the Doha Declaration. The WorldTrade Organisation (WTO) in its Aug. 30,2003 decision temporarily allowedgeneric companies to produce versionsof patented originator drugs with a com-pulsory licence provided the drugs wereonly destined for export. No-one knowshow it will work in practice or whereproblems will be.

Canadian social, political and administra-tive goodwill indispensable: Without thegoodwill and determination of peoplesuch as civil society organisations, someCanadian public servants and politicians,and UN AIDS Envoy Stephen Lewis, the18-month process to-date would likelynot have happened.

Technical hurdles: The complexities andrestrictions included in the legislation

may result in the process being unwork-able in practice.

List of medicines: A restrictive list of med-icines has no place in the legislation, andyet it exists. Half of the medicines on thelist are no longer under patent or are oldand rarely used drugs, while the other halfis severely limited. The 3FDC MSF hasasked Apotex to produce is not on the listand its inclusion could be refused orblocked or cause a delay.

Corporate goodwill required: There is noguarantee for generic companies that adrug will pass the approval process inHealth Canada and no guarantee patentholders will not litigate.

Limited financial incentives for companies:Some generic companies claim the gov-ernment should provide better financialincentives (such as tax breaks or grants)which would encourage the generic com-panies to engage in the process of pro-ducing a drug under the legislation.

WHAT NEXT?

The accessibility of just one basic first-line HIV/AIDS treatment is a success initself. The fact that it will be a Canadiandrug is a point of pride for Canadians.

But, we must look at the bigger picture.Since the Doha Declaration in 2001promoting “access to medicines forall,” no medicine has been producedunder the declaration. If this Canadiandrug reaches people in developingcountries, it will have taken five yearsto get one generic company in one WTOmember state to produce one AIDSdrug under paragraph 6. In five years,how many people have died ofHIV/AIDS? UNAIDS estimates overthree million in 2004 alone.

This pace is simply not acceptable. Andwith few countries jumping to followCanada’s lead and generic companiesin Europe clearly stating their disinter-est in the process, the hope that thisparagraph 6 style legislation willchange the direction of the AIDS crisisis fading.

So Canada can be pleased it has donesomething. But we cannot allow ourselvesto believe it is the answer. Access to med-icines for all is still a dream…and Dohastill empty words on paper.

Rachel Kiddell-MonroeAccess campaign coordinator

THE DREAM OF ACCESS

A c c e s s t o e s s e n t i a l m e d i c i n e

TO MEDICINES FOR ALL

Often, advocates for global equity inhealth preach to the hallelujahs of the

already converted. It is a facile task toconvince, for instance, the readers of thismagazine that those infected with HIVneed better access to testing and treat-ment, and that their communities needcomprehensive education to prevent fur-ther transmission. It is much more diffi-cult to reach those less inclined to appre-ciate the importance of world health,their minds necessarily on matters ofgreater individual importance. It is a chal-lenge of Medécins Sans Frontières (MSF),as it is for the likes of the WHO or the RedCross, to provide persuasive argumentsfor why health, like disease, should knowno borders.

Often MSF argues on behalf of individu-als, and their nations, whose voice is muf-fled by poverty or war. Eventually, it ishoped, these people will find words oftheir own. In Zambia, they are.

The MSF project in northern Zambia iscentred in the rural area of Nchelenge, arevised remnant of the programme thattreated the flood of refugees from thenearby Democratic Republic of Congo

(DRC). The war in DRC has moved on,and so has MSF. HIV education, testing,and counselling of Zambian people beganin 2001. The first patient received anti-retrovirals (ARVs) in January of 2004.People come from hundreds of kilometresaway to access the programme.

HIV has been part of Zambian life fordecades. But like so many other southernAfrican countries, its effects have beenseen and not heard. Most countries havenot had as much foresight as Uganda inmaking their struggle with the diseaseplain and part of an open dialoguebetween patients, their government, andthe media. Until now, a similar discoursein Zambia has been hampered by pover-ty, stigma and misinformation. With thehelp of MSF, and a growing, empoweredgroup of patients committed to living“positively,” this is changing.

In support groups in Nchelenge, alongwith their corollaries in an MSF project incentral Zambia, people are finding theirvoice. Each day, dozens of people sittogether, positive and negative, and dis-cuss their community’s struggle with HIVand how to win it. They talk about stigma,misinformation, how best to educate theirfriends and families. They talk aboutbusiness ideas that will provide for the

sickest among them. They talk aboutwhat their government needs to do forthem. The discourse is informed, andoften passionate. They leave the smallroom committed to change and armedwith ideas.

HIV in Zambia is now front page news.Nearly every day, the Lusaka dailies fea-ture a story about access, or a prominentspokesperson. Politicians, including thepresident, are harangued for not beingopenly tested. According to the head ofmission of the Nchelenge project, RiekjeElema, the visibility of the Zambian HIVcommunity is growing by the month.

With elections pending in 2006, theirs isa group that the politicians are payingclose attention to. It is suspected that thegovernment will soon announce its plan tomake ARVs freely available throughoutthe country. Together Zambian peoplehave done something that MSF could onlyaspire to. Instead of trying to convince areluctant audience that their argumentsare worth listening to, they are provingthat they cannot be ignored.

James MaskalykMedical doctor visiting MSF projects,

Zambia

Z a m b i a

power inZAMBIA

Dispatches Vol.7, Ed.2

patient

page 9


Ispent the year of my 20th birthdayimmersed in the lives of the families of

Egyptian kings and the Massai, walkingbarefoot through the Himalayas like anIndian guru, fascinated by the many dif-ferent cultures. Upon returning to Canadain 1989, I began my studies in anthropol-ogy, a path that has led me to my currentunusual status as a post-doctoral doctorin anthropology.

Somewhere at the beginning of thispath I got to know Médecins SansFrontières (MSF); the vision, the peopleand the practical side of the organiza-

tion attracted my attention. I dedicatedthe past seven years of my professionallife to trying to understand MSF’shumanitarian culture and its relationswith aboriginal groups. This has beenthe subject of my doctoral thesis and abook, and has influenced my personalapproach to applying anthropology. Iam especially interested in the combin-ing of these two medicines: humanitar-ian biomedical medicine and tradition-al Aboriginal medicine, a combinationthat requires cooperation from bothparties. This has brought me to mystory today.

MSF recently invited me to Itaka Guasu,home of the aboriginal Guarani people insouthern Bolivia. These survivors of slav-ery, missionary conversions and manyother forms of exploitation by the Spanishcolonizers are now faced with serioushealth problems, including a disease thathas caused the sudden death of manymen and women in their 40s.

Today this disease is known as Chagasdisease, named after the scientist CarlosChagas, who, in 1909, discovered theparasite responsible: tripanosoma cruzi.Chagas disease has reached epidemicproportions. This disease is insidious; itdevelops slowly and progressively for upto 30 years. Since it has no apparentsymptoms, it is difficult to detect andrecognize, until, suddenly, the persondies. It has especially devastated poorand marginalized areas where aboriginalpeople live.

When I received this invitation, an MSFteam was already intervening with peoplein southern Bolivia to try to controlChagas disease and hopes to soon beworking with the Guarani, offering themthe drug benznidazole. However, usingthe pharmacological treatment in an iso-

lated manner is not sufficient for control-ling this disease. The cause must be elim-inated — the insect (vinchuca), whichcarries the parasite and spreads it tohumans, is abundant in the homes here.

This is where things become complicatedbecause the active participation of eachGuarani household is essential. To pre-vent re-infection, the houses must bedestroyed, rebuilt, sprayed and cleanedusing a specific hygiene process; petsmust live outside. These measures wouldentail major changes to their lifestyle andthe Guarani are resisting. The MSF proj-ect coordinator sent me a special invita-tion so that we could both go see the rea-sons for this lack of interest on the part ofthe Guarani in implementing the publichealth recommendations. There had to bean explanation with this dignified andknowledgeable people. We went to seethe traditional doctors, who often com-pete with the new therapeutic knowledgebeing brought in.

First we met with the aboriginal and inter-national representatives already workingin the area to obtain their approval to beable to talk with the people currently tak-ing care of these populations’ health. We

then went to meet with these people. Thefirst representative we met, Don Felix,was both a health care assistant and aherbologist. He worked simultaneouslywith pharmaceutical products and plant-based products, and had worked with theupurupuanos (healers/diviners) for manyyears already. No one from an internation-al health care organization had ever cometo ask him about his traditional therapeu-tic knowledge, and he was pleasantly sur-prised that we were interested in hisknowledge of medical plants and his roleas mediator between the cultures.

Don Felix and everyone with whom wespoke insisted on the crucial role thatupurupuanos play with the Guarani.These healers diagnose ill health by read-ing coca leaves; their advice is highlyappreciated and they still have a majorsocial impact. They do not talk aboutChagas disease as such, but have theskills and knowledge likely to provideexplanations of it, explanations thatwould be meaningful to the Guarani. Thismay be where the answer lies to help abo-riginal populations integrate methods ofpreventing re-infection by vinchuca andto fight against Chagas disease.Therapists from the local social setting

C h a g a s d i s e a s e

BEYONDcultures

MEETINGS BETWEEN

HUMANITARIAN AID GROUPS

AND ABORIGINAL PEOPLES ARE

AN EXCELLENT OPPORTUNITY

TO BETTER UNDERSTAND

HUMAN HEALTH ISSUES IN

DIFFERENT CONTEXTS.


Ispent the year of my 20th birthdayimmersed in the lives of the families of

Egyptian kings and the Massai, walkingbarefoot through the Himalayas like anIndian guru, fascinated by the many dif-ferent cultures. Upon returning to Canadain 1989, I began my studies in anthropol-ogy, a path that has led me to my currentunusual status as a post-doctoral doctorin anthropology.

Somewhere at the beginning of thispath I got to know Médecins SansFrontières (MSF); the vision, the peopleand the practical side of the organiza-

tion attracted my attention. I dedicatedthe past seven years of my professionallife to trying to understand MSF’shumanitarian culture and its relationswith aboriginal groups. This has beenthe subject of my doctoral thesis and abook, and has influenced my personalapproach to applying anthropology. Iam especially interested in the combin-ing of these two medicines: humanitar-ian biomedical medicine and tradition-al Aboriginal medicine, a combinationthat requires cooperation from bothparties. This has brought me to mystory today.

MSF recently invited me to Itaka Guasu,home of the aboriginal Guarani people insouthern Bolivia. These survivors of slav-ery, missionary conversions and manyother forms of exploitation by the Spanishcolonizers are now faced with serioushealth problems, including a disease thathas caused the sudden death of manymen and women in their 40s.

Today this disease is known as Chagasdisease, named after the scientist CarlosChagas, who, in 1909, discovered theparasite responsible: tripanosoma cruzi.Chagas disease has reached epidemicproportions. This disease is insidious; itdevelops slowly and progressively for upto 30 years. Since it has no apparentsymptoms, it is difficult to detect andrecognize, until, suddenly, the persondies. It has especially devastated poorand marginalized areas where aboriginalpeople live.

When I received this invitation, an MSFteam was already intervening with peoplein southern Bolivia to try to controlChagas disease and hopes to soon beworking with the Guarani, offering themthe drug benznidazole. However, usingthe pharmacological treatment in an iso-

lated manner is not sufficient for control-ling this disease. The cause must be elim-inated — the insect (vinchuca), whichcarries the parasite and spreads it tohumans, is abundant in the homes here.

This is where things become complicatedbecause the active participation of eachGuarani household is essential. To pre-vent re-infection, the houses must bedestroyed, rebuilt, sprayed and cleanedusing a specific hygiene process; petsmust live outside. These measures wouldentail major changes to their lifestyle andthe Guarani are resisting. The MSF proj-ect coordinator sent me a special invita-tion so that we could both go see the rea-sons for this lack of interest on the part ofthe Guarani in implementing the publichealth recommendations. There had to bean explanation with this dignified andknowledgeable people. We went to seethe traditional doctors, who often com-pete with the new therapeutic knowledgebeing brought in.

First we met with the aboriginal and inter-national representatives already workingin the area to obtain their approval to beable to talk with the people currently tak-ing care of these populations’ health. We

then went to meet with these people. Thefirst representative we met, Don Felix,was both a health care assistant and aherbologist. He worked simultaneouslywith pharmaceutical products and plant-based products, and had worked with theupurupuanos (healers/diviners) for manyyears already. No one from an internation-al health care organization had ever cometo ask him about his traditional therapeu-tic knowledge, and he was pleasantly sur-prised that we were interested in hisknowledge of medical plants and his roleas mediator between the cultures.

Don Felix and everyone with whom wespoke insisted on the crucial role thatupurupuanos play with the Guarani.These healers diagnose ill health by read-ing coca leaves; their advice is highlyappreciated and they still have a majorsocial impact. They do not talk aboutChagas disease as such, but have theskills and knowledge likely to provideexplanations of it, explanations thatwould be meaningful to the Guarani. Thismay be where the answer lies to help abo-riginal populations integrate methods ofpreventing re-infection by vinchuca andto fight against Chagas disease.Therapists from the local social setting

C h a g a s d i s e a s e

BEYONDcultures

MEETINGS BETWEEN

HUMANITARIAN AID GROUPS

AND ABORIGINAL PEOPLES ARE

AN EXCELLENT OPPORTUNITY

TO BETTER UNDERSTAND

HUMAN HEALTH ISSUES IN

DIFFERENT CONTEXTS.


M e d i c a l d e v e l o p m e n t s

The Drugs for Neglected DiseasesInitiative (DNDi) has announced the

development of a new formulation ofcombination drug therapy for the treat-ment of malaria. Every year, malariakills 1-2 million people. Ninety per centof deaths occur in sub-Saharan Africa.The disease is present in over 100countires and threatens 40 per cent ofthe world’s population.

This new fixed-dose formulation is the com-bination of two drugs, artesunate andamodiaquine (AS/AQ), in one tablet. Theadult dosage has been simplified to twotablets once a day for three days (six tabletstotal), drastically reduced from the currentregimen of four tablets twice a day for threedays (24 tablets total). DNDi has alsodeveloped a paediatric co-formulation –small, easy to swallow, water-soluble tabletsfor children.

DNDi is a not-for-profit drug developmentinitiative established in 2003 by four pub-licly-funded research organizations: KenyaMedical Research Institute, IndianCouncil for Medical Research, OswaldoCruz Foundation Brazil, MalaysianMinistry of Health; a private researchinstitute, the Institut Pasteur; an interna-tional research organization, WHO’sTropical Diseases Research programme;and Médecins Sans Frontières.

DNDi also recently signed an agreementwith Sanofi-Aventis to complete the devel-opment of the AS/AQ fixed-dose formula-tion and prepare the dossier that is manda-tory for registration as well as for WHO drugpre-qualification.

The drug will be available at a target price ofless than $1 US for an adult treatment and$0.50 US for children to the public sector,international organisations, and nongovern-mental organizations (NGOs). Sanofi-Aventishas agreed to give three per cent of privatesector sales revenue to DNDi, which DNDiwill use to reduce the price of treatment.

Sanofi-Aventis will be in charge of the firstregistration, production and distribution ofAS/AQ and has agreed to do this at cost forthe public sector, international organisa-tions, and NGOs. The new drug should beavailable in mid 2006.

DNDi’s agreement with Sanofi-Aventis isnon-exclusive. However, DNDi has guar-anteed exclusivity to Sanofi-Aventis forthe duration of the product developmentprogramme and until the first registrationis obtained.

DNDi aims to develop new, improved andfield-relevant drugs for neglected diseasessuch as leishmaniasis, human African try-panosomiasis (sleeping sickness), andChagas disease that afflict the very poor indeveloping countries. It raises awareness ofthe urgent need to develop drugs for thesediseases and uses DNDi projects tostrengthen existing capacity in disease-endemic countries.

To learn more about DNDi and the crucialimpact of developing drugs for neglecteddiseases, visit www.dndi.org.

From DNDi NewsletterNo10 April 2005

On June 8, 2005, DNDi launched anappeal – with events around the world– which calls on governments to pro-vide significant sustained support tobring essential new vaccines anddiagnostics to people suffering anddying from neglected diseases.

The date marks the beginning of ayear-long campaign to mobilize like-minded organizations and individu-als, including the scientific commu-nity, media and high-profile opinionleaders, to sign and present theappeal at the World Health Assemblyin 2006.

Every day over 35,000 people die frominfectious diseases such as AIDS,malaria, and tuberculosis, as well asthe most neglected diseases such asleishmaniasis, Chagas disease andsleeping sickness.

Without bold new steps, disease willcontinue to ravage the developingworld, with global consequences.Governments should act NOW.

To find out more about the campaignand how you can become involved,and to see a list of who has alreadysigned the petition, please go towww.dndi.org.

TAKE ACTION ONNEGLECTED DISEASES

NEW DRUG

can provide social and cultural tools sothat biotechnology is useful. Thus, thechances of controlling Chagas diseasecould be increased, and pharmaceuticaltreatments could be made more effective.

Scientific discoveries can only be usefuland effective once they are a significantpart of everyday life. Instead of unilater-ally “educating” the target populations,in this case, the Guarani, on the medicalprinciples and technology on whichhumanitarian knowledge is based, MSF,through my visit, launched the idea ofbringing together these “discoveries”with those uncovered by the local peopleregarding health care and human dis-ease. This allows a more understand-able, flexible multidirectional approach,which works and cooperates with theexisting therapeutic potential. Com-munication and the exchange of signifi-cant knowledge between the two groups

should bear fruit. Without this dialogue,an opportunity is missed.

Meetings between humanitarian aid groupsand aboriginal peoples are an excellentopportunity to better understand humanhealth issues in different contexts. Myprior research on an MSF project with theaboriginal peoples of the Brazilian Amazonrainforest showed that the so-called “neu-tral” biomedical approach adopted overallby MSF becomes political and culturallydistinct when used in projects involvingthe local and national populations. Weneed to be flexible, adaptable and under-standing to work in different cultural envi-ronments. My stay in Bolivia essentiallyinvolved giving the Guarani people andtheir traditional medicine the time to taketheir place in the discussions on Chagasdisease. The national context of Bolivia, inwhich the Guarani are currently living, ismore favourable to these contributions.

Bolivia is a multi-ethnic society with along tradition of living with Chagas dis-ease. This parasite can be traced back tomummies from the ancient Inca civiliza-tions (1400 BC) and the country’sWankari (AD 400). The tradition ofKallaway aboriginal herbologists, whichonce was as organized in the upper Andesas the medical tradition is today at theinternational level, is still concerned withthe health issues surrounding Chagas dis-ease and has developed certain treat-ments and methods to minimize its scale.Bolivia has had many experiences ofcooperation between traditional and med-ical approaches to health, which cangreatly contribute to the fight againstChagas disease.

Julie LaplanteAnthropologist, MSF consultant

SIMPLIFIES MALARIA TREATMENT


M e d i c a l d e v e l o p m e n t s

The Drugs for Neglected DiseasesInitiative (DNDi) has announced the

development of a new formulation ofcombination drug therapy for the treat-ment of malaria. Every year, malariakills 1-2 million people. Ninety per centof deaths occur in sub-Saharan Africa.The disease is present in over 100countires and threatens 40 per cent ofthe world’s population.

This new fixed-dose formulation is the com-bination of two drugs, artesunate andamodiaquine (AS/AQ), in one tablet. Theadult dosage has been simplified to twotablets once a day for three days (six tabletstotal), drastically reduced from the currentregimen of four tablets twice a day for threedays (24 tablets total). DNDi has alsodeveloped a paediatric co-formulation –small, easy to swallow, water-soluble tabletsfor children.

DNDi is a not-for-profit drug developmentinitiative established in 2003 by four pub-licly-funded research organizations: KenyaMedical Research Institute, IndianCouncil for Medical Research, OswaldoCruz Foundation Brazil, MalaysianMinistry of Health; a private researchinstitute, the Institut Pasteur; an interna-tional research organization, WHO’sTropical Diseases Research programme;and Médecins Sans Frontières.

DNDi also recently signed an agreementwith Sanofi-Aventis to complete the devel-opment of the AS/AQ fixed-dose formula-tion and prepare the dossier that is manda-tory for registration as well as for WHO drugpre-qualification.

The drug will be available at a target price ofless than $1 US for an adult treatment and$0.50 US for children to the public sector,international organisations, and nongovern-mental organizations (NGOs). Sanofi-Aventishas agreed to give three per cent of privatesector sales revenue to DNDi, which DNDiwill use to reduce the price of treatment.

Sanofi-Aventis will be in charge of the firstregistration, production and distribution ofAS/AQ and has agreed to do this at cost forthe public sector, international organisa-tions, and NGOs. The new drug should beavailable in mid 2006.

DNDi’s agreement with Sanofi-Aventis isnon-exclusive. However, DNDi has guar-anteed exclusivity to Sanofi-Aventis forthe duration of the product developmentprogramme and until the first registrationis obtained.

DNDi aims to develop new, improved andfield-relevant drugs for neglected diseasessuch as leishmaniasis, human African try-panosomiasis (sleeping sickness), andChagas disease that afflict the very poor indeveloping countries. It raises awareness ofthe urgent need to develop drugs for thesediseases and uses DNDi projects tostrengthen existing capacity in disease-endemic countries.

To learn more about DNDi and the crucialimpact of developing drugs for neglecteddiseases, visit www.dndi.org.

From DNDi NewsletterNo10 April 2005

On June 8, 2005, DNDi launched anappeal – with events around the world– which calls on governments to pro-vide significant sustained support tobring essential new vaccines anddiagnostics to people suffering anddying from neglected diseases.

The date marks the beginning of ayear-long campaign to mobilize like-minded organizations and individu-als, including the scientific commu-nity, media and high-profile opinionleaders, to sign and present theappeal at the World Health Assemblyin 2006.

Every day over 35,000 people die frominfectious diseases such as AIDS,malaria, and tuberculosis, as well asthe most neglected diseases such asleishmaniasis, Chagas disease andsleeping sickness.

Without bold new steps, disease willcontinue to ravage the developingworld, with global consequences.Governments should act NOW.

To find out more about the campaignand how you can become involved,and to see a list of who has alreadysigned the petition, please go towww.dndi.org.

TAKE ACTION ONNEGLECTED DISEASES

NEW DRUG

can provide social and cultural tools sothat biotechnology is useful. Thus, thechances of controlling Chagas diseasecould be increased, and pharmaceuticaltreatments could be made more effective.

Scientific discoveries can only be usefuland effective once they are a significantpart of everyday life. Instead of unilater-ally “educating” the target populations,in this case, the Guarani, on the medicalprinciples and technology on whichhumanitarian knowledge is based, MSF,through my visit, launched the idea ofbringing together these “discoveries”with those uncovered by the local peopleregarding health care and human dis-ease. This allows a more understand-able, flexible multidirectional approach,which works and cooperates with theexisting therapeutic potential. Com-munication and the exchange of signifi-cant knowledge between the two groups

should bear fruit. Without this dialogue,an opportunity is missed.

Meetings between humanitarian aid groupsand aboriginal peoples are an excellentopportunity to better understand humanhealth issues in different contexts. Myprior research on an MSF project with theaboriginal peoples of the Brazilian Amazonrainforest showed that the so-called “neu-tral” biomedical approach adopted overallby MSF becomes political and culturallydistinct when used in projects involvingthe local and national populations. Weneed to be flexible, adaptable and under-standing to work in different cultural envi-ronments. My stay in Bolivia essentiallyinvolved giving the Guarani people andtheir traditional medicine the time to taketheir place in the discussions on Chagasdisease. The national context of Bolivia, inwhich the Guarani are currently living, ismore favourable to these contributions.

Bolivia is a multi-ethnic society with along tradition of living with Chagas dis-ease. This parasite can be traced back tomummies from the ancient Inca civiliza-tions (1400 BC) and the country’sWankari (AD 400). The tradition ofKallaway aboriginal herbologists, whichonce was as organized in the upper Andesas the medical tradition is today at theinternational level, is still concerned withthe health issues surrounding Chagas dis-ease and has developed certain treat-ments and methods to minimize its scale.Bolivia has had many experiences ofcooperation between traditional and med-ical approaches to health, which cangreatly contribute to the fight againstChagas disease.

Julie LaplanteAnthropologist, MSF consultant

SIMPLIFIES MALARIA TREATMENT


DispatchesMédecins Sans Frontières/

Doctors Without Borders

720 Spadina Avenue, Suite 402Toronto, Ontario, M5S 2T9

Tel: 416.964.0619Fax: 416.963.8707

Toll free: 1.800.982.7903Email: [email protected]

www.msf.ca

Editors:linda o. nagy

Dominique Desrochers

Editorial Director:Tommi Laulajainen

Contributors:Carrie Bernard, DNDi, Nancy Forgrave, Rachel Kiddell-Monroe, Julie Laplante,

James Maskalyk, David Morley, Irene Turpie

Circulation: 90,000Layout: Artshouse Communications Inc.

Printing: Warren's Imaging and DryographySummer 2005

ISSN 1484-9372

Photo credits:Jet Belgraver, Chris de Bode,

Jean Marc Giboux, Julie Laplante,Sebastien Le Clezio, Greg Locke,

Stefan Pleger, John Reardon, Julie Rémy, Gilles Saussier,

Stephen Shames, Serge Sibert/Cosmos,

Kenneth Tong

After over seven years as ExecutiveDirector of MSF Canada, I am leaving

my position this summer. I have learned agreat deal with MSF.

Much has happened over these years, butsome people and events stand out in mymind:

• The contribution Canadian doctors likeRichard Bedell, David Tu, CherylMcDermid, and Sumeet Sodhi havemade in the fight against HIV/AIDS;

• The vital role of the Access to EssentialMedicines Campaign in bringing downthe cost of AIDS medications andchanging the way malaria is treated inmany parts of the world;

• The dedication of our national staff inRepublic of Congo, with whom I hadthe pleasure to work last year when Iserved as head of mission in that for-gotten, war-torn country;

• The commitment of so many Canadianvolunteers whose ongoing dedicationhas made such a difference to so many– Jane Little, Steve Cornish, VincentEchavé, Michael Hall, the Skinnider sis-ters, Reine Lebel, Leslie Shanks – I

could fill the page with the names of thepeople who commit to easing the pain ofthe world’s forgotten people;

• The understanding of Canadians whocontinued to support MSF even whenwe have spoken against the commonunderstanding of the day – be it ourconcern over the mixing of military andhumanitarian actions in Afghanistan,the use of humanitarian workers forpolitical activities in Kosovo, or, mostrecently, our decision to stop fundrais-ing once we had met our requirementfor tsunami relief.

MSF is a wonderfully energetic organiza-tion, and I feel privileged to have had thechance to work with an excellent staffhere in Canada. We have grown into oneof the most effective and well-knowninternational agencies in the country.Once I leave this role with the organiza-tion, I will be working on a book aboutMSF for youth, commissioned by aCanadian publisher.

Without the remarkable support of you,our donors, we would not have the inde-pendence and ability to do the work we do

– to go behind rebel lines and bring med-ical care to the poor; to pioneer antiretro-viral treatment for people with AIDS inforgotten corners of Africa; to stand up togovernment and international bodies whoput their own interests ahead of those ofthe world’s poor.

But I cannot be triumphalist when there isso much still to be done. Only 10 per centof the people in the developing world whoneed AIDS medication get it. In Darfur, inRepublic of Congo, in Somalia, our volun-teers do wonderful work – but the scale ofsuffering sometimes overwhelms us. Wecannot even work in Afghanistan rightnow, as the murder of our five colleaguesthere last year remains unresolved.

But a strength of MSF is that we will notallow ourselves to become paralysed inthe face of daunting and overwhelmingodds; we do whatever we can to find waysto help. And your support helps make thatpossible. Thank you.

David MorleyExecutive Director, MSF Canada

GOODBYE AND THANK YOU

M S F C a n a d a n e w s

Set in central Angola during the finalstages of the country’s 30-year civil

war, No One Can Stop the Rain is the truestory of two ordinary Médecins SansFrontières (MSF) volunteers – a surgeonand his wife, leaving behind their com-fortable lives in mid-career. In doing sothey are confronted by both the best andworst aspects of humanity.

Based on correspondence and diaryentries, the book chronicles the couple’sjourney to Kuito, deep in the heart ofAngola. The remnants of this provincialcapital had the unenviable reputation ofbeing one of the world’s most heavily land-

mined cities. The events witnessed by theauthors as they worked alongside civilians– victims of landmines, the malnourished,and the displaced – provide a uniqueinsight into life in this vast humanitariancitadel. Through the couple’s eyes, thereader not only experiences something ofthe expected, the trauma of war, but alsogains a rich insight into the less expected:the ordinary life of both local residentsand field volunteers.

No One Can Stop the Rain is written byKarin Moorhouse and Dr. Wei Cheng andpublished by Insomniac Press. It is nowavailable in bookstores.

Confronting humanity in Angola

M S F C a n a d a r e a d s

ANGOLAMiriam Lindsay

BURUNDIEugénie GrangerGabriela PhalDiane RachieleJennifer Weterings

CHADKevin CoppockVance CulbertFrédéric DubéDarcy Gagnon

COLOMBIADarryl Stellmach

DEMOCRATIC REPUBLIC OF CONGO

Nicolas BarrouilletFrédéric BeaudoinPaul BlasigÉmilie FrédérickSylvain GroulxSerena KasparianDawn Keim

Jean-Sébastien MatteAndrew MortonMarlene PowerMireille RoyPatrick Ulrich

ETHIOPIAMartin AlpertIsabelle Aubry

HAITISylvain CharbonneauRobert ParkerJean Sander

INDIALynne ChobotarSajida HussainClaude Trépanier

INDONESIASasha BernatskyMichelle Chouinard Brigitte LaroseGurnam SodhiKarin Sutherland

IVORY COASTJessika HuardKurt Jansen

KENYASylvain DeslippesDavid MichalskiTiffany Moore

LIBERIAAsit MitraCarrie Morrison

MYANMARNancy DaleCarol FrenetteJim NewtonManisha Rajora

NIGERIAAdam Childs

PAKISTANDavid de Bold

REPUBLIC OF CONGOMaryse BonnelTyler Fainstat

Sophia KapellasPatrick RobitailleHeather Thomson

SIERRA LEONEJohana AmarPriscilla BrookeChentale de MontignyNancy Graham

SOMALIASteve DennisBruce Lampard

SOUTH AFRICAPeter Saranchuk

SUDANReshma AdatiaMario FortinIvan GaytonMegan HunterZayd MajokaNasser SalamArun SharmaSheila StamHassan Valji

UGANDADonald ChambersAsha GervanMaïwenn HenriquetThomas KellyThierry OulhenTom Ripley

UZBEKISTANCatherine de Ravinel

ZAMBIABonnie FournierEva LamSima Patel

CANADIANS ON MISSION


DispatchesMédecins Sans Frontières/

Doctors Without Borders

720 Spadina Avenue, Suite 402Toronto, Ontario, M5S 2T9

Tel: 416.964.0619Fax: 416.963.8707

Toll free: 1.800.982.7903Email: [email protected]

www.msf.ca

Editors:linda o. nagy

Dominique Desrochers

Editorial Director:Tommi Laulajainen

Contributors:Carrie Bernard, DNDi, Nancy Forgrave, Rachel Kiddell-Monroe, Julie Laplante,

James Maskalyk, David Morley, Irene Turpie

Circulation: 90,000Layout: Artshouse Communications Inc.

Printing: Warren's Imaging and DryographySummer 2005

ISSN 1484-9372

Photo credits:Jet Belgraver, Chris de Bode,

Jean Marc Giboux, Julie Laplante,Sebastien Le Clezio, Greg Locke,

Stefan Pleger, John Reardon, Julie Rémy, Gilles Saussier,

Stephen Shames, Serge Sibert/Cosmos,

Kenneth Tong

After over seven years as ExecutiveDirector of MSF Canada, I am leaving

my position this summer. I have learned agreat deal with MSF.

Much has happened over these years, butsome people and events stand out in mymind:

• The contribution Canadian doctors likeRichard Bedell, David Tu, CherylMcDermid, and Sumeet Sodhi havemade in the fight against HIV/AIDS;

• The vital role of the Access to EssentialMedicines Campaign in bringing downthe cost of AIDS medications andchanging the way malaria is treated inmany parts of the world;

• The dedication of our national staff inRepublic of Congo, with whom I hadthe pleasure to work last year when Iserved as head of mission in that for-gotten, war-torn country;

• The commitment of so many Canadianvolunteers whose ongoing dedicationhas made such a difference to so many– Jane Little, Steve Cornish, VincentEchavé, Michael Hall, the Skinnider sis-ters, Reine Lebel, Leslie Shanks – I

could fill the page with the names of thepeople who commit to easing the pain ofthe world’s forgotten people;

• The understanding of Canadians whocontinued to support MSF even whenwe have spoken against the commonunderstanding of the day – be it ourconcern over the mixing of military andhumanitarian actions in Afghanistan,the use of humanitarian workers forpolitical activities in Kosovo, or, mostrecently, our decision to stop fundrais-ing once we had met our requirementfor tsunami relief.

MSF is a wonderfully energetic organiza-tion, and I feel privileged to have had thechance to work with an excellent staffhere in Canada. We have grown into oneof the most effective and well-knowninternational agencies in the country.Once I leave this role with the organiza-tion, I will be working on a book aboutMSF for youth, commissioned by aCanadian publisher.

Without the remarkable support of you,our donors, we would not have the inde-pendence and ability to do the work we do

– to go behind rebel lines and bring med-ical care to the poor; to pioneer antiretro-viral treatment for people with AIDS inforgotten corners of Africa; to stand up togovernment and international bodies whoput their own interests ahead of those ofthe world’s poor.

But I cannot be triumphalist when there isso much still to be done. Only 10 per centof the people in the developing world whoneed AIDS medication get it. In Darfur, inRepublic of Congo, in Somalia, our volun-teers do wonderful work – but the scale ofsuffering sometimes overwhelms us. Wecannot even work in Afghanistan rightnow, as the murder of our five colleaguesthere last year remains unresolved.

But a strength of MSF is that we will notallow ourselves to become paralysed inthe face of daunting and overwhelmingodds; we do whatever we can to find waysto help. And your support helps make thatpossible. Thank you.

David MorleyExecutive Director, MSF Canada

GOODBYE AND THANK YOU

M S F C a n a d a n e w s

Set in central Angola during the finalstages of the country’s 30-year civil

war, No One Can Stop the Rain is the truestory of two ordinary Médecins SansFrontières (MSF) volunteers – a surgeonand his wife, leaving behind their com-fortable lives in mid-career. In doing sothey are confronted by both the best andworst aspects of humanity.

Based on correspondence and diaryentries, the book chronicles the couple’sjourney to Kuito, deep in the heart ofAngola. The remnants of this provincialcapital had the unenviable reputation ofbeing one of the world’s most heavily land-

mined cities. The events witnessed by theauthors as they worked alongside civilians– victims of landmines, the malnourished,and the displaced – provide a uniqueinsight into life in this vast humanitariancitadel. Through the couple’s eyes, thereader not only experiences something ofthe expected, the trauma of war, but alsogains a rich insight into the less expected:the ordinary life of both local residentsand field volunteers.

No One Can Stop the Rain is written byKarin Moorhouse and Dr. Wei Cheng andpublished by Insomniac Press. It is nowavailable in bookstores.

Confronting humanity in Angola

M S F C a n a d a r e a d s

ANGOLAMiriam Lindsay

BURUNDIEugénie GrangerGabriela PhalDiane RachieleJennifer Weterings

CHADKevin CoppockVance CulbertFrédéric DubéDarcy Gagnon

COLOMBIADarryl Stellmach

DEMOCRATIC REPUBLIC OF CONGO

Nicolas BarrouilletFrédéric BeaudoinPaul BlasigÉmilie FrédérickSylvain GroulxSerena KasparianDawn Keim

Jean-Sébastien MatteAndrew MortonMarlene PowerMireille RoyPatrick Ulrich

ETHIOPIAMartin AlpertIsabelle Aubry

HAITISylvain CharbonneauRobert ParkerJean Sander

INDIALynne ChobotarSajida HussainClaude Trépanier

INDONESIASasha BernatskyMichelle Chouinard Brigitte LaroseGurnam SodhiKarin Sutherland

IVORY COASTJessika HuardKurt Jansen

KENYASylvain DeslippesDavid MichalskiTiffany Moore

LIBERIAAsit MitraCarrie Morrison

MYANMARNancy DaleCarol FrenetteJim NewtonManisha Rajora

NIGERIAAdam Childs

PAKISTANDavid de Bold

REPUBLIC OF CONGOMaryse BonnelTyler Fainstat

Sophia KapellasPatrick RobitailleHeather Thomson

SIERRA LEONEJohana AmarPriscilla BrookeChentale de MontignyNancy Graham

SOMALIASteve DennisBruce Lampard

SOUTH AFRICAPeter Saranchuk

SUDANReshma AdatiaMario FortinIvan GaytonMegan HunterZayd MajokaNasser SalamArun SharmaSheila StamHassan Valji

UGANDADonald ChambersAsha GervanMaïwenn HenriquetThomas KellyThierry OulhenTom Ripley

UZBEKISTANCatherine de Ravinel

ZAMBIABonnie FournierEva LamSima Patel

CANADIANS ON MISSION

MAKING A LEGACY GIFT TO MSF

Nancy ForgravePersonal giving officer

Documents

Dispatches (Summer 2005)