Dispatches (Summer 2008)

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

Vol.10, Ed.2

IN THIS ISSUE

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1999 Nobel Peace Prize Laureate

Refugees and IDPs

Gaining acceptancefor mental healthcarein Darfur

Letter from the field:Central AfricanRepublic

Cycle of displacement

Earthquake relief in China

Diary from Myanmar

Ollie’s Field Journal: A 9/10ths Happy StoryFrom Africa

Canadians on mission LIFE ON THE RUN42 MILLION STRUGGLE TO SURVIVE

A special edition devotedto displaced people

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Dispatches Vol.10, Ed.2

R e f u g e e s a n d I D P s

Astraggling line of people comes intoview on the horizon. They are walking

slowly, their feet dragging. They are carryingtheir smallest children on their shoulders orbacks, clutching little bundles containingtheir belongings. Older children shufflealongside, the sharpness of their bones jut-ting against the skin. They look weary, likepeople who have moved through panic tosomewhere beyond, craving safety and rest.

The images are all too familiar, thoughthe landscape and the nature of the crisismay change. The number of people whohave been forced by conflict, violence ordisaster to flee their homes continues togrow each year, and today totals a stag-gering 42 million refugees and internallydisplaced persons (IDPs) worldwide -

almost 10 million more than the entirepopulation of Canada.

People who have been forced to flee theirhomes generally have no notice, no time topack or plan, and no clear destination.Camps are established to help provide aplace where these people can settle tem-porarily and receive food, shelter, water andmedical assistance in safety. Often they willarrive in a state of high vulnerability afterdays of walking, and may well have beenaffected by the conflict long before theyfled their homes. Children may be malnour-ished, or be suffering from diarrheal dis-ease. They may be suffering from endemictropical diseases, like malaria, that are fatalwithout treatment. In the camp, crowdedconditions and inadequate sanitation can

be deadly, leading to outbreaks of seriousdiseases like measles or cholera.

Refugees and IDPs are also often trauma-tized by their experiences, which mayinclude having witnessed the death of afamily member or violence inflicted onsomeone they love. Sexual violence is a par-ticularly brutal and common occurrence,and too often is used as a deliberateweapon against civilians. Even when theyhave not been the target of violence, how-ever, as in the case of natural disaster, cop-ing with the devastating loss of people andhomes leaves a terrible burden to bear.

This edition of Dispatches focuses on theplight of refugees and IDPs around theworld, but particularly on those displaced

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NO ONE CHOOSES TO BE A REFUGEE

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by conflict - the majority of those withwhom Médecins Sans Frontières (MSF)works. In situations of conflict humani-tarian organizations play an essential rolenot only in responding to immediate,vital needs for food, water, shelter andmedical care, but also by simply beingthere. International presence can afforda measure of protection to those at risk,but perhaps most crucially, it provides areassurance to those who have sufferedenormous losses that their plight has notbeen forgotten.

For millions of refugees and IDPs living inprotracted situations, the fear of havingbeen forgotten is very real. No matter howwell-supplied with food, water and health-care, camps are only ever intended as atemporary solution. In many countries,however, the conflict shows no sign ofabating, and places of temporary dis-placement have become lifelong traps.On the borders of Sudan, Somalia,Myanmar and Afghanistan, for example,refugees have passed whole generationswaiting for the conflict to be resolved so they can return. Many of Colombia’sinternally displaced have lived amid violence for 45 years. Five years after the start of the conflict in Darfur, millionsare still displaced, and the situation is not improving: In 2007 alone, another

300,000 people fled their homes. Formany people displaced in the world today,the question is not when, but whetherthey will be able to return.

There can be room for hope, however. InMarch 2007 a peace agreement signed inIvory Coast allowed many people to returnhome. In Uganda a significant number ofIDPs were able to begin making their wayback to their communities in the wake ofyears of fighting. The process of rebuild-ing will be long and difficult, but for someit is, at last, beginning. The crucial ingre-dient in all of these situations has beennot only assistance, but governments andinstitutions taking responsibility for thewelfare of their people. The one can neverbe a replacement for the other.

Clea KahnHumanitarian affairs officer

Clea Kahn has worked for MSF in SriLanka, Bangladesh and Chad. She iscurrently a humanitarian affairs officerfor MSF projects in DemocraticRepublic of Congo.

WHAT IS THE DIFFERENCE BETWEENA REFUGEE AND AN IDP? A refugee is a person who, having fledtheir home, has crossed an internationalborder. In a situation of large-scale dis-placement, large groups of people may bedesignated as refugees. Individuals whoflee persecution must have their situationassessed in order to determine whetherthey qualify for protection. Internationalrefugee law protects people in this situa-tion, and the United Nations HighCommissioner for Refugees (UNHCR) isresponsible for ensuring refugees are pro-tected.1 Internally displaced persons(IDPs) do not cross an international borderand do not receive any special protections.They remain under the protection of theirgovernment, which can be problematic insituations where the government is a partyto the conflict or responsible for humanrights violations that caused their dis-placement in the first place. The protec-tions to which IDPs are entitled are out-lined in the United Nations’ GuidingPrinciples on Internal Displacement. 1Palestinian refugees are the exception, as there is a specialbody responsible for their situation under international law.

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KALMA CAMP, DARFUR - Musa waschained naked to a tree stump for five

years as an act of love. In Darfur, Sudan, asin many regions of the world where treatmentfor psychiatric illness is seldom understood,nor available, protecting a man from injuringhimself and others can push families to dras-tic measures. If they kept him bound, Musa’sparents reasoned, they could feed him. Theycould give him water. He would stay alive.The conflict did not provoke his mental ill-ness, but it made the burden of his survivalall the heavier on his family.

It couldn’t have helped that Musa’s family,along with the estimated 90,000 others liv-ing in one of the biggest camps for internal-ly displaced people (IDPs) in Darfur, had tocope with the stress of surviving a humani-tarian crisis of devastating proportions. Fiveyears of arson, killings, rape, looting andfear is more than most could bear. Campdwellers experience the added stress ofwondering if peace will ever return so thatthey can migrate back to their home vil-lages, to their farms. It doesn’t help when

the camp that is supposed to be theirrefuge is attacked or becomes the scene ofinter-ethnic violence. Over the years,Médecins Sans Frontières (MSF) hasexpanded its notions of comprehensivemedical care in conflict zones to includewhat are called psychosocial interventions.These include counseling, clinical support,and community education programs forthose suffering the impacts of war and dis-placement. And they’re essential for sur-vivors in Darfur.

“Violence does not only cause pain in thebody but also pain in the heart,” explainsMSF mental health advisor Kaz de Jong.“Survival in emergencies depends not onlyon physical fitness but also the mental con-dition of the people. We have seen peoplein therapeutic feeding centres, for example,not wanting to eat because they did not seea reason for living.”

MSF began providing primary healthcare inKalma Camp in early 2004 and, by 2006,had added a mental health program to help

those experiencing violence-related stress,adjustment problems, psychosis, anxiety anda host of other burdens. Amal HashimAlgack, a Khartoum-trained psychologist,was involved in the earliest days of training adozen IDPs in the camp to become outreachworkers and psychosocial caregivers. Thecentral idea was, and still is, to offer work-shops that help people recognize in them-selves and in others the symptoms of psy-chological stress. The next goal is to givefamilies support as they strengthen their ownremarkable coping skills. The overwhelmedcan seek therapy for themselves and theirloved ones at the MSF clinic.

“It was a big effort to change the minds ofthese people, for them to believe in mentalhealth treatment,” Algack says. “Most willjust say it’s devils in people’s minds.”

This is what Musa’s parents believed. Theyfirst tried with a traditional healer whoattempted to expel the demons by inscribingsome paper with verses and dipping it intoa glass of water until the ink seeped out.


S u d a n

Gaining acceptance for mental healthcare

IN DARFUR

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The chains from which Musa was freed after five years.

Musa then drank the blackened liquid, buttime and again, the treatment failed.

A relative of Musa’s who knew about theMSF mental health program, who wasimpressed by its positive results, invited theorganization to try its methods on the youngman chained up on the far reaches of thesprawling camp.

“He was like an animal,” Algack shudders,recalling what they witnessed. His handsand feet were chained together to thatstump, amidst the stench of years of excre-ment and urine. “He was aggressivetowards everyone - beating his father andmother when they came near.”

The MSF counselors urged Musa’s parentsto release him into their care. The fatherdoubted their methods, and wanted to seeyet another fakhi, or traditional healer.

After five sessions with the family, thepsychologist was finally permitted to talkto Musa. These sessions went on formonths. The MSF team would come backday after day, filled with sorrow at the

young man’s situation. Watching himstruggle against the chains. He was delu-sional, dangerous. A severe psychotic liv-ing an inhumane existence.

“We even cried,” Algack admits. “Everybodywho saw Musa cried, even the MSF drivers.”

Over the course of seven months they per-sisted. There were three failed attemptswhen Musa’s parents relented andunchained him. Every time, he exacted vio-lent outrage. By January 2007, MSF’smental health program started includingprescription medication. This made all thedifference to someone in Musa’s condition.Within a month on neuroleptic drug thera-py, Musa was freed. The counseling finallybegan to take effect.

“Now he is a man again,” she reflects. “He’ssmart and can function with the help of themedication.” Musa, now 33, works with hisfather, weaving straw mats that they sell inthe South Sudan hub of Nyala, 15 km away.It took drug therapy to trigger Musa’s positiveresponse to the home visits, individual andfamily counseling that MSF offered.

MSF considers mental healthcare anessential element of its primary healthprogram in Kalma Camp. The goal is tohelp people regain some sense of controlover their emotions, their behaviour, theirstress levels and their ability to functiondespite the precariousness of camp liv-ing. For most, community educationworkshops give them the information theyneed to help themselves and one anothersurvive day after day of traumatic experi-ences in an IDP camp.

Here, families remain totally dependanton a massive humanitarian effort to stabi-lize their physical health and nutritionalstatus. Yes, their biological survival isimportant. Some are even benefiting fromservices, like clinics and schools, thatwere not available to them before the war.But Kalma’s basic health indicatorsobscure multiple layers of torment thatMSF is committed to alleviating.

Avril BenoîtDirector of communications

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Psychologist Amal Hashim Algacktalks to Musa.

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Ithought I’d send an update on my workhere with MSF in the Central African

Republic (CAR). Overall, this has been themost amazing experience. Medically, Icouldn’t have asked for better. Our workhere is so vital to the community. We treatover 100 patients every week for malaria,the biggest killer in Africa. Last week, wetransfused five children who had severeanemia from malaria. For four of the trans-fusions, we had to use our “living bloodbank,” one of my pet projects. This involvespeople from the community who volunteerto be blood donors and who are tested forblood-borne illnesses, blood type, etc.When we need them, we find them athome, retest them, and then they candonate. It’s an amazing system, andinvolves no refrigeration! Also last week, wedid an emergency caesarean on a woman at2 a.m. The baby was healthy, weighing in at4.4 kilograms. I know that without MSF

being here, both mother and baby wouldhave died. There are examples like theseevery day, which always keeps me going,even during the rough spots.

This has been an exceptionally difficultweek for MSF here in CAR. On Monday, alone gunman fired on one of our vehiclesas we were heading towards a mobile clin-ic in one of our neighbouring projects. Hewas aiming to kill, as he fired three shots,barely missing the driver, and striking agarde-malade in the head. This unfortu-nate woman was accompanying her childback to her village, and leaves behind fiveother children. This was a senselessattack, and will likely go unpunished, asthe law enforcement all over CAR issketchy at best - this country is just toopoor to afford it. Even in Boguila we havegendarmes and military in the area whoare well armed but have no vehicles, not

even a motorcycle. Such lawlessnessleaves the entire population open to rob-beries and violence by bandits (such asthe many coupeurs de route who rob vil-lages or passers-by every other day in thisarea), or Chadian mercenaries (such asthe ones who burned down four villagesjust 80 kilometres from here last week).The terrible incident in Vakaga provinceon Monday, however, is more significantthan just the needless death of a youngmother of six. It also means that MSF willhave to slow down our work in the area,and possibly close the project altogether.How many people will be lost becauseMSF is not there? It’s difficult to assess.It is certain, however, that all of the peo-ple of Vakaga province will suffer greatlyfrom this attack.

Also this week, I met Marguerite, a 16-year-old girl who was raped by someone

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

Letter from the Central African R

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from her village. The incident occurredfour months ago but, as with most womenhere who suffer from sexual violence, shefelt she couldn’t tell anyone. She was tooafraid of the repercussions - that she wouldbe blamed or ostracized for the attack, thatshe might be deemed unfit to marry. Thephysical trauma she suffered became moreand more apparent, however, as time wentby. Indeed, she could barely walk withoutassistance by the time she came here fortreatment. She had suffered severe vaginallacerations and ulcerations which hadbecome infected. Luckily, she did not testpositive for either HIV or hepatitis B, whichare so easily transmitted with sexual vio-lence. We have a really good team here,and I’m proud to say she received excellenttreatment on all levels. We even have apsychologist working with us who was ableto help the patient cope, at least for theinitial phase.

This morning, I just left Edith, who is sittingall alone in the tuberculosis (TB) dorm wejust finished building. She was perched onher homemade bamboo bed, with barelyenough strength to sit up to eat her bowl ofpopoto, or corn gruel. Edith is a real fight-er, and she needs to be. She has what wecall a co-infection, having both HIV and TB.Last week, we saw her during one of ourmobile clinics, and she was close to death.She is 25 years old, of average height, andweighs only 26.3 kilograms. After muchdiscussion with Edith’s mother, we electedto transfer her here with her mother andEdith’s eight-month-old baby. The next day,Edith’s mother took her granddaughteraway in the middle of the night withouttelling anybody. I was so angry when I heardthis that tears came to my eyes. I justcouldn’t believe a mother could do this toher daughter. I’ve run this over in my mind,and the only answer I can come up with is

that Edith’s mother has decided to care forthe rest of her children and grandchildren,who still need her help. What an impossiblydifficult choice, to leave a dying daughterin order to tend to those who still need you.Unfortunately, this is a decision many peo-ple here are forced to make.

Sometimes all of this gets to be too much.So when the first rain came this afternoon,instead of seeking shelter, I ran out into ourbackyard. I stood there shouting at the sky,hoping the rain would wash it all away. Ashort while later the sun came out, quicklydrying any evidence of the downpour. And,with a heavy sigh, I dried off and went backto the hospital, ready to face the afternoononslaught of patients.

D’Arcy GagnonMedical doctor

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Cycle of D

C o l o m b i a

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This is how Carlos Castaño described his paramilitary campaign targetting

Colombia’s rural communities during thelate 1990s and early 2000s.

The ultra-right paramilitaries knew theywould have difficulty taking on the left wingguerillas in their own territory - the moun-tains, swamps and forests. They took a dif-ferent approach, deciding the rural commu-nities were supporting groups like theRevolutionary Armed Forces of Colombia(FARC) and the National Liberation Army(ELN), and so made it their objective to dis-place these communities, thus removingthe guerillas’ “lifeline.”

The paramilitaries, famed for their use ofchainsaws, used methods of torturing andkilling designed to create widespread terrorand leave a lasting, traumatic impression onthose witnessing such events. They gatheredpeople together to watch the executions ofthose they regarded as collaborators. Beinga shopkeeper was enough to earn this label.Across Colombia hundreds of thousands lefttheir homes in search of safety.

Targeted killings, massacres and conflictare the triggers for the first stage in thecycle of displacement. People abandonrural communities and tend to move to

urban areas. There they are often stigma-tized and have difficulty finding work andadequate housing. Many decide to returnand re-establish their communities. Manycommunities again find themselves inbetween conflicting groups and accused byone side of supporting the other. Targetedkillings take place and the cycle repeatswith further displacement.

“They [the armed groups] come to buythings, they chat with you, they ask youthings,” said one shopkeeper. “What hap-pens is when they come and see we arebadly off, they leave us alone, but whenthey see that people are getting it togetherthey come and hit you up again. We hopethat if they come back they are only goingto ask you for a little bit of groceries. Whatare you going to do?”

It is not only violence that is responsible forthe displacements. The so-called war ondrugs also contributes. The principal tacticused to eradicate cocaine production iscrop spraying. The problem is that it killseverything; many farmers with small hold-ings have had their source of food destroyedand are unable to feed their families. Someopt to move to urban centres, others searchout fertile land to start again while continu-ally watching the skies.

“Taking the water away from the fish.”

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Médecins Sans Frontières (MSF) is presentand working with communities at eachstage in the cycle of displacement. Wehave services for displaced communities inurban centres and we support returningcommunities. Many of our patients havebeen through this cycle two or three times.One father of four, who fled his communi-ty and later returned, said: “When the vio-lence came we had no choice but to leaveeverything behind and go to the city. Wenever imagined back then that displace-ment was going to be a trip with no end,with no point of arrival. We move, but wedo not move on. Looking back, we havebeen in three ‘places’ during this journey -the violence at home before we left, themisery of the slums after we fled, and thelack of sleep now that we have returned towhat we used to call home. One neverceases to be ‘a displaced person.’ It is astigma, a way of life.”

We recently visited a small group of dis-placed people in a remote area ofAntioquia. Seventeen families had left theirvillage after the FARC had killed three localpeople. The families were living together in

one house. The displacement and currentliving conditions were taking their toll. Itwas the second displacement for this com-munity. Many were saying they had nowmade the decision to never go back, otherswere contemplating the idea of returningand a small number had begun visiting thevillage to tend to crops and arrange belong-ings. Multiple displacements leave peoplein limbo. They seem to be in one place inbody and another place in mind.

As a psychologist, the biggest challenge Iface is assisting people to recover fromtrauma when they have no stability orsecurity in their lives. This is extremelydifficult, if not impossible, in a context ofmultiple displacements. But the peoplein this village all wanted to talk and weare here to listen.

This cycle of multiple displacements hasemerged out of a complex conflict in whichnobody knows from where the next threatwill emerge. The paramilitaries have beendemobilizing but are reforming just asquickly with new names and agendas.There are numerous groups of left-wing

guerillas, and all armed groups are protect-ing their investment in the drug trade. ForMSF, managing security is problematicwhen it’s difficult to keep track of all ofthis, to understand who is likely to be athreat to us. This is exactly the same for thepeople living in these areas.

When you’re sipping coffee in the affluentcafés of Colombia’s major cities, it is easyto forget there are more than three millioninternally displaced people in this coun-try. Only Sudan, Iraq and DemocraticRepublic of Congo rival Colombia in thenumber of people making the decision toleave their homes in search of safety intheir own country.

This conflict is hidden and very dirty, withone clear loser: Colombia’s rural poor.

It would seem you can’t take the wateraway from the fish.

Simon MidgleyClinical psychologist

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The Chinese government is now estimat-ing that more than five million were left

homeless by the 8.0 magnitude earthquakethat devastated parts of the country’sSichuan province on May 12. A total of 34Médecins Sans Frontières (MSF) teammembers are now in the affected regioncarrying out assessments, providing surgi-cal and basic medical care, as well as men-tal health services, and donating tents andmedicines to the relief effort.

Today, a convoy of 10 trucks carrying 2,050large family tents arrived in Deyang andwas directed, in close collaboration with theChinese Red Cross, to Mianzhu and otherareas most affected by the earthquake.MSF has now donated 3,800 large familytents worth some $1.7 million, includingtransportation, to the relief effort. Two cargoflights carrying 1,750 tents arrived lastweekend and were distributed in the affect-ed region and damaged healthcare facilitiesin Guanghan and Hanwang with the help ofthe Sichuan Red Cross and dozens of vol-unteers. The Chinese government has esti-mated that there is a need for approximate-

ly 3.3 million tents to house those lefthomeless by the quake.

“The need for shelter is tremendous,” saidMSF emergency logistical coordinatorNicolas Tocqué. “I have been in refugeesettings where assisting 80,000 people inone location was overwhelming, but it doesnot compare to the millions who need shel-ter in China after this earthquake. Theyneed tents not just in quantity, but of goodquality, so that families can live in them forthe many months it may take to constructadequate housing and infrastructure.”

On May 22, MSF finished its week-longclinical and surgical support to a temporarytriage referral hospital in Guanghan, as themajority of patients have been transferredto other facilities and the rest will leave inthe coming days. During the past week,MSF provided surgical and post-operativecare to some 70 wounded patients whowere transported, many by helicopter, tothe triage centre from some of the hardest-hit areas in the region. MSF has made adonation of medicines and medical sup-

plies to the hospital and will continue itsmental health work in the facility until thelast patients wounded in the earthquakeare transferred.

The demand for mental health workremains in hospitals taking care of thewounded and settlements where earth-quake survivors are living throughout theregion, and there is clear recognition ofthe need to respond to it. In addition toMSF’s mental healthcare work in thetriage centre in Guanghan, MSF is colla-borating with the Huaxi Hospital inChengdu to provide mental health sup-port and training and is looking into thepossibility of expanding the mental healthcomponent of our program.

At the time of the earthquake, MSF staffmembers were working in Nanning,Guangxi Zhuang Autonomous Region,where the organization has been running anHIV/AIDS treatment program since 2003 incollaboration with the Guangxi PublicHealth Bureau and the Nanning CDC. MSFhas worked in China since 1988.

C h i n a

EARTHQUAKE RELIEF IN CHINASnapshot: May 23

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Dr. Khine Myae, a native of Myanmar, wasone of the first physicians Médecins

Sans Frontières (MSF) sent to the devastatedIrrawaddy Delta to provide assistance after itwas battered by Cyclone Nargis at the begin-ning of May. Below he remembers the firstfew days after the cyclone struck.

SATURDAY, 4 MAY 2008

Last night Yangon was struck by a deadlycyclone. The news reached me by radio inLashio (eastern Myanmar) where I was visit-ing our HIV project. Throughout the day wereceived more and more news about theenormous destruction. I am very worriedabout my family. I am here with two col-leagues from Yangon but we can’t reach any-one there. The entire telephone system isdown. We tried to book a flight but Yangon’sairport was seriously damaged and no planescan land there at the moment. We have nochoice but to take the bus tomorrow. It will

take 24 hours and we can only hope that thebus will make it to Yangon.

MONDAY, 6 MAY

8 a.m. We are approaching Yangon andmy mobile phone finally works again. Mygirlfriend, parents and children are allokay. I am extremely relieved. In Yangon,we see the destruction. Not one electrici-ty pole or advertising sign still seems tobe standing and almost all of the enor-mous old trees have been knocked down.Cars and buildings lie buried beneathbranches and tree trunks. Our bus can’tgo much farther so we walk the rest of theway. When I arrive home, I see my girl-friend. She also works for MSF. “We haveto go to the office,” she says immediate-ly, “it’s terrible in the Irrawaddy Delta.” Atthe office, I hear more details. Whole vil-lages have been wiped off the map bygiant storm surges. Probably tens of thou-


M y a n m a r

BETWEEN MAY 5 AND JUNE 4, MSF TEAMS DISTRIBUTED IN MYANMAR:

1,250 tonnes of rice

410 tonnes of beans

190,000 litres of cooking oil

70 tonnes of canned fish

1,400 kg of salt

125,000 packs of energy biscuits and therapeutic food

120,000 plastic sheets

20,000 mosquito nets

48,000 jerry cans

3,000 blankets

16,500 soap bars

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In relief operations such as this one, with adisaster comparable in scale to the 2004tsunami, MSF would usually send to thefield a large number of experienced interna-tional staff - doctors, emergency coordina-tors, water and sanitation experts. However,initial restrictions imposed by Myanmarauthorities officially prevented foreignexperts from working in the Delta in the firstthree weeks after the cyclone.

For instance, in the town of Bogale, MSFinternational staff were tolerated but couldnot carry out activities in the periphery ofthe town. MSF could work with its nationalstaff, but has insisted it needed more inter-national staff in the field.

On May 23rd, UN Secretary General Ban KiMoon came to Yangon, and announced thatthe Myanmar government had agreed togive international aid workers unhinderedaccess to the Delta. A few days earlier, MSFhad actually obtained formal authorizationfor eight international staff to go and carryout activities in the Delta.

“That was a first, but obviously not enough,”said Frank Smithuis, head of mission forMSF in Myanmar. “Given the scale of thedisaster, we need more experts in the field.Our national staff are very capable, but theyhave no experience of working in emergen-cies. They have done a tremendous job, butthey need expertise to support them.”

International staff presence is also an addedguarantee that aid remains independent andis distributed objectively. One month afterthe disaster, more travel authorizations forMSF expatriates were received.

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sands of people lack shelter and thou-sands have been killed. The medical coor-dinator and a doctor already left last nightfor the Delta region and are requestingmore help. They need medical teams andmaterials. As much as possible, as quick-ly as possible. A few hours later, I’m sittingin a car with two teams. Next we will getinto a boat that will take us to the disasterarea. We’ll arrive tomorrow morning.

TUESDAY, 7 MAY

5 a.m. As we dock in Heyngyi, I see the firstpeople. I notice that many of them have afaraway look in their eyes. It seems as ifthey are looking right through me and don’tactually see me standing there.

A few people help us to unload and ask uswhy we are there. We explain that we arefrom MSF and that we’ve come to bring med-ical help and equipment. Together with themen we go to find a suitable place to start

working. While 80 per cent of the buildingsare severely damaged, the population ofHeyngyi has been lucky. People and animalswere able to save themselves by getting to asection of the city built on higher groundwhen the water rushed in. That explains whythere were so few deaths here. However,many people were injured in the storm and alarge number have lost their homes. In aschool without a roof we come across a fewhundred homeless families. We can startworking in a half-destroyed building ownedby a women’s group. The local people helpme to sweep all the mud out of the buildingand a few men repair the roof with plasticsheeting. As soon as that is done, the firstpatients start to arrive. Our first boat carryingfood and plastic sheeting and other suppliesarrives a few hours later. Today, our first day,I see more than 200 patients.

Khine MyaeMedical doctor

THE ACCESS ISSUE

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B o o k r e v i e w

Worldwide, more than five millionchildren die every year due to mal-

nutrition. Patti McIntosh’s book Ollie’sField Journal: A 9/10ths Happy StoryFrom Africa, hopes to help children inCanada understand how something can be done about this, and inspire themto act.

McIntosh spent three weeks in Niger,travelling to Niamey, Zinder and Gouchilearning about a ready-to-use food namedPlumpy’nut (or the “peanut paste pre-scription” as it is called in the book) froma Médecins Sans Frontières (MSF) fieldteam. In Niger, a country with one of theworst rates of chronic and acute child-hood malnutrition in the world, this foodhas become a lifesaver.

The product is remarkably simple, made of peanut paste, powdered milk, sugar,vegetable oil, dry whey, and enriched withvitamins and minerals. Children seem tolove the sweet taste. The food itself is anessential medicine that gives them thelife-saving nutrition they need.

“So many babies have been saved bythis and I wanted to write a children’sbook that showed how successful thissimple solution is for such a big prob-lem,” says McIntosh.

Traditional malnutrition therapy involvesadmitting a child to hospital to receiveinfusions of nutrients, and then sendingher and her family home with powderedmilk that must be mixed with water. InNiger, as well as many other placeswhere clean drinking water is scarce, the powdered milk mixture was causingchildren to become ill because of con-taminated water.

With this simple, ready-to-use food inits small package, many mothers nolonger have to leave their malnourishedchildren in the hospital. They can treatthem at home with a weeklong supply ofthe food.

“I wanted a positive story to come out ofAfrica,” says McIntosh. “One filled withhope, happiness and success.” McIntosh

tells the story through the voice of 10-year-old Ophélie, whom everyone calls Ollie.

Ollie’s trip to Niger is inspired by the suc-cessful work her mother is doing there tohelp malnourished children. While inNiger, Ollie becomes friends with otherchildren, sees a giraffe and even learnssome new words in Hausa, a regional lan-guage. A scrapbook-like journal docu-ments her trip. The bright photos ofmothers and their smiling, growingbabies put real faces to a real story. Theauthor turns a complex issue, nutrition,into something children can wrap theirminds around.

“I hope children take away from Ollie an interest in global citizenship andworking for the well-being of others,”says McIntosh.

To order a copy of the book and for more in-formation, visit www.juniorglobalcitizen.org.

April Sutton

OLLIE’S FIELD JOURNAL:A 9/10ths Happy Story From Africa

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A young girl eats at an MSF feeding centre in Niger.

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BANGLADESHShannon Lee Fredericton, NB Project coordinatorJulia Payson Vernon, BC Financial coordinator

BURUNDIJoel Montanez Moncton, NB Mental health specialist

CAMEROONSerge Kaboré Québec, QC Medical coordinator

CENTRAL AFRICAN REPUBLICLindsay Bryson Montréal, QC Medical coordinatorCarol Frenette

St-Charles-de-Bellechasse, QC Head of missionD’Arcy Gagnon Toronto, ON DoctorMélanie Lachance Poisson

Québec, QC NurseLuella Smith Waterside, NB Doctor

CHADMichelle Chouinard St-Quentin, NB Project coordinatorSteven Cohen Ottawa, ON Mental health specialistEdith Fortier Montréal, QC LogisticianAndrée-Anne Gauthier La Malbaie, QC NurseIvan Gayton Vancouver, BC Project coordinatorSylvain Groulx Montréal, QC Head of missionGuylaine Houle Montréal, QC LogisticianElizabeth Kavouris Vancouver, BC NursePaule Kemgni Québec, QC DoctorJean Marc Kuyper Montréal, QC LogisticianCatee Lalonde Montréal, QC LogisticianPierre Langlois

Ste-Catherine de Hatley, QC LogisticianElisabeth Martel St-Pie-de-Guire, QC NurseNathalie Pambrun Winnipeg, MB MidwifeLuke Shankland Montréal, QC Logistician

CHINAYvan Marquis Québec, QC Project coordinatorPeter Saranchuk St. Catharines, ON Doctor

COLOMBIAMartin Girard Montréal, QC Project coordinatorEsther Hsieh Vancouver, BC Logistician

DEMOCRATIC REPUBLIC OF CONGOEva Adomako Montréal, QC AdministratorRachida Aouameur

Montréal, QC Human resources administratorDaniel Arnold Port Coquitlam, BC LogisticianMélanie Bergeron Sherbrooke, QC Liaison officerMarie Éve Bilodeau Ottawa, ON Training officerOwen Campbell Montréal, QC LogisticianSteffen De Kok Sydenham, ON LogisticianChristo Kouame Toronto, ON DoctorMiriam Lindsay Irlande, QC LogisticianOonagh Skye Marie-Curry Montréal, QC LogisticianAlphonsine Mukakigeri Québec, QC LogisticianTara Newell London, ON Project coordinatorNadia Perreault Mascouches, QC NurseDominique Proteau Québec, QC NurseHeather Thomson Ottawa, ON Medical coordinator

ETHIOPIAVanessa Bailey Victoria, BC NurseDave Croft Vancouver, BC Project coordinatorRichard Currie Vancouver, BC DoctorRachelle Seguin Greenfield Parc, QC NurseJoli Shoker Prince George, BC NurseDaniel Nash Ottawa, ON Logistician

HAITIAnnie Dallaire Montréal, QC Financial coordinatorKevin Tokar Ottawa, ON Logistician

INDIACaroline Kowal Winnipeg, MB Doctor

IRANSusan Trotter St. Albert, AB Nurse

IVORY COASTDiane Rachiele Montréal, QC Financial coordinator

JORDANMaryse Bonel Morin Heights, QC Nurse

KENYALori Beaulieu Prince George, BC Logistical coordinatorIndu Gambhir Ottawa, ON Medical coordinatorMaguil Gouja Montréal, QC Financial coordinator

LAOSRichard Poitras Noyan, QC Logistician

MOZAMBIQUEIsabelle Casavant Montréal, QC Nurse

MYANMARRink De Lange Ste Cécile de Masham, QC

Water and sanitation specialistFrédéric Dubé Québec, QC LogisticianRobert Genest Montréal, QC NurseMathieu Léonard Sherbrooke, QC Logistician

NEPALIsabelle Chotard Québec, QC Doctor

NIGERMatthew Calvert Ottawa, ON LogisticianMarisa Cutrone Montréal, QC NurseJosé Godbout Blainville, QC NurseFrédérik Matte Montréal, QC Communication officerJoséphine Millet Montréal, QC NurseNicole Parker Stellarton, NS LogisticianAudrey St-Arnaud Blainville, QC Nurse

NIGERIAMiriam Berchuk Calgary, AB AnesthesiologistMarilyn Hurrell Winnipeg, MB Medical coordinator

PAKISTANDarryl Stellmach Calgary, AB Project coordinator

REPUBLIC OF CONGOAhmed Alas Edmonton, AB DoctorDuncan Coady Toronto, ON Financial coordinatorLai-Ling Lee Ottawa, ON Head of missionJake Wadland Ottawa, ON Logistician

SOMALIALori Beaulieu Prince George, BC CoordinatorLuis Neira Montréal, QC Medical coordinator

SOUTH AFRICAAdrienne Carter Victoria, BC Mental health specialistCheryl McDermid Vancouver, BC Doctor

SRI LANKAReshma Adatia Richmond, BC Project coordinatorJohn Crosbie Toronto, ON LogisticianSusan O’Toole Barrie, ON DoctorIvan Zenar Brampton, ON Project coordinator

SUDANKevin Berchuk Toronto, ON NurseCharmaine Brett Ottawa, ON Human resourcesNadine Crossland Spiritwood, SK NursePeter Heikemp Montréal, QC LogisticianLeanna Hutchins Canmore, AB LogisticianBrenda Holoboff Advent Bay, AB Financial coordinatorKylah Jackson Unionville, ON NurseSarah Lamb Toronto, ON LogisticianLauralee Morris Brampton, ON DoctorWendy Rhymer Winnipeg, MB NurseGrace Tang Toronto, ON Project coordinatorMichael White Toronto, ON Logistician

SWAZILANDPaul Mathers Winnipeg, MB Doctor

UGANDADavid Johnston Surrey, BC LogisticianKerri Ramstead Winnipeg, MB Nurse

YEMENPeter Mak Toronto, ON Anesthesiologist

ZIMBABWEHarry MacNeil

Toronto, ON Water and sanitation specialist

page 15

DispatchesMédecins Sans Frontières/Doctors Without Borders

720 Spadina Avenue, Suite 402 Toronto, Ontario, M5S 2T9Tel: 416.964.0619Fax: 416.963.8707Toll free: 1.800.982.7903Email: [email protected]

Editor:linda o. nagy

Editorial director:Avril Benoît

Translation coordinator:Julie Rémy

Contributors:Avril BenoîtD’Arcy GagnonClea KahnSimon MidgleyApril Sutton

Circulation: 104,500Layout: Tenzing CommunicationsPrinting: Warren’s Waterless Printing

Summer 2008

ISSN 1484-9372

C a n a d i a n s o n m i s s i o n

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15CHOOSE TO MAKE A DIFFERENCETo make a donation, or for more information on our projects around the world, contact us:

1-800-982-7903 | [email protected]

720 Spadina Ave, Suite 402 | Toronto, ON M5S 2T9

www.msf.ca

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Dispatches (Summer 2008)

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