Dispatches (Summer 2006)

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

Vol.8, Ed.2

IN THIS ISSUE

2

4

5

6

8

10

11

12

14

1999 Nobel Peace Prize Laureate

MSF Expo 2006:On mission in Canada

Access to EssentialMedicines and DNDi

Insufficiencies andsuffering: Chagas

Treatment for life

Witnessing whitedeath in Uzbekistan

Community-basedmalaria treatment

Effective drugs mustreach patients

The new tuberculosis:TB in the era of HIV

MSF profile: Peter Saranchuk ACCESS

to essential medicines and drugs for neglected diseases

Ottawa . . . . . . . . . May 17-28Hamilton . . . . May 31 - June 4Windsor . . . . . . . . . June 7-11London . . . . . . . . . June 14-18Montreal . . . . June 28 - July 9Sherbrooke . . . . . . July 12-16Québec City . . . . . . July 19-23Toronto . . . . . . . . August 2-18

EXPO 2006WILL VISIT THE FOLLOWING CITIES THIS SUMMER: OTTAWA

HAMILTON

WINDSOR

LONDON

MONTREAL

SHERBROOKE

QUÉBEC CITY

TORONTO

For exact locations or to learn more about the Expo, visit www.msf.ca

Médecins Sans Frontières’ (MSF)ongoing campaign to improve access

to essential medicines for the world’spoorest was, in a sense, a direct result offrustration. Around the world, in countryafter country, MSF’s doctors were con-fronted by disease on a mass scale – hun-dreds or even thousands of patients whoneeded life-saving treatment – and werehamstrung in their ability to help becausediagnostic tools were too old or becausethe drugs they needed were too expensive.For many, accustomed to the resourcesavailable in the health systems of wealthycountries, this was outrageous.

This summer Canadians will have theopportunity to get a small taste of what thisexperience is like. The MSF Expo is aninteractive exhibit touring eight cities acrossOntario and Québec, giving Canadians anopportunity to ‘go on mission’ with MSF andconfront for themselves some of the world’smost neglected diseases.

An anticipated 10,000 visitors to the Expo’s48-foot trailer will spin a wheel to decidewhich country they will work in, each withits own distinct challenges. Those on mis-sion in Bolivia, for example, will confrontChagas, a disease virtually unheard of inCanada, but which takes the lives of an esti-mated 50,000 people each year in LatinAmerica. In Uzbekistan the challenge istuberculosis (TB), particularly in its multi-drug resistant form. Depending primarily ona diagnostic test developed in 1882 and ondrugs developed in the 1950s and 60s,

page 3Dispatches Vol.8, Ed.2

M S F E x p o 2 0 0 6

volunteers struggle to provide treatmentsthat are expensive and burdensome fortheir patients. In countries where the popu-lation is already poor, directly observedtherapy over six months, or up to two yearsin the case of multi-drug resistance, can beimpractical, even impossible.

At the end of their virtual mission, each vis-itor will have the opportunity to debrief withMSF staff and volunteers, many of whomhave actually confronted these challengesin the field. It is the experiences of MSFfield volunteers that have informed the cre-ation of the exhibit, and while the messageis often one of frustration, it is equally oneof hope. “With good nursing care, treat-ment of infections, and the introduction of

ARVs [antiretroviral medications], our teamhad excellent success at bringing a lot ofpeople ‘back to life’ – from being on theirdeath-beds to becoming well enough tolead normal lives after a few months oftreatment,” recalls Dr. Peter Saranchuk ofhis work with AIDS patients in a SouthAfrican hospice. Last year MSF’s AIDS proj-ects in 29 countries provided treatment tomore than 60,000 patients, approximately3,500 of them children.

The MSF Expo will profile four diseases infour different countries, and it is hopedthat the exhibition will encourage visitorsto learn more, and perhaps even to takeaction themselves. MSF’s work to improvediagnosis and treatment for neglected

diseases is a multi-pronged effort, aimingto encourage research and developmentfor new diagnostic tools and drugs, moreflexible legislation which will allow forbetter access to lower-cost generic med-ications, and expanded treatment of neg-lected diseases in resource-poor and inse-cure settings. Visitors to the Expo willlearn how Canada and individualCanadians can make a difference, includ-ing signing a petition to join us in callingupon the Canadian government to domore, and supporting our field workers intheir medical work.

For more information about the Expo,visit us at www.msf.ca.

MSF EXPO 2006ON MISSION IN CANADA

Awoman was dying, and there was one drug that the doctors thought mightsave her. It had been discovered by a local druggist who made it at

considerable personal expense. The druggist was, however, charging 10 timeswhat the drug cost to produce. The sick woman’s husband went to everyone heknew to borrow the money, but could only raise about $1,000 – half of theprice of the drug. He told the druggist that his wife was dying and asked himto sell it more cheaply or allow him to pay later, but the druggist refused. Theman became desperate, broke into the store, and stole the drug for his wife.

Every year, millions of people worldwide die unnecessarily from diseasebecause they are poor. The connection between poverty and lack of access tomedicines can seem as simple as the story above, but the underlying causesand the search for viable solutions is highly complex. These include issues ofinternational law, investment in research and development (R&D)overwhelmingly directed at patients in developed countries, and thewillingness and capacity of governments to provide adequate treatments forpeople in poor and often remote parts of the world.

Médecins Sans Frontières (MSF) is dedicated to ensuring that access toessential medicines for neglected diseases remains on the agenda of theworld’s policy-makers. This edition of Dispatches and the interactive MSF Expotouring Ontario and Quebec this summer both aim to raise awareness of theplight of millions whose access to life-saving drugs is severely restricted bypoverty and lack of political will. Years of innovative field work and advocacyare yielding results, however, and MSF has been a driving force behind severalrecent initiatives, including the World Health Assembly resolution in May2006 to establish a global plan of action to address the current crisis in R&D.

Such potential breakthroughs, however, cannot be considered a solution to theaccess to medicines crisis. This summer offers an opportunity for instigatingeven greater change. In August 2006, Toronto will host the XVI InternationalAIDS Conference, bringing together approximately 20,000 participants fromaround the world. MSF will be there, presenting research and lessons learned,and pushing for more rapid progress. One of the key messages will be thecritical role of governments as a driving force for aggressive, needs-based R&D,and MSF will call upon the Canadian government to take up the challenge.

The story at the top of this page is actually a hypothetical dilemma designedby a psychologist more than 50 years ago as a tool to examine human morality.Presented with this scenario, the people judged to have reached the higheststage of moral reasoning were those who recognised that a human life hasgreater value than money or property. As a global society, we have not yetevolved this far, but with your help we are coming closer.

Please visit our website at www.msf.ca to learn more about neglecteddiseases and access to essential medicines, including our message to PrimeMinister Stephen Harper about the role the Canadian Government can play inmaking drugs more accessible to the people who need them.

Ben Chapman - General director (Interim)MSF Canada

© linda o. nagy © MSF

© linda o. nagy

Ottawa . . . . . . . . . May 17-28Hamilton . . . . May 31 - June 4Windsor . . . . . . . . . June 7-11London . . . . . . . . . June 14-18Montreal . . . . June 28 - July 9Sherbrooke . . . . . . July 12-16Québec City . . . . . . July 19-23Toronto . . . . . . . . August 2-18

EXPO 2006WILL VISIT THE FOLLOWING CITIES THIS SUMMER: OTTAWA

HAMILTON

WINDSOR

LONDON

MONTREAL

SHERBROOKE

QUÉBEC CITY

TORONTO

For exact locations or to learn more about the Expo, visit www.msf.ca

Médecins Sans Frontières’ (MSF)ongoing campaign to improve access

to essential medicines for the world’spoorest was, in a sense, a direct result offrustration. Around the world, in countryafter country, MSF’s doctors were con-fronted by disease on a mass scale – hun-dreds or even thousands of patients whoneeded life-saving treatment – and werehamstrung in their ability to help becausediagnostic tools were too old or becausethe drugs they needed were too expensive.For many, accustomed to the resourcesavailable in the health systems of wealthycountries, this was outrageous.

This summer Canadians will have theopportunity to get a small taste of what thisexperience is like. The MSF Expo is aninteractive exhibit touring eight cities acrossOntario and Québec, giving Canadians anopportunity to ‘go on mission’ with MSF andconfront for themselves some of the world’smost neglected diseases.

An anticipated 10,000 visitors to the Expo’s48-foot trailer will spin a wheel to decidewhich country they will work in, each withits own distinct challenges. Those on mis-sion in Bolivia, for example, will confrontChagas, a disease virtually unheard of inCanada, but which takes the lives of an esti-mated 50,000 people each year in LatinAmerica. In Uzbekistan the challenge istuberculosis (TB), particularly in its multi-drug resistant form. Depending primarily ona diagnostic test developed in 1882 and ondrugs developed in the 1950s and 60s,


M S F E x p o 2 0 0 6

volunteers struggle to provide treatmentsthat are expensive and burdensome fortheir patients. In countries where the popu-lation is already poor, directly observedtherapy over six months, or up to two yearsin the case of multi-drug resistance, can beimpractical, even impossible.

At the end of their virtual mission, each vis-itor will have the opportunity to debrief withMSF staff and volunteers, many of whomhave actually confronted these challengesin the field. It is the experiences of MSFfield volunteers that have informed the cre-ation of the exhibit, and while the messageis often one of frustration, it is equally oneof hope. “With good nursing care, treat-ment of infections, and the introduction of

ARVs [antiretroviral medications], our teamhad excellent success at bringing a lot ofpeople ‘back to life’ – from being on theirdeath-beds to becoming well enough tolead normal lives after a few months oftreatment,” recalls Dr. Peter Saranchuk ofhis work with AIDS patients in a SouthAfrican hospice. Last year MSF’s AIDS proj-ects in 29 countries provided treatment tomore than 60,000 patients, approximately3,500 of them children.

The MSF Expo will profile four diseases infour different countries, and it is hopedthat the exhibition will encourage visitorsto learn more, and perhaps even to takeaction themselves. MSF’s work to improvediagnosis and treatment for neglected

diseases is a multi-pronged effort, aimingto encourage research and developmentfor new diagnostic tools and drugs, moreflexible legislation which will allow forbetter access to lower-cost generic med-ications, and expanded treatment of neg-lected diseases in resource-poor and inse-cure settings. Visitors to the Expo willlearn how Canada and individualCanadians can make a difference, includ-ing signing a petition to join us in callingupon the Canadian government to domore, and supporting our field workers intheir medical work.

For more information about the Expo,visit us at www.msf.ca.

MSF EXPO 2006ON MISSION IN CANADA

Awoman was dying, and there was one drug that the doctors thought mightsave her. It had been discovered by a local druggist who made it at

considerable personal expense. The druggist was, however, charging 10 timeswhat the drug cost to produce. The sick woman’s husband went to everyone heknew to borrow the money, but could only raise about $1,000 – half of theprice of the drug. He told the druggist that his wife was dying and asked himto sell it more cheaply or allow him to pay later, but the druggist refused. Theman became desperate, broke into the store, and stole the drug for his wife.

Every year, millions of people worldwide die unnecessarily from diseasebecause they are poor. The connection between poverty and lack of access tomedicines can seem as simple as the story above, but the underlying causesand the search for viable solutions is highly complex. These include issues ofinternational law, investment in research and development (R&D)overwhelmingly directed at patients in developed countries, and thewillingness and capacity of governments to provide adequate treatments forpeople in poor and often remote parts of the world.

Médecins Sans Frontières (MSF) is dedicated to ensuring that access toessential medicines for neglected diseases remains on the agenda of theworld’s policy-makers. This edition of Dispatches and the interactive MSF Expotouring Ontario and Quebec this summer both aim to raise awareness of theplight of millions whose access to life-saving drugs is severely restricted bypoverty and lack of political will. Years of innovative field work and advocacyare yielding results, however, and MSF has been a driving force behind severalrecent initiatives, including the World Health Assembly resolution in May2006 to establish a global plan of action to address the current crisis in R&D.

Such potential breakthroughs, however, cannot be considered a solution to theaccess to medicines crisis. This summer offers an opportunity for instigatingeven greater change. In August 2006, Toronto will host the XVI InternationalAIDS Conference, bringing together approximately 20,000 participants fromaround the world. MSF will be there, presenting research and lessons learned,and pushing for more rapid progress. One of the key messages will be thecritical role of governments as a driving force for aggressive, needs-based R&D,and MSF will call upon the Canadian government to take up the challenge.

The story at the top of this page is actually a hypothetical dilemma designedby a psychologist more than 50 years ago as a tool to examine human morality.Presented with this scenario, the people judged to have reached the higheststage of moral reasoning were those who recognised that a human life hasgreater value than money or property. As a global society, we have not yetevolved this far, but with your help we are coming closer.

Please visit our website at www.msf.ca to learn more about neglecteddiseases and access to essential medicines, including our message to PrimeMinister Stephen Harper about the role the Canadian Government can play inmaking drugs more accessible to the people who need them.

Ben Chapman - General director (Interim)MSF Canada

© linda o. nagy © MSF

© linda o. nagy

ACCESS


Another day of work in Guatemala. Weput on our shirts with the little red fig-

ure placed strategically over the heart andset off to see our patients, whose averageage is 10. These are children who are ill,who will one day be disabled, not becausethey are missing a limb or are deprived ofone of their senses, but because of aninsufficiency in their heart: insufficient towork, insufficient to run and, sometimes,insufficient to sustain life. These patientshave Chagas disease which, among itsnumerous long-term complications, willproduce a cardiac insufficiency.

Insufficiency begins here even before birth.With luck, the pregnancy will continue tofull term and the baby will be born at home,in the insufficiently sanitary conditions ofwhat are called ‘rubbish’ houses: bamboocane structures covered with dried bananaleaves, themselves insufficient to accom-modate 10 people. Everything should con-tinue well if the insufficient nutritionalstate of the mother, based on a diet of corntortillas and frijoles, allows, but it shouldn’tbe forgotten that this mother, whose average age at the time of her first birth isbetween 14 and 16, could herself alreadyhave Chagas, in which case fate has playedher hand from the beginning.

In this land, luck is a variable commodityand when it touches someone, it is gener-ally insufficient.

Returning to our patient; assuming that hehas started life with luck on his side, with noworse problems than insufficient nutrition,hard work from early childhood, insufficienteducation, and minimal hygiene and healthcare, he reaches adolescence and will con-tinue to forge his path in a world full ofinsufficiencies not solely cardiac-related.

Further along he will realise that his salaryis insufficient to feed his family or buymedicine for him or his children. The pro-duction of medicines used to treat Chagasis insufficient because, according to thosewho produce them, there is an insufficientnumber of clients with purchasing power.The final straw is that he will have insuffi-cient symptoms for a doctor with insuffi-cient knowledge of the disease to detect itin time, since this illness, Chagas, is insuf-ficiently known not only by doctors, but bythe general population.

So the lives of these people pass by, fullof insufficiencies. It is the perfect breed-ing ground for diseases like Chagas,tuberculosis, AIDS, and a potentially very

long list of ills that continue to take thelives of the poorest of the poor. Thestrangest thing of all is that the numberscontinue to rise. They make up millionsall over the world and nobody with suffi-cient power to act can find sufficient rea-sons to put an end to all of this.

Jorge NyariMedical doctor, Guatemala

(Text translated from Spanish)

C h a g a s

Every day, worldwide, approximately35,000 people die from diseases like

malaria, tuberculosis, HIV/AIDS and kalaazar. It is an enormous toll, yet the issueremains low on the list of international pri-orities. In 1999, using the media attentionand funding awarded with the Nobel PeacePrize, Médecins Sans Frontières (MSF) setout to change this, launching the Campaignfor Access to Essential Medicines. This ini-tiative seeks to improve access to affordablemedications for the world’s poorest, to lowerthe prices of existing medicines, to bringabandoned drugs back into production, tostimulate research and development for dis-eases that primarily affect the poor, and toovercome other barriers to access.

The campaign has been marked by signifi-cant successes, but there remains an enor-mous amount of work to be done. AIDStherapy can now cost as little as $165 perpatient per year, as compared to more than$10,000 four years ago, for example, butsecond-line antiretroviral treatment cancost four to 10 times more than first-linetreatments, even at discounted prices.

In 2003 MSF joined forces with six otherorganisations to form the Drugs forNeglected Diseases initiative (DNDi), fos-tering international collaboration, particu-

larly with and between developing coun-tries, to share knowledge and stimulateresearch and development.

Neglected diseases are those which primari-ly affect people in developing countries andwhich do not represent a commerciallyviable market for pharmaceutical compa-nies. While some of these are better-known,like tuberculosis, malaria and HIV/AIDS,others fall well beneath the radar in coun-tries like Canada: human African trypanoso-miasis (sleeping sickness), Chagas diseaseand schistosomiasis, to name but a few.While we hear little about these diseases,the toll that they take internationally is enor-mous. Each year malaria is estimated to killbetween one and two million people, whileChagas claims an estimated 50,000 lives.

The challenges of preventing, diagnosingand treating these diseases are enormous.They are prevalent primarily in poor coun-tries with insufficient infrastructure andwhere highly trained medical personnel arethin on the ground. Victims of these dis-eases often also suffer from poverty andfrom stigma associated with their diseases.These enormous barriers are compoundedby the lack of options available: tuberculo-sis diagnosis and treatment tools that arenot available for infants, children’s dosages

of HIV/AIDS drugs that must be manuallyderived with painstaking care from adult-sized pills, and treatments for sleepingsickness and kala azar that are dangerous,painful and have not been updated sincethe 1930s and 40s.

For many years, the international communi-ty simply refused to acknowledge the scopeof the problem. Not only is research anddevelopment commercially unpalatable,but diagnostic tools and treatment optionsare very difficult to implement in resource-poor and conflict-affected countries. MSF’s pioneering work, particularly withHIV/ AIDS, has shown that this is not onlypossible, but critical. Treatment affects notonly individual health, but also the healthof communities that are often crippled bythe socio-economic impact of disease. MSFcontinues to campaign actively for thedevelopment of simple, adaptable, afford-able tools that can be used to curtail thedeadly impact of neglected diseases in theworld’s poorest countries.

For more information about theCampaign for Access to EssentialMedicines, please visit us atwww.accessmed-msf.org.

D N D i

TO ESSENTIAL MEDICINES & DRUGS FOR NEGLECTED DISEASES

Insufficiencies and the suffering caused by

CHAGAS

American trypanosomiasis, or Chagasdisease, is caused by insects oftenfound in cracks in the walls and roofsof the mud and straw housing commonin poor rural areas and urban slums ofLatin America. The bite is rarely visibleand there are usually no obvious symp-toms during the acute phase, allowingthe parasite to multiply in the body foryears, even decades. When the chronicphase begins, it is generally already toolate for treatment: symptoms such asheart failure can be irreversible, caus-ing gradual illness and resulting in asignificant decrease in quality of lifeand life expectancy.

© Christian Schwetz © Eric Miller

© Juan Carlos Tomasi

ACCESS


Another day of work in Guatemala. Weput on our shirts with the little red fig-

ure placed strategically over the heart andset off to see our patients, whose averageage is 10. These are children who are ill,who will one day be disabled, not becausethey are missing a limb or are deprived ofone of their senses, but because of aninsufficiency in their heart: insufficient towork, insufficient to run and, sometimes,insufficient to sustain life. These patientshave Chagas disease which, among itsnumerous long-term complications, willproduce a cardiac insufficiency.

Insufficiency begins here even before birth.With luck, the pregnancy will continue tofull term and the baby will be born at home,in the insufficiently sanitary conditions ofwhat are called ‘rubbish’ houses: bamboocane structures covered with dried bananaleaves, themselves insufficient to accom-modate 10 people. Everything should con-tinue well if the insufficient nutritionalstate of the mother, based on a diet of corntortillas and frijoles, allows, but it shouldn’tbe forgotten that this mother, whose average age at the time of her first birth isbetween 14 and 16, could herself alreadyhave Chagas, in which case fate has playedher hand from the beginning.

In this land, luck is a variable commodityand when it touches someone, it is gener-ally insufficient.

Returning to our patient; assuming that hehas started life with luck on his side, with noworse problems than insufficient nutrition,hard work from early childhood, insufficienteducation, and minimal hygiene and healthcare, he reaches adolescence and will con-tinue to forge his path in a world full ofinsufficiencies not solely cardiac-related.

Further along he will realise that his salaryis insufficient to feed his family or buymedicine for him or his children. The pro-duction of medicines used to treat Chagasis insufficient because, according to thosewho produce them, there is an insufficientnumber of clients with purchasing power.The final straw is that he will have insuffi-cient symptoms for a doctor with insuffi-cient knowledge of the disease to detect itin time, since this illness, Chagas, is insuf-ficiently known not only by doctors, but bythe general population.

So the lives of these people pass by, fullof insufficiencies. It is the perfect breed-ing ground for diseases like Chagas,tuberculosis, AIDS, and a potentially very

long list of ills that continue to take thelives of the poorest of the poor. Thestrangest thing of all is that the numberscontinue to rise. They make up millionsall over the world and nobody with suffi-cient power to act can find sufficient rea-sons to put an end to all of this.

Jorge NyariMedical doctor, Guatemala

(Text translated from Spanish)

C h a g a s

Every day, worldwide, approximately35,000 people die from diseases like

malaria, tuberculosis, HIV/AIDS and kalaazar. It is an enormous toll, yet the issueremains low on the list of international pri-orities. In 1999, using the media attentionand funding awarded with the Nobel PeacePrize, Médecins Sans Frontières (MSF) setout to change this, launching the Campaignfor Access to Essential Medicines. This ini-tiative seeks to improve access to affordablemedications for the world’s poorest, to lowerthe prices of existing medicines, to bringabandoned drugs back into production, tostimulate research and development for dis-eases that primarily affect the poor, and toovercome other barriers to access.

The campaign has been marked by signifi-cant successes, but there remains an enor-mous amount of work to be done. AIDStherapy can now cost as little as $165 perpatient per year, as compared to more than$10,000 four years ago, for example, butsecond-line antiretroviral treatment cancost four to 10 times more than first-linetreatments, even at discounted prices.

In 2003 MSF joined forces with six otherorganisations to form the Drugs forNeglected Diseases initiative (DNDi), fos-tering international collaboration, particu-

larly with and between developing coun-tries, to share knowledge and stimulateresearch and development.

Neglected diseases are those which primari-ly affect people in developing countries andwhich do not represent a commerciallyviable market for pharmaceutical compa-nies. While some of these are better-known,like tuberculosis, malaria and HIV/AIDS,others fall well beneath the radar in coun-tries like Canada: human African trypanoso-miasis (sleeping sickness), Chagas diseaseand schistosomiasis, to name but a few.While we hear little about these diseases,the toll that they take internationally is enor-mous. Each year malaria is estimated to killbetween one and two million people, whileChagas claims an estimated 50,000 lives.

The challenges of preventing, diagnosingand treating these diseases are enormous.They are prevalent primarily in poor coun-tries with insufficient infrastructure andwhere highly trained medical personnel arethin on the ground. Victims of these dis-eases often also suffer from poverty andfrom stigma associated with their diseases.These enormous barriers are compoundedby the lack of options available: tuberculo-sis diagnosis and treatment tools that arenot available for infants, children’s dosages

of HIV/AIDS drugs that must be manuallyderived with painstaking care from adult-sized pills, and treatments for sleepingsickness and kala azar that are dangerous,painful and have not been updated sincethe 1930s and 40s.

For many years, the international communi-ty simply refused to acknowledge the scopeof the problem. Not only is research anddevelopment commercially unpalatable,but diagnostic tools and treatment optionsare very difficult to implement in resource-poor and conflict-affected countries. MSF’s pioneering work, particularly withHIV/ AIDS, has shown that this is not onlypossible, but critical. Treatment affects notonly individual health, but also the healthof communities that are often crippled bythe socio-economic impact of disease. MSFcontinues to campaign actively for thedevelopment of simple, adaptable, afford-able tools that can be used to curtail thedeadly impact of neglected diseases in theworld’s poorest countries.

For more information about theCampaign for Access to EssentialMedicines, please visit us atwww.accessmed-msf.org.

D N D i

TO ESSENTIAL MEDICINES & DRUGS FOR NEGLECTED DISEASES

Insufficiencies and the suffering caused by

CHAGAS

American trypanosomiasis, or Chagasdisease, is caused by insects oftenfound in cracks in the walls and roofsof the mud and straw housing commonin poor rural areas and urban slums ofLatin America. The bite is rarely visibleand there are usually no obvious symp-toms during the acute phase, allowingthe parasite to multiply in the body foryears, even decades. When the chronicphase begins, it is generally already toolate for treatment: symptoms such asheart failure can be irreversible, caus-ing gradual illness and resulting in asignificant decrease in quality of lifeand life expectancy.

© Christian Schwetz © Eric Miller

© Juan Carlos Tomasi


UNAIDS reported in December 2005 thatsome 40 million people worldwide are

living with HIV/AIDS. Of the 6.5 million peo-ple in developing and transitional countrieswho urgently need life-saving AIDS drugs,only 1.3 million are receiving them. Despitepromises and speeches, not enough is beingdone to make sure that the drugs needed toincrease and sustain treatment are accessi-ble to those who need them to stay alive.

Providing over 60,000 patients with life-prolonging antiretroviral (ARV) medicines in29 countries, Médecins Sans Frontières(MSF) teams know first-hand the successfuloutcomes of treatment of adults and chil-dren in resource-poor settings. Thesepatients provide living testimony that it canbe done. But for how long?

Patients will inevitably need second-linedrugs after a few years on treatment,

because resistance develops. Today thesenew drugs are far too expensive. Withoutsome dramatic price reductions, patientsrisk having vital treatment interruptedbecause it is priced out of their reach.Research and development on new medi-cines and diagnostics must be increaseddramatically. These are just some of themany barriers to treatment.

H I V / A I D S

NEW, ADAPTED AND AFFORDABLEMEDICINES NEEDED URGENTLY

“If [my pills] are not kept in the refrigerator,after 4 weeks at an average temperature of45 degrees, this is what you have: a uselessblob of melted pills... As sweet as [a newversion of the drug Kaletra] may sound, asit does not need refrigeration, it does notexist here. This makes nonsense of thewhole effort. If these drugs are not here, alot of lives will be put in danger.”- Ibrahim U., patient in MSF programme

in Lagos, Nigeria

Non-refrigerated versions like the oneIbrahim describes are still only available inthe United States where, ironically, 99 percent of the population has a refrigerator.

DEADLY DUO: TUBERCULOSIS AND AIDS CO-INFECTION

Tuberculosis (TB) is a common opportunis-tic infection, and a leading cause of mortal-ity among people with HIV/AIDS. Early TBdiagnosis, prompt treatment and access toARVs are essential to prolong lives. In ruralChina, a study conducted by MSF showedthat one in four HIV-positive persons arediagnosed with active TB. Of these, a con-siderable proportion are unable to complete

anti-TB treatment, and many die. The mostrecent drugs for TB are more than 50 yearsold, and existing diagnostic tools are out-dated and inadequate.

"I am sick and tired of watching TB killmy patients. It often feels as though Ipractice medicine with my hands tiedbehind my back. Since I have to use a19th–century diagnostic tool that iswrong more times than not, it is like beingblindfolded as well." - Dr. Martha Bedelu, an MSF physician

working in South Africa

AIDS SPOTLIGHT IN TORONTO AUGUST 2006: DON’T TURN IT OFF

The XVI International AIDS Conference, amajor biennial conference on the AIDSpandemic, takes place in Toronto from Aug. 13 to 18, 2006. There is no doubtthat people in Canada and around the worldwill be hearing a lot about AIDS this sum-mer. But the attention and action must besustained much longer than just one week.

MSF teams see the daily reality of AIDS:patients, including children, who will diewithout treatment but who cannot affordthe ARV medicines taken for granted indeveloped countries. Our doctors grapple

with medicines ill-adapted for poor coun-tries, lack of formulations for children withAIDS, lack of infrastructure and inadequatehuman resources.

At the same time, MSF programmes pro-vide results, not least of which is thenumber of people whose lives have beenprolonged. They also provide valuableresearch data that outlines needs, lessonslearned, barriers and successes.Importantly, MSF also bears witness tothe effectiveness of treatment inresource-poor settings, and how livesimprove drastically when people have thetreatment they need.

“I am a mother of two. I have been livingwith HIV for 11 years now and have beenon ARVs for one year, eight months. Livingopenly with my illness has been like a call-ing, especially since I am in a professionalfield. AIDS has been portrayed for poor peo-ple only, but we can come out and say,‘Anyone can get it. People don’t have to dieof AIDS.’”- Monique, student

and social economist in Kenya

Carol DevineProgramme officer

• MSF will share case studies and speak of positive outcomes for adultsand children receiving ARV treatment from Cambodia to Cape Town.

• MSF will share information on its direct medical care related to AIDSand opportunistic infections and will speak out about obstacles to pro-viding effective assistance for HIV/AIDS and related diseases.

• MSF submitted 57 scientific and non-scientific abstracts for the con-ference from AIDS programmes in over 20 countries. These representthe continuing learning process that is part of MSF’s ongoing effortsto improve HIV/AIDS treatment and care in the developing world.

• MSF Canada HIV Consultant Dr. David Tu will make a presentation on Aug. 12 at a pre-conference event: HIV/AIDS, Conflict andDisplacement. Dr. Tu will speak about his experience with ground-breaking AIDS treatment in Democratic Republic of Congo.

• MSF’s Expo on access to essential medicines tours Québec andOntario this summer, and will be in Toronto to coincide with the XVIInternational AIDS Conference.

PROVIDING OVER 60,000

PATIENTS WITH LIFE-PROLONGING

ANTIRETROVIRAL (ARV) MEDICINES

IN 29 COUNTRIES, MSF TEAMS

KNOW FIRST-HAND THE

SUCCESSFUL OUTCOMES OF

TREATMENT OF ADULTS AND

CHILDREN IN RESOURCE-POOR

SETTINGS. THESE PATIENTS

PROVIDE LIVING TESTIMONY

THAT IT CAN BE DONE.

2006XVI International AIDS Conference

LIFEtreatment for

"95 per cent of our patients are nowadhering to their treatment regimens.They know that if they really want tosurvive, they can."

- MSF counsellor Loy Diep inCambodia, where MSF provideslife-extending ARV treatment tomore than 5,400 of the 25,000people in need.

“I can’t believe it. I almostdied! I’m so excited. I can doeverything now. I am so happy.”

- Prudence Radebe. Prudenceis one of 40,000 HIV-positive people on ARVs inSouth Africa, and one ofonly 4,000 in the EasternCape, one of the poorestregions in the country. She has been taking ARVssupplied by MSF for thelast 14 months. The BBChas been following herjourney as she fights back and proves theeffectiveness of treatmentat almost any stage.

© Jonathan Torgovnik


UNAIDS reported in December 2005 thatsome 40 million people worldwide are

living with HIV/AIDS. Of the 6.5 million peo-ple in developing and transitional countrieswho urgently need life-saving AIDS drugs,only 1.3 million are receiving them. Despitepromises and speeches, not enough is beingdone to make sure that the drugs needed toincrease and sustain treatment are accessi-ble to those who need them to stay alive.

Providing over 60,000 patients with life-prolonging antiretroviral (ARV) medicines in29 countries, Médecins Sans Frontières(MSF) teams know first-hand the successfuloutcomes of treatment of adults and chil-dren in resource-poor settings. Thesepatients provide living testimony that it canbe done. But for how long?

Patients will inevitably need second-linedrugs after a few years on treatment,

because resistance develops. Today thesenew drugs are far too expensive. Withoutsome dramatic price reductions, patientsrisk having vital treatment interruptedbecause it is priced out of their reach.Research and development on new medi-cines and diagnostics must be increaseddramatically. These are just some of themany barriers to treatment.

H I V / A I D S

NEW, ADAPTED AND AFFORDABLEMEDICINES NEEDED URGENTLY

“If [my pills] are not kept in the refrigerator,after 4 weeks at an average temperature of45 degrees, this is what you have: a uselessblob of melted pills... As sweet as [a newversion of the drug Kaletra] may sound, asit does not need refrigeration, it does notexist here. This makes nonsense of thewhole effort. If these drugs are not here, alot of lives will be put in danger.”- Ibrahim U., patient in MSF programme

in Lagos, Nigeria

Non-refrigerated versions like the oneIbrahim describes are still only available inthe United States where, ironically, 99 percent of the population has a refrigerator.

DEADLY DUO: TUBERCULOSIS AND AIDS CO-INFECTION

Tuberculosis (TB) is a common opportunis-tic infection, and a leading cause of mortal-ity among people with HIV/AIDS. Early TBdiagnosis, prompt treatment and access toARVs are essential to prolong lives. In ruralChina, a study conducted by MSF showedthat one in four HIV-positive persons arediagnosed with active TB. Of these, a con-siderable proportion are unable to complete

anti-TB treatment, and many die. The mostrecent drugs for TB are more than 50 yearsold, and existing diagnostic tools are out-dated and inadequate.

"I am sick and tired of watching TB killmy patients. It often feels as though Ipractice medicine with my hands tiedbehind my back. Since I have to use a19th–century diagnostic tool that iswrong more times than not, it is like beingblindfolded as well." - Dr. Martha Bedelu, an MSF physician

working in South Africa

AIDS SPOTLIGHT IN TORONTO AUGUST 2006: DON’T TURN IT OFF

The XVI International AIDS Conference, amajor biennial conference on the AIDSpandemic, takes place in Toronto from Aug. 13 to 18, 2006. There is no doubtthat people in Canada and around the worldwill be hearing a lot about AIDS this sum-mer. But the attention and action must besustained much longer than just one week.

MSF teams see the daily reality of AIDS:patients, including children, who will diewithout treatment but who cannot affordthe ARV medicines taken for granted indeveloped countries. Our doctors grapple

with medicines ill-adapted for poor coun-tries, lack of formulations for children withAIDS, lack of infrastructure and inadequatehuman resources.

At the same time, MSF programmes pro-vide results, not least of which is thenumber of people whose lives have beenprolonged. They also provide valuableresearch data that outlines needs, lessonslearned, barriers and successes.Importantly, MSF also bears witness tothe effectiveness of treatment inresource-poor settings, and how livesimprove drastically when people have thetreatment they need.

“I am a mother of two. I have been livingwith HIV for 11 years now and have beenon ARVs for one year, eight months. Livingopenly with my illness has been like a call-ing, especially since I am in a professionalfield. AIDS has been portrayed for poor peo-ple only, but we can come out and say,‘Anyone can get it. People don’t have to dieof AIDS.’”- Monique, student

and social economist in Kenya

Carol DevineProgramme officer

• MSF will share case studies and speak of positive outcomes for adultsand children receiving ARV treatment from Cambodia to Cape Town.

• MSF will share information on its direct medical care related to AIDSand opportunistic infections and will speak out about obstacles to pro-viding effective assistance for HIV/AIDS and related diseases.

• MSF submitted 57 scientific and non-scientific abstracts for the con-ference from AIDS programmes in over 20 countries. These representthe continuing learning process that is part of MSF’s ongoing effortsto improve HIV/AIDS treatment and care in the developing world.

• MSF Canada HIV Consultant Dr. David Tu will make a presentation on Aug. 12 at a pre-conference event: HIV/AIDS, Conflict andDisplacement. Dr. Tu will speak about his experience with ground-breaking AIDS treatment in Democratic Republic of Congo.

• MSF’s Expo on access to essential medicines tours Québec andOntario this summer, and will be in Toronto to coincide with the XVIInternational AIDS Conference.

PROVIDING OVER 60,000

PATIENTS WITH LIFE-PROLONGING

ANTIRETROVIRAL (ARV) MEDICINES

IN 29 COUNTRIES, MSF TEAMS

KNOW FIRST-HAND THE

SUCCESSFUL OUTCOMES OF

TREATMENT OF ADULTS AND

CHILDREN IN RESOURCE-POOR

SETTINGS. THESE PATIENTS

PROVIDE LIVING TESTIMONY

THAT IT CAN BE DONE.

2006XVI International AIDS Conference

LIFEtreatment for

"95 per cent of our patients are nowadhering to their treatment regimens.They know that if they really want tosurvive, they can."

- MSF counsellor Loy Diep inCambodia, where MSF provideslife-extending ARV treatment tomore than 5,400 of the 25,000people in need.

“I can’t believe it. I almostdied! I’m so excited. I can doeverything now. I am so happy.”

- Prudence Radebe. Prudenceis one of 40,000 HIV-positive people on ARVs inSouth Africa, and one ofonly 4,000 in the EasternCape, one of the poorestregions in the country. She has been taking ARVssupplied by MSF for thelast 14 months. The BBChas been following herjourney as she fights back and proves theeffectiveness of treatmentat almost any stage.

© Jonathan Torgovnik


They lay there, eight women in eightchipped metal beds, four against each

wall, in the small shabby hospital room.Each was serving a term of six to ninemonths strapped in the vice-like plastercast that was their treatment shell for thespinal tuberculosis (TB) they were alljudged to have. No stimulation, no reprievein the long days and only one family mem-ber there to attend to their needs and cooktheir meagre meals. On other wards in thispost-Soviet hospital, deprived of basicamenities and essential medicines, 250patients wandered the corridors and thegrounds like ghosts searching for the lifethat was slowly and cruelly escaping them.Each would be there a minimum of ninemonths; many for years.

This is part of the picture that stays in mymind of my time volunteering as a medicaldoctor for Médecins Sans Frontières (MSF)in a tuberculosis project in Uzbekistan.

Tuberculosis, the white death, continuesto ravage this deprived, almost destituteregion of Central Asia. This once prosper-ous area, where fish from the Aral Sea fedthousands of starving Russians during thefamine after the First World War, has beendried out and cast aside now, after 80years of over-extended cotton cultivationunder an irrigation system that hasdeprived the sea of its life-giving water.The sea is now shallow, highly saline,dead and a fraction of its former size. Theport town of Muynak is over 100 kilo-metres from the shore as it recedes.

This is the Aral region of Uzbekistan andTurkmenistan where MSF arrived in1997, identified tuberculosis as a signif-icant cause of morbidity and mortality,

and started a tuberculosis diagnosis andtreatment programme.

Utilizing the World Health Organization(WHO) treatment protocol for TB, know asDirectly Observed Treatment Short Course(DOTS), MSF started from scratch, set updiagnostic labs, established treatment pro-cedures, arranged appropriate drugs, pro-vided extensive training and documentedfailures and successes.

Other than the crumbling physical struc-tures there was very little to work with.Ministry of Health staff was irregularlypaid and working with outdated equip-ment and unproven treatments. Manywere suspicious and disdainful of theMSF programme and the usurpers thatchampioned it.

Over time and through example, however,the programme made headway. Diagnosticsimproved, regular treatment with appropri-ate drugs replaced interrupted treatmentswith inappropriate drugs, and hospital stayswere confined to the infectious period only.Community treatment replaced extensiveinstitutional confinement for the non-infec-tious and most Ministry staff steadilyaccepted the new approach.

MSF continues to work in this forgottenregion along the ancient silk route but hasmodified the programme to now concen-trate on working with Ministry of Healthstaff in identifying and treating the mostdifficult and complicated cases of thewhite death: multi-drug resistant tubercu-losis (MDR TB). It has identified short-falls in the DOTS programme, made theseknown to WHO and is one of the few inter-national medical organisations that has

embarked on developing a treatmentmodel for MDR TB. MSF is learning onceagain as it moves forward.

Tuberculosis has received little attention inlaboratories and medical research centressince it largely made an exit from theWestern world thanks to improved hygieneand living conditions, as well as the discov-ery of the wonder drug Rifampicin in the1960s. The WHO had even predicted thatTB would be no more after the year 2050.

Unfortunately, unless improved medi-cines are discovered that are cheap, workover a shorter time and can be adminis-tered as one or two pills a day, there is lit-tle likelihood that tuberculosis will beconsigned to history. Many of the old frontline drugs, including Rifampicin, havedeveloped resistance. Alternative drugsare very costly, highly toxic and requireextensive usage to be hopeful of anyeffect against MDR TB. Without newefforts in research and development toaddress these concerns, the white deathwill be with us well into the future.

A further frightening and complicating fac-tor to reducing the prevalence of tuberculo-sis is the role this disease has as a co-infec-tion with HIV/AIDS. With the global spreadof HIV/AIDS, tuberculosis got a new leaseon life as a principal opportunistic infectionwith this scourge. Riding on the coat tailsof HIV/AIDS has multiplied its spread andit is now seen again in regions of the worldwhere it had been almost forgotten.

Douglas KittleMedical doctor

T u b e r c u l o s i s

• Every year, 2 million people die of TB and 8 million people develop active TB.

• One third of the world is currently infected, and16 million suffer from active TB.

• 95 % of TB cases and 98 % of TB deaths occurin poor countries. The epidemic is expected toworsen in the next few years, especially inAfrica and Southeast Asia.

• Every year over 1.5 million people acquireactive TB in sub-Saharan Africa. This number isrising rapidly as a result of the HIV/AIDSepidemic: TB is an opportunistic disease thatpreys on HIV-positive people whose immunesystems are weakened.

• TB is a leading cause of death among peoplewith AIDS, and in some regions of Africa, three-quarters of TB patients are HIV-infected.

• TB spreads through the air and is highlycontagious. On average, a person with infectiousTB infects 10-15 others every year.

WHITE DEATH IN UZBEKISTANWITNESSING

© Tom Craig


They lay there, eight women in eightchipped metal beds, four against each

wall, in the small shabby hospital room.Each was serving a term of six to ninemonths strapped in the vice-like plastercast that was their treatment shell for thespinal tuberculosis (TB) they were alljudged to have. No stimulation, no reprievein the long days and only one family mem-ber there to attend to their needs and cooktheir meagre meals. On other wards in thispost-Soviet hospital, deprived of basicamenities and essential medicines, 250patients wandered the corridors and thegrounds like ghosts searching for the lifethat was slowly and cruelly escaping them.Each would be there a minimum of ninemonths; many for years.

This is part of the picture that stays in mymind of my time volunteering as a medicaldoctor for Médecins Sans Frontières (MSF)in a tuberculosis project in Uzbekistan.

Tuberculosis, the white death, continuesto ravage this deprived, almost destituteregion of Central Asia. This once prosper-ous area, where fish from the Aral Sea fedthousands of starving Russians during thefamine after the First World War, has beendried out and cast aside now, after 80years of over-extended cotton cultivationunder an irrigation system that hasdeprived the sea of its life-giving water.The sea is now shallow, highly saline,dead and a fraction of its former size. Theport town of Muynak is over 100 kilo-metres from the shore as it recedes.

This is the Aral region of Uzbekistan andTurkmenistan where MSF arrived in1997, identified tuberculosis as a signif-icant cause of morbidity and mortality,

and started a tuberculosis diagnosis andtreatment programme.

Utilizing the World Health Organization(WHO) treatment protocol for TB, know asDirectly Observed Treatment Short Course(DOTS), MSF started from scratch, set updiagnostic labs, established treatment pro-cedures, arranged appropriate drugs, pro-vided extensive training and documentedfailures and successes.

Other than the crumbling physical struc-tures there was very little to work with.Ministry of Health staff was irregularlypaid and working with outdated equip-ment and unproven treatments. Manywere suspicious and disdainful of theMSF programme and the usurpers thatchampioned it.

Over time and through example, however,the programme made headway. Diagnosticsimproved, regular treatment with appropri-ate drugs replaced interrupted treatmentswith inappropriate drugs, and hospital stayswere confined to the infectious period only.Community treatment replaced extensiveinstitutional confinement for the non-infec-tious and most Ministry staff steadilyaccepted the new approach.

MSF continues to work in this forgottenregion along the ancient silk route but hasmodified the programme to now concen-trate on working with Ministry of Healthstaff in identifying and treating the mostdifficult and complicated cases of thewhite death: multi-drug resistant tubercu-losis (MDR TB). It has identified short-falls in the DOTS programme, made theseknown to WHO and is one of the few inter-national medical organisations that has

embarked on developing a treatmentmodel for MDR TB. MSF is learning onceagain as it moves forward.

Tuberculosis has received little attention inlaboratories and medical research centressince it largely made an exit from theWestern world thanks to improved hygieneand living conditions, as well as the discov-ery of the wonder drug Rifampicin in the1960s. The WHO had even predicted thatTB would be no more after the year 2050.

Unfortunately, unless improved medi-cines are discovered that are cheap, workover a shorter time and can be adminis-tered as one or two pills a day, there is lit-tle likelihood that tuberculosis will beconsigned to history. Many of the old frontline drugs, including Rifampicin, havedeveloped resistance. Alternative drugsare very costly, highly toxic and requireextensive usage to be hopeful of anyeffect against MDR TB. Without newefforts in research and development toaddress these concerns, the white deathwill be with us well into the future.

A further frightening and complicating fac-tor to reducing the prevalence of tuberculo-sis is the role this disease has as a co-infec-tion with HIV/AIDS. With the global spreadof HIV/AIDS, tuberculosis got a new leaseon life as a principal opportunistic infectionwith this scourge. Riding on the coat tailsof HIV/AIDS has multiplied its spread andit is now seen again in regions of the worldwhere it had been almost forgotten.

Douglas KittleMedical doctor

T u b e r c u l o s i s

• Every year, 2 million people die of TB and 8 million people develop active TB.

• One third of the world is currently infected, and16 million suffer from active TB.

• 95 % of TB cases and 98 % of TB deaths occurin poor countries. The epidemic is expected toworsen in the next few years, especially inAfrica and Southeast Asia.

• Every year over 1.5 million people acquireactive TB in sub-Saharan Africa. This number isrising rapidly as a result of the HIV/AIDSepidemic: TB is an opportunistic disease thatpreys on HIV-positive people whose immunesystems are weakened.

• TB is a leading cause of death among peoplewith AIDS, and in some regions of Africa, three-quarters of TB patients are HIV-infected.

• TB spreads through the air and is highlycontagious. On average, a person with infectiousTB infects 10-15 others every year.

WHITE DEATH IN UZBEKISTANWITNESSING

© Tom Craig

Dispatches Vol.8, Ed.2

Malaria is by far the biggest life-threaten-ing disease in the Chittagong Hill

Tracts of Bangladesh. Most tribal popula-tions in the country live in the Hill Tracts andhave poor access to health-care services.Many community leaders report the death ofone or two people with fever each month.

In the absence of proper clinical assess-ments and diagnostic tests, people inmany communities in Bangladesh receiveineffective treatment from poorly regulat-ed drug distribution, often with no physi-cian consultation. When I first arrived atthe malaria programme in the ChittagongHill Tracts with Médecins Sans Frontières(MSF), I was conflicted in my ideals abouthow to support existing traditional beliefsabout illness while ensuring a modern,aggressive implementation of Westernmedicine in treating malaria.

Accessing some communities involves driv-ing on rough, steep roads for an hour, thenhiking, climbing, and wading through waterfor an additional hour or two. Although I wasthrilled to be hiking through such a beauti-ful jungle, I could not help but think how dif-ficult it would be to transport a seriously illcommunity member to a health-care facility.

Upon arrival in a village of 40 families, theoutreach supervisor introduced me to themalaria field site worker. The malaria fieldsite worker is a community member trainedby MSF to assess and treat falciparummalaria, the parasite responsible for themajority of malaria infections and the mostlethal. This person is part of MSF’s malariafield site programme, which travels toremote locations for education, assessmentand treatment.

The village I visited that day consisted ofbuildings made entirely of resources fromthe land; the community truly appeared tobe self-sustaining. The people were full ofenergy and everyone seemed to have a role.Men and women were decorated in flowers,make-up, and jewellery. After a brief intro-duction to the area, the community mem-bers gathered for the health education pres-entation by an MSF outreach worker.

Before the presentation, a woman with afever presented herself to the malaria field

site worker. The malaria field site worker isable to diagnose falciparum malaria using aparacheck, a single-use slide that reacts toa single drop of infected blood. If theparacheck indicates that the patient has fal-ciparum malaria, the field site worker cantreat the patient with appropriate doses ofCoartem, an artemisinin-based combinationtherapy increasingly used to treat malaria.

In this case the woman withdrew from theassessment when she saw the finger prickneedle used to extract the blood. Sheepishlyshe stood away from the malaria field siteworker. The children and some other peoplein the community began clapping theirhands and singing a teasing song, until thewoman became amused and agreed to havea paracheck done. The same woman thenhelped the malaria field site worker ensurethat other people with fever got tested aswell, providing a reassuring message aboutthe process to the community.

All of this was evidence that this communi-ty approved and encouraged the life-savingmalaria field programme. In my opinion,when treating malaria in communities thatare difficult to access, community involve-ment is crucial.

Kevin BarlowRegistered nurse

Bandarban, Bangladesh

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

page 11

M a l a r i a

MALARIA KILLS BETWEEN 1 AND 2

MILLION PEOPLE EVERY YEAR, ITS

HIGHEST TOLL AMONG THE MOST

VULNERABLE: YOUNG CHILDREN IN

REMOTE RURAL AREAS, PREGNANT

WOMEN, AND REFUGEES OR

DISPLACED PERSONS.

Chloroquine, one of the most commonantimalarial drugs, was developed in

1934. It represented the ideal drug:effective, very cheap to produce (approxi-mately 20 cents per treatment), and easyto administer. But after 60 years of use,its effectiveness has decreased dramati-cally due to growing drug resistance.

Scientists now agree that the most effective treatment for malaria is a com-bination of drugs using artemisinin derivatives, highly potent extracts of the Chinese plant Artemesia annua.Artemisinin-based combination therapy

(ACT) is the quickest and most reliableway of clearing malaria infection, and it isvery well tolerated. Using a combinationof drugs shortens the treatment course,and has been shown to protect each indi-vidual drug from resistance.

In 2005, MSF treated approximately 1.8million malaria patients in 40 countriesin Africa, Asia and Latin America. MSFhas been advocating for ACTs since 2001and uses them consistently in its pro-grammes worldwide.

The World Health Organization (WHO) isnow actively encouraging malaria-endemic countries to switch to ACT.Overall, 40 countries in the world haveincluded ACT in their malaria treatmentprotocols and a further 14 are consider-ing doing so. However, of these, over 70per cent are either not applying the poli-cy at all, or are implementing it veryslowly. This is due to a combination ofobstacles, including lack of political willand financial and human resources; lack

of training for health workers and theresulting poor recognition of the benefitsof ACTs among the communities; short-ages of ACTs of assured quality; the factthat health workers do not have access torapid diagnostic tests; and poor access tohealth care in general. So malaria, a cur-able disease, continues to kill a childevery 30 seconds.

“Without rapid steps to ensure that effec-tive drugs actually reach the people whoneed them, governments’ decisionsremain virtual and end up having nomeaning for those who were supposed tobenefit from them,” says Dr. KarimLaouabdia, director of MSF’s Campaignfor Access to Essential Medicines.“Giving patients chloroquine againstmalaria is about as effective as givingthem a bag of sugar - medically and ethi-cally, it is just wrong. We know imple-menting ACTs is no easy task, but no oneshould be allowed to drag their feet inmaking sure these life-saving drugs get toall those who need them.”

malaria treatmentCOMMUNITY-BASED

reach patientsEFFECTIVE DRUGS MUST

MALARIA KILLS ONE AFRICAN CHILD

EVERY 30 SECONDS AND IS THE

LEADING CAUSE OF DEATH FOR

CHILDREN UNDER FIVE YEARS OF AGE.

© Stephan Grosse Rüschkamp/MSF © Sebastian Bolesch

© Carlos Quarenghi

© Stephan Grosse Rüschkamp/MSF


Malaria is by far the biggest life-threaten-ing disease in the Chittagong Hill

Tracts of Bangladesh. Most tribal popula-tions in the country live in the Hill Tracts andhave poor access to health-care services.Many community leaders report the death ofone or two people with fever each month.

In the absence of proper clinical assess-ments and diagnostic tests, people inmany communities in Bangladesh receiveineffective treatment from poorly regulat-ed drug distribution, often with no physi-cian consultation. When I first arrived atthe malaria programme in the ChittagongHill Tracts with Médecins Sans Frontières(MSF), I was conflicted in my ideals abouthow to support existing traditional beliefsabout illness while ensuring a modern,aggressive implementation of Westernmedicine in treating malaria.

Accessing some communities involves driv-ing on rough, steep roads for an hour, thenhiking, climbing, and wading through waterfor an additional hour or two. Although I wasthrilled to be hiking through such a beauti-ful jungle, I could not help but think how dif-ficult it would be to transport a seriously illcommunity member to a health-care facility.

Upon arrival in a village of 40 families, theoutreach supervisor introduced me to themalaria field site worker. The malaria fieldsite worker is a community member trainedby MSF to assess and treat falciparummalaria, the parasite responsible for themajority of malaria infections and the mostlethal. This person is part of MSF’s malariafield site programme, which travels toremote locations for education, assessmentand treatment.

The village I visited that day consisted ofbuildings made entirely of resources fromthe land; the community truly appeared tobe self-sustaining. The people were full ofenergy and everyone seemed to have a role.Men and women were decorated in flowers,make-up, and jewellery. After a brief intro-duction to the area, the community mem-bers gathered for the health education pres-entation by an MSF outreach worker.

Before the presentation, a woman with afever presented herself to the malaria field

site worker. The malaria field site worker isable to diagnose falciparum malaria using aparacheck, a single-use slide that reacts toa single drop of infected blood. If theparacheck indicates that the patient has fal-ciparum malaria, the field site worker cantreat the patient with appropriate doses ofCoartem, an artemisinin-based combinationtherapy increasingly used to treat malaria.

In this case the woman withdrew from theassessment when she saw the finger prickneedle used to extract the blood. Sheepishlyshe stood away from the malaria field siteworker. The children and some other peoplein the community began clapping theirhands and singing a teasing song, until thewoman became amused and agreed to havea paracheck done. The same woman thenhelped the malaria field site worker ensurethat other people with fever got tested aswell, providing a reassuring message aboutthe process to the community.

All of this was evidence that this communi-ty approved and encouraged the life-savingmalaria field programme. In my opinion,when treating malaria in communities thatare difficult to access, community involve-ment is crucial.

Kevin BarlowRegistered nurse

Bandarban, Bangladesh

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

page 11

M a l a r i a

MALARIA KILLS BETWEEN 1 AND 2

MILLION PEOPLE EVERY YEAR, ITS

HIGHEST TOLL AMONG THE MOST

VULNERABLE: YOUNG CHILDREN IN

REMOTE RURAL AREAS, PREGNANT

WOMEN, AND REFUGEES OR

DISPLACED PERSONS.

Chloroquine, one of the most commonantimalarial drugs, was developed in

1934. It represented the ideal drug:effective, very cheap to produce (approxi-mately 20 cents per treatment), and easyto administer. But after 60 years of use,its effectiveness has decreased dramati-cally due to growing drug resistance.

Scientists now agree that the most effective treatment for malaria is a com-bination of drugs using artemisinin derivatives, highly potent extracts of the Chinese plant Artemesia annua.Artemisinin-based combination therapy

(ACT) is the quickest and most reliableway of clearing malaria infection, and it isvery well tolerated. Using a combinationof drugs shortens the treatment course,and has been shown to protect each indi-vidual drug from resistance.

In 2005, MSF treated approximately 1.8million malaria patients in 40 countriesin Africa, Asia and Latin America. MSFhas been advocating for ACTs since 2001and uses them consistently in its pro-grammes worldwide.

The World Health Organization (WHO) isnow actively encouraging malaria-endemic countries to switch to ACT.Overall, 40 countries in the world haveincluded ACT in their malaria treatmentprotocols and a further 14 are consider-ing doing so. However, of these, over 70per cent are either not applying the poli-cy at all, or are implementing it veryslowly. This is due to a combination ofobstacles, including lack of political willand financial and human resources; lack

of training for health workers and theresulting poor recognition of the benefitsof ACTs among the communities; short-ages of ACTs of assured quality; the factthat health workers do not have access torapid diagnostic tests; and poor access tohealth care in general. So malaria, a cur-able disease, continues to kill a childevery 30 seconds.

“Without rapid steps to ensure that effec-tive drugs actually reach the people whoneed them, governments’ decisionsremain virtual and end up having nomeaning for those who were supposed tobenefit from them,” says Dr. KarimLaouabdia, director of MSF’s Campaignfor Access to Essential Medicines.“Giving patients chloroquine againstmalaria is about as effective as givingthem a bag of sugar - medically and ethi-cally, it is just wrong. We know imple-menting ACTs is no easy task, but no oneshould be allowed to drag their feet inmaking sure these life-saving drugs get toall those who need them.”

malaria treatmentCOMMUNITY-BASED

reach patientsEFFECTIVE DRUGS MUST

MALARIA KILLS ONE AFRICAN CHILD

EVERY 30 SECONDS AND IS THE

LEADING CAUSE OF DEATH FOR

CHILDREN UNDER FIVE YEARS OF AGE.

© Stephan Grosse Rüschkamp/MSF © Sebastian Bolesch

© Carlos Quarenghi

© Stephan Grosse Rüschkamp/MSF


H I V / T B c o - i n f e c t i o n

Imagine you haven’t been feeling well forweeks. You’ve been coughing, and wake

up during the night sweating so much thesheets are soaked. You don’t feel like eatingand have lost five kilograms.

Your spouse died a few years earlier fromtuberculosis (TB), so a family member rec-ommends that you go to the local clinic fora test. You give the nurse there two sputumsamples, and are told to come back in twoweeks for test results.

The local laboratory uses the conventionaltest to diagnose TB, examining sputum

samples under a microscope to find TBgerms. In your case, they can’t find any, soyour samples are reported as negative. Atyour follow-up clinic appointment, you aretold that you don’t have TB. But you arefeeling worse: the cough is no better, you’velost another five kilograms, and you havenever felt so tired. What is going on?

You are, in fact, a victim of the new era ofTB, a consequence of the HIV pandemic.Your spouse unknowingly passed on HIV toyou, and the virus has gradually weakenedyour immune system. Despite what theclinic nurse told you, you are suffering fromtuberculosis of the lungs; the TB germs aremultiplying inside your lungs and are caus-ing the cough, night sweats and weightloss. But the test traditionally used to diag-nose TB (microscopy) no longer works inthe majority of people who are co-infectedwith both HIV and TB.

There are two ways this scenario can go now:

1. You have some money saved, and youuse it to see a private doctor who sendsyou for a chest X-ray. The doctor sees evi-dence of tuberculosis and refers you tothe TB clinic to start treatment. The goodnews is that you gradually start to feelbetter: the night sweats are gone, your

cough and appetite improve, and youstart to regain weight. The bad news isthat the TB treatment lasts six months,and the clinic insists on “directly-observed treatment” (DOTS), whichmeans you have to go in person everyday, without exception, to receive themedication. As a result, you have to stopworking for six months.

You are poorer in six months, but atleast the TB has been cured. Then yourprivate doctor tells you that you needantiretrovirals (ARVs) to improve yourweakened immune system (a result ofHIV), and prevent further life-threaten-ing infections. You can’t afford theARVs and go on to suffer from repeatedinfections until you eventually die froma brain infection the following year.

2. You don’t have any money to see a pri-vate doctor or get an X-ray. The doctorwho used to work in the public clinic hasleft to work in a Western country, andthey haven’t been able to find a replace-ment. You see the clinic nurse again,who gives you some vitamins and aweek’s worth of antibiotics. But these donot help. You gradually get sicker as theTB germs multiply and spread insideyour body. You start to vomit regularly

and lose more weight. You soon becomebed-ridden and your children do theirbest to make you comfortable at home.You die later that month from undiag-nosed TB, simply because there was noquick and accurate test available to diag-nose TB in HIV-positive people. Your fourchildren are now orphans.

This last scenario in particular is notunusual; it takes place over and overagain in every community around theworld where HIV prevalence is high.Countless people are dying from tubercu-losis of the lungs (pulmonary TB) simplybecause the traditional test is not accu-rate in HIV-positive people.

To make matters worse, the HIV pandemichas also resulted in tuberculosis occurringmore often outside of the lungs (extra-pul-monary TB). Weakened immune systemsallow the TB germ to cause disease inalmost any part of the body: the brain(meningitis), the lymph nodes, the lining

around the heart, the breast, the abdomen,the bone marrow, joints, and so on. Extra-pulmonary TB is also often difficult to diag-nose, and a common cause of death in HIV-positive adults and children.

Fortunately, there is some progress beingmade in the fight against TB. MédecinsSans Frontières has created an integratedHIV-TB clinic in Khayelitsha, South Africa,where different strategies are being used tocorrectly diagnose both pulmonary andextra-pulmonary TB earlier in both childrenand adults, thereby preventing unnecessarydeath from TB in many HIV patients. Inaddition, all TB patients are encouraged tobe tested for HIV. If positive, they are givenaccess to comprehensive HIV care, prevent-ing death from other serious infections towhich they are vulnerable.

Peter SaranchukMedical doctor

Khayelitsha, South Africa

To prevent unnecessary deatharound the world, MSF demandsthat all HIV-positive children andadults are given access to:

• quicker and more accurate testsfor TB

• newer and better TB medications,with fewer side effects

• less cumbersome ways of receivingTB treatment than directly-observed treatment, especiallysince the risk of developing multi-drug resistant TB is increased iftreatment is interrupted

In communities where HIV and TBare prevalent:

• over 10 % of HIV patients developTB each year, whereas HIV-negativepeople have a 5-10 % lifetime riskof developing active TB, followingexposure to the TB germ

• the traditional test for pulmonaryTB (microscopy) is inaccurate inthe majority of HIV-infected peo-ple, so correct diagnosis of activeTB is delayed (or worse yet, nevermade). As a result, TB is themost common infection causingdeath in HIV-infected people.

• the number of TB cases continuesto rise every year, as the HIV pan-demic spreads

Why HIV and TB together are ‘double-trouble’

THE NEW TUBERCULOSIS

TB IN THE ERA OF HIV

© Mariella Furrer

© Mariella Furrer


H I V / T B c o - i n f e c t i o n

Imagine you haven’t been feeling well forweeks. You’ve been coughing, and wake

up during the night sweating so much thesheets are soaked. You don’t feel like eatingand have lost five kilograms.

Your spouse died a few years earlier fromtuberculosis (TB), so a family member rec-ommends that you go to the local clinic fora test. You give the nurse there two sputumsamples, and are told to come back in twoweeks for test results.

The local laboratory uses the conventionaltest to diagnose TB, examining sputum

samples under a microscope to find TBgerms. In your case, they can’t find any, soyour samples are reported as negative. Atyour follow-up clinic appointment, you aretold that you don’t have TB. But you arefeeling worse: the cough is no better, you’velost another five kilograms, and you havenever felt so tired. What is going on?

You are, in fact, a victim of the new era ofTB, a consequence of the HIV pandemic.Your spouse unknowingly passed on HIV toyou, and the virus has gradually weakenedyour immune system. Despite what theclinic nurse told you, you are suffering fromtuberculosis of the lungs; the TB germs aremultiplying inside your lungs and are caus-ing the cough, night sweats and weightloss. But the test traditionally used to diag-nose TB (microscopy) no longer works inthe majority of people who are co-infectedwith both HIV and TB.

There are two ways this scenario can go now:

1. You have some money saved, and youuse it to see a private doctor who sendsyou for a chest X-ray. The doctor sees evi-dence of tuberculosis and refers you tothe TB clinic to start treatment. The goodnews is that you gradually start to feelbetter: the night sweats are gone, your

cough and appetite improve, and youstart to regain weight. The bad news isthat the TB treatment lasts six months,and the clinic insists on “directly-observed treatment” (DOTS), whichmeans you have to go in person everyday, without exception, to receive themedication. As a result, you have to stopworking for six months.

You are poorer in six months, but atleast the TB has been cured. Then yourprivate doctor tells you that you needantiretrovirals (ARVs) to improve yourweakened immune system (a result ofHIV), and prevent further life-threaten-ing infections. You can’t afford theARVs and go on to suffer from repeatedinfections until you eventually die froma brain infection the following year.

2. You don’t have any money to see a pri-vate doctor or get an X-ray. The doctorwho used to work in the public clinic hasleft to work in a Western country, andthey haven’t been able to find a replace-ment. You see the clinic nurse again,who gives you some vitamins and aweek’s worth of antibiotics. But these donot help. You gradually get sicker as theTB germs multiply and spread insideyour body. You start to vomit regularly

and lose more weight. You soon becomebed-ridden and your children do theirbest to make you comfortable at home.You die later that month from undiag-nosed TB, simply because there was noquick and accurate test available to diag-nose TB in HIV-positive people. Your fourchildren are now orphans.

This last scenario in particular is notunusual; it takes place over and overagain in every community around theworld where HIV prevalence is high.Countless people are dying from tubercu-losis of the lungs (pulmonary TB) simplybecause the traditional test is not accu-rate in HIV-positive people.

To make matters worse, the HIV pandemichas also resulted in tuberculosis occurringmore often outside of the lungs (extra-pul-monary TB). Weakened immune systemsallow the TB germ to cause disease inalmost any part of the body: the brain(meningitis), the lymph nodes, the lining

around the heart, the breast, the abdomen,the bone marrow, joints, and so on. Extra-pulmonary TB is also often difficult to diag-nose, and a common cause of death in HIV-positive adults and children.

Fortunately, there is some progress beingmade in the fight against TB. MédecinsSans Frontières has created an integratedHIV-TB clinic in Khayelitsha, South Africa,where different strategies are being used tocorrectly diagnose both pulmonary andextra-pulmonary TB earlier in both childrenand adults, thereby preventing unnecessarydeath from TB in many HIV patients. Inaddition, all TB patients are encouraged tobe tested for HIV. If positive, they are givenaccess to comprehensive HIV care, prevent-ing death from other serious infections towhich they are vulnerable.

Peter SaranchukMedical doctor

Khayelitsha, South Africa

To prevent unnecessary deatharound the world, MSF demandsthat all HIV-positive children andadults are given access to:

• quicker and more accurate testsfor TB

• newer and better TB medications,with fewer side effects

• less cumbersome ways of receivingTB treatment than directly-observed treatment, especiallysince the risk of developing multi-drug resistant TB is increased iftreatment is interrupted

In communities where HIV and TBare prevalent:

• over 10 % of HIV patients developTB each year, whereas HIV-negativepeople have a 5-10 % lifetime riskof developing active TB, followingexposure to the TB germ

• the traditional test for pulmonaryTB (microscopy) is inaccurate inthe majority of HIV-infected peo-ple, so correct diagnosis of activeTB is delayed (or worse yet, nevermade). As a result, TB is themost common infection causingdeath in HIV-infected people.

• the number of TB cases continuesto rise every year, as the HIV pan-demic spreads

Why HIV and TB together are ‘double-trouble’

THE NEW TUBERCULOSIS

TB IN THE ERA OF HIV

© Mariella Furrer

© Mariella Furrer


DispatchesMédecins Sans Frontières/

Doctors Without Borders

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

Tel: 416.964.0619Fax: 416.963.8707

Toll free: 1.800.982.7903Email: [email protected]

www.msf.ca

Editor:Clea Kahn

Editorial directors:Laurence Hughes

linda o. nagy

Copy Editors:Dominique Desrochers

Jennifer HoffGregory Vandendaelen

Contributors:Kevin Barlow, Carol Devine, Clea Kahn, Douglas Kittle,

Jorge Nyari, Peter Saranchuk

Circulation: 95,000Layout: Artshouse Communications Inc.

Printing: Warren's Imaging and Dryography

Summer 2006

Cover photo: Pep Bonet

ISSN 1484-9372

page 15

How did you come to work with MSF?I became interested in the medical prob-lems that kill millions of people around theworld early in their lives, but which werarely see in Canada. The more I thoughtabout this disparity, the more it botheredme. I studied malaria, tuberculosis, andHIV at the London School of Hygiene andTropical Medicine. I realised that I wasn'tgoing to have total professional satisfactionuntil I did some international medical work.MSF had a good reputation, and I finallytook the plunge and applied.

What has your experience been like? I first worked in Democratic Republic ofCongo, a country suffering from the ravagesof chronic conflict. MSF’s project showedthat comprehensive HIV care can be suc-cessful even in such settings. I suffered abit of culture shock upon arriving. I wasn'tprepared for the restrictions required by theconstant threat of conflict. I also had diffi-culty with the language barrier: we usuallyhad to translate from English into French,then French into Swahili (and back again!)when seeing patients.

My mission in South Africa was a perfectfit, so rewarding that I stayed two years. Iworked with local nurses and doctors in anHIV clinic, seeing thousands of childrenand young adults suffering from infections(especially tuberculosis) as a result ofimmune systems weakened by HIV. We suc-cessfully treated most of these infections,then provided antiretroviral medication,

preventing death from further infections.The most striking thing was proving to thelocals that people did not have to die fromthe disease. Five years ago in this samecommunity, AIDS hospices were placeswhere young adults and children went todie. Now, they are places of hope.

What would you say to people thinking ofworking with MSF? If you are interested, just do it. Your televi-sion, car, money, and work opportunitieswill be here when you back! You will bechallenged to do things you might not havehad the opportunity to do in Canada – manage others, educate large numbers ofpeople, stand up and give lectures, or evendo operational research in your project tobenefit your patients.

I have had some of the best moments ofmy life in Africa: from being the onlymuzungu (white person) on the MSF foot-ball team playing on a lush hilltop in theCongo, to being overwhelmed by the soundof simple traditional music, to having theopportunity to camp in the Kalahari desertamongst the wildlife.

I plan to continue to working with MSFbecause of the challenges and rewards. Ienjoy travelling and experiencing other cul-tures – and working in a country's health-care system is a fantastic way to experiencetheir culture! Most of all, I want to do some-thing to help reduce the enormous dispari-ty between countries in this world.

“I WANT TO DO SOMETHING TO

HELP REDUCE THE ENORMOUS

DISPARITY BETWEEN COUNTRIES

IN THIS WORLD.”

P r o f i l e

A fter 10 years working in family practices and emergency departments acrossCanada, Peter Saranchuk went on his first mission with Médecins Sans Frontières

(MSF) in 2002. Here he reflects upon what brought him to the work and his experi-ences in the field.

Peter Saranchuk, MD

CANADIANS ON MISSIONANGOLAAnne Henderson

ARMENIARobert Parker

BURUNDIFrancine BélisleMichel DumontPierre LabrancheCatherine MasonRichard PoitrasDiane RachieleRaghu Vengupal

CAMBODIANicole Tanguay

CENTRAL AFRICANREPUBLICNoah BernsteinGeneviève CôtéIvan GaytonSherri GradyPierre KronstromMélanie MarcotteJean-François Nouveaux

CHADChristine BonneauMaryse BonnelAnnie DesiletsMike FarkMario FortinMichelle LaheyMarie-Claude LemayPaul N’guyenOmar OdehGislaine TélémaqueBenoît Wullens

CHINAMichelle ChouinardYvan Marquis

COLOMBIATyler FainstatDarryl Stellmach

DEMOCRATIC REPUBLIC OF CONGONathalie BelleauErwan ChenevalStéphanie FerlandAndré FortinJean-François HarveyThomas KelleyDolores LadouceurMichael LewisJudy MacConneryFrédéric ManseauJohn Paul MorganAndré MungerIvik OlekAlexis PorterMarlene PowerDominique ProteauLeslie ShanksJames SquierJulienne TurcotteFred Wiegand

ETHIOPIAIsabelle AubryJaroslava Belava

INDIAKaren Abbs

INDONESIAAsha Gervan

IRANMagdalena Gonzalez

IVORY COASTAndrea BoysenDenise ChouinardKevin CoppockSteve Dennis

Vincent ÉchavéHélène LessardJean-Pierre PagéElaine SansoucyArun Sharma

KENYASylvain Groulx

LIBERIABrian BakerPatricia GouldPatrick LaurentMiguel MendozaAllana ShwetzHidi Ullah

MYANMARVinay Jindal

NEPALKatja Mogensen

NIGERIAStephanie GeeMichel LacharitéJohn Pringle

PAKISTANIan AdairJustin ArmstrongJoe BelliveauDavid CroftCara KosackThierry Petry

PAPUA NEW GUINEAAdam Childs

PERUYanik Delvigne

REPUBLIC OF CONGOBrenda HoloboffJessika HuardKurt Jansen

Pikka LamGrace TangMartine Vézina

SIERRA LEONEConcetta Buonaiuto

SOMALIAReshma AdatiaViolet BaronLindsay BrysonSylvain DeslippesNaomi FecteauMegan HunterTabata MaloDavid Michalski

SUDANLori BeaulieuIndu GambhirJoni GuptillCaroline KhoubesserianEvelyn LamTiffany MooreJulia PaysonLuella SmithSheila StamSusie TectorDanielle TrépanierVanessa Van Schoor

UGANDAEileen SkinniderHeather ThompsonClaude Trépanier

UZBEKISTANMichelle Tubman

ZAMBIAFarah AliPaulo RottmanChris WarrenVanessa Wright

ZIMBABWEJoel Melanson

© Didier Ruef / pixsil.com

Interested in working overseaswith MSF? Visit www.msf.ca to learn more.


DispatchesMédecins Sans Frontières/

Doctors Without Borders

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

Tel: 416.964.0619Fax: 416.963.8707

Toll free: 1.800.982.7903Email: [email protected]

www.msf.ca

Editor:Clea Kahn

Editorial directors:Laurence Hughes

linda o. nagy

Copy Editors:Dominique Desrochers

Jennifer HoffGregory Vandendaelen

Contributors:Kevin Barlow, Carol Devine, Clea Kahn, Douglas Kittle,

Jorge Nyari, Peter Saranchuk

Circulation: 95,000Layout: Artshouse Communications Inc.

Printing: Warren's Imaging and Dryography

Summer 2006

Cover photo: Pep Bonet

ISSN 1484-9372

page 15

How did you come to work with MSF?I became interested in the medical prob-lems that kill millions of people around theworld early in their lives, but which werarely see in Canada. The more I thoughtabout this disparity, the more it botheredme. I studied malaria, tuberculosis, andHIV at the London School of Hygiene andTropical Medicine. I realised that I wasn'tgoing to have total professional satisfactionuntil I did some international medical work.MSF had a good reputation, and I finallytook the plunge and applied.

What has your experience been like? I first worked in Democratic Republic ofCongo, a country suffering from the ravagesof chronic conflict. MSF’s project showedthat comprehensive HIV care can be suc-cessful even in such settings. I suffered abit of culture shock upon arriving. I wasn'tprepared for the restrictions required by theconstant threat of conflict. I also had diffi-culty with the language barrier: we usuallyhad to translate from English into French,then French into Swahili (and back again!)when seeing patients.

My mission in South Africa was a perfectfit, so rewarding that I stayed two years. Iworked with local nurses and doctors in anHIV clinic, seeing thousands of childrenand young adults suffering from infections(especially tuberculosis) as a result ofimmune systems weakened by HIV. We suc-cessfully treated most of these infections,then provided antiretroviral medication,

preventing death from further infections.The most striking thing was proving to thelocals that people did not have to die fromthe disease. Five years ago in this samecommunity, AIDS hospices were placeswhere young adults and children went todie. Now, they are places of hope.

What would you say to people thinking ofworking with MSF? If you are interested, just do it. Your televi-sion, car, money, and work opportunitieswill be here when you back! You will bechallenged to do things you might not havehad the opportunity to do in Canada – manage others, educate large numbers ofpeople, stand up and give lectures, or evendo operational research in your project tobenefit your patients.

I have had some of the best moments ofmy life in Africa: from being the onlymuzungu (white person) on the MSF foot-ball team playing on a lush hilltop in theCongo, to being overwhelmed by the soundof simple traditional music, to having theopportunity to camp in the Kalahari desertamongst the wildlife.

I plan to continue to working with MSFbecause of the challenges and rewards. Ienjoy travelling and experiencing other cul-tures – and working in a country's health-care system is a fantastic way to experiencetheir culture! Most of all, I want to do some-thing to help reduce the enormous dispari-ty between countries in this world.

“I WANT TO DO SOMETHING TO

HELP REDUCE THE ENORMOUS

DISPARITY BETWEEN COUNTRIES

IN THIS WORLD.”

P r o f i l e

A fter 10 years working in family practices and emergency departments acrossCanada, Peter Saranchuk went on his first mission with Médecins Sans Frontières

(MSF) in 2002. Here he reflects upon what brought him to the work and his experi-ences in the field.

Peter Saranchuk, MD

CANADIANS ON MISSIONANGOLAAnne Henderson

ARMENIARobert Parker

BURUNDIFrancine BélisleMichel DumontPierre LabrancheCatherine MasonRichard PoitrasDiane RachieleRaghu Vengupal

CAMBODIANicole Tanguay

CENTRAL AFRICANREPUBLICNoah BernsteinGeneviève CôtéIvan GaytonSherri GradyPierre KronstromMélanie MarcotteJean-François Nouveaux

CHADChristine BonneauMaryse BonnelAnnie DesiletsMike FarkMario FortinMichelle LaheyMarie-Claude LemayPaul N’guyenOmar OdehGislaine TélémaqueBenoît Wullens

CHINAMichelle ChouinardYvan Marquis

COLOMBIATyler FainstatDarryl Stellmach

DEMOCRATIC REPUBLIC OF CONGONathalie BelleauErwan ChenevalStéphanie FerlandAndré FortinJean-François HarveyThomas KelleyDolores LadouceurMichael LewisJudy MacConneryFrédéric ManseauJohn Paul MorganAndré MungerIvik OlekAlexis PorterMarlene PowerDominique ProteauLeslie ShanksJames SquierJulienne TurcotteFred Wiegand

ETHIOPIAIsabelle AubryJaroslava Belava

INDIAKaren Abbs

INDONESIAAsha Gervan

IRANMagdalena Gonzalez

IVORY COASTAndrea BoysenDenise ChouinardKevin CoppockSteve Dennis

Vincent ÉchavéHélène LessardJean-Pierre PagéElaine SansoucyArun Sharma

KENYASylvain Groulx

LIBERIABrian BakerPatricia GouldPatrick LaurentMiguel MendozaAllana ShwetzHidi Ullah

MYANMARVinay Jindal

NEPALKatja Mogensen

NIGERIAStephanie GeeMichel LacharitéJohn Pringle

PAKISTANIan AdairJustin ArmstrongJoe BelliveauDavid CroftCara KosackThierry Petry

PAPUA NEW GUINEAAdam Childs

PERUYanik Delvigne

REPUBLIC OF CONGOBrenda HoloboffJessika HuardKurt Jansen

Pikka LamGrace TangMartine Vézina

SIERRA LEONEConcetta Buonaiuto

SOMALIAReshma AdatiaViolet BaronLindsay BrysonSylvain DeslippesNaomi FecteauMegan HunterTabata MaloDavid Michalski

SUDANLori BeaulieuIndu GambhirJoni GuptillCaroline KhoubesserianEvelyn LamTiffany MooreJulia PaysonLuella SmithSheila StamSusie TectorDanielle TrépanierVanessa Van Schoor

UGANDAEileen SkinniderHeather ThompsonClaude Trépanier

UZBEKISTANMichelle Tubman

ZAMBIAFarah AliPaulo RottmanChris WarrenVanessa Wright

ZIMBABWEJoel Melanson

© Didier Ruef / pixsil.com

Interested in working overseaswith MSF? Visit www.msf.ca to learn more.

LEAVING A LEGACY OF HOPE

One of the great privileges of working with MédecinsSans Frontières (MSF) is being able to see the direct

link between the compassion of our supporters and thelife-saving work that takes place every day in the field.

MSF depends on the support of large numbers of peo-ple around the world who share our concern for thosewhose humanity and dignity is threatened by conflict,disaster or disease. This support is expressed not onlythrough financial contributions, but also by helping usspeak out on behalf of people whose voices are oftennot heard. In talking with Canadians, I am constantly

moved by their enormous compassion and their desireto reach out to those in need, no matter how distant orremote their plight may seem.

Today, many of our MSF supporters are choosing toreach out to others with a legacy gift. By naming MSFas a beneficiary in your will, you continue to offeranother basic necessity of life: hope.

Nancy Forgrave Director of fundraising

Nancy ForgraveDirector of fundraising(416) 642-3466 / 1 800 [email protected]

Just a few wordsin your will...

For information about making a giftin your will to Médecins Sans Frontières,

please use the enclosed envelope or contact:

www.msf.ca402 - 720 Spadina AveToronto ON M5S 2T9

© Tomas Van Houtryve

Documents

Dispatches (Summer 2006)