MSF CANADA MAGAZINE Volume 16 Edition 2 Summer 2012

Dispatches

Sahel: Recurring food crisis, p. 02 | Chad: Hope on the horizon, p. 03 | PakiStan: Making a difference in Quetta, p. 05South Sudan: People and health facilities targeted, p. 07 | aCCountability: MSF Canada 2011 annual report, p. 08

Multidrug-reSiStant tuberCuloSiS: Surviving two years of isolation, p. 10 Sierra leone: An ambulance driver’s dedication, p. 12 | MSF in Canada: New executive director at the helm, p. 14

malnutrition in sahel

a food crisis has been declared in the Sahel region of Africa. Lives are threatened as some areas in

the region expect to face acute nu-tritional crisis in the coming months. Médecins Sans Frontières (MSF) is expanding its nutritional activities to address the seasonal peak in malnutri-tion rates, while also developing lon-ger-term approaches it can integrate into its regular programs.

The Sahel, located between the Sahara desert in the north and the Sudanese savannah in the south, spreads across 11 countries. Food production in the region has dwindled, mainly due to tempera-ture extremes and arid conditions that make the land often challenging or im-possible to farm.

The UN estimates that 15 million peo-ple in six countries in the region are

living with moderate or acute food shortages and insecurity. One million children face the threat of malnutrition.

These worrying numbers have seen MSF open new malnutrition programs in Chad, including in the city of Bil-tine and the town of Yao, where rates of acute malnutrition of more than 20 per cent have been reported. Teams are also evaluating the nutritional situa-tion in other areas of Chad, as well as in Mali, Niger, Mauritania and Senegal.

Stéphane Doyon, manager of MSF’s mal-nutrition campaign, said in April 2012 that the crisis was in its early stages and it was too soon to fully grasp its impact. “Traditionally, the most difficult period is still ahead, between May and July. How-ever, we already project that hundreds of thousands of children will suffer from acute severe malnutrition, as they do ev-ery year in this region.”

In Niger alone, the Ministry of Health, MSF and other organizations treated 330,000 children for severe acute mal-nutrition in 2010, a crisis year. But in 2011, when yields from the region’s food crops were greater, the number of children treated still totalled 307,000.

This year, early warnings issued last fall by the governments of six countries in the region made it possible to develop an ambitious response. This response now exists on paper, but it will not be easy to implement. Financing has not yet been obtained and accessing the region’s most remote areas will be a challenge. In addition, insecurity and violence in certain areas are already complicating the deployment of aid.

MSF is expanding its activities in the Sahel in response to urgent needs, but is also implementing long-term strategies to combat the recurring mal-nutrition crisis.

In 2011, MSF treated more than 100,000 severely malnourished chil-dren in Niger. More than 90 per cent of them recovered. In Niger and Mali, MSF also provided milk-based nutritional supplements to more than 35,000 chil-dren in conjunction with its regular pe-diatric programs.

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RecURRiNG

food crisis

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i still remember arriving in Babalme, Chad in July 2011. The Médecins Sans Frontières (MSF) vehicle had to use a

local guide to point at indistinguishable features on the horizon, a lone tree or a sand dune, to direct us more than 12 ki-lometres off the last known track in the desert sand. It was a bleak picture.

The area was drier than the rest of the Sahel region, not a single mud brick building, no school, no health centre – just people living a pastoralist life in a forgotten corner of Chad near the bor-der with Niger.

Our team was warmly received. In a bush shelter, we sat on Chadian rugs in the shade from the relentlessly burning sun

and drank tea for our first meeting with the local tribal chiefs and village elders.

We addressed their hope that MSF would cure all local health problems and fix the neglect by the state. We explained that while we did not have the resources to give medical care to everyone and we could not take the place of their govern-ment, what we could do was offer to open an ambulatory therapeutic feed-ing centre to treat the many severely malnourished children under five in the area. Once a week, a mobile medical team would arrive to assess, diagnose and treat children in the shade of a tree in the centre of the village. Mothers with their sick children would have to ride on donkeys from the surrounding villages.

I was impressed by the reaction of the men in Babalme to our very limited offer-ing to their expansive unmet community needs. When MSF nurses and communi-ty health workers addressed the waiting mothers to inform them about the nutri-tion program, all political and religious authorities stood behind us to show the strongest possible endorsement for MSF’s intentions.

Oumar Zezerti Kosso, a village chief, offered to train and work as a com-munity health worker. He would be riding a horse from village to village to do community mobilization, health education, to screen the children for malnutrition, and to refer them if nec-essary for treatment at the ambulatory

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clinic. He dedicated four days a week to do outreach and was also helping out on clinic days. His 92-year-old father, a former chief, and his deputy carried on his political functions.

And what a response we got from the community! Within two weeks, we had almost 100 children enrolled in the program: some of them needed to be transferred to intensive care in the re-gional centre. They were too sick and too weak to be treated in the communi-

ty. Within a month, we discharged the first children as cured and the number of new admissions started to decrease. Inversely, the number of requests from the community started to increase.

Of course, it was difficult for the medi-cal teams to refer all requests for basic health and medical care to the nearest government health centre, a four-day camel ride away. Yet MSF’s limited mandate here allowed only treating lifesaving emergencies.

But then we also received a request for two bags of cement: the community de-cided to build the first-ever latrine as a demonstration project near the tree that served as our clinic site.

Next, the community leaders asked MSF to establish a permanent health centre to meet the needs of the people. This was beyond what our team could pro-vide, but we lobbied the Ministry of Health to consider such a request.

By the time MSF announced the closure of the nutrition project in October – because the number of severely mal-nourished children was drastically reduced – there were rumours that the dream of a health centre could come true. In November, we organized a workshop for continuing education in nutrition care for all government nurse practitioners in the region. A nurse appointed for Babalme participated. At the same time, the community re-cruited volunteers to a nearby oasis to fabricate several hundred mud bricks for a future health centre.

It was rewarding to see how a commu-nity and its leaders could be inspired by the dedication of our mobile medi-cal teams, who drove to this outpost in the desert on a weekly basis and dem-onstrated that change is possible. With simple means, we turned around the fate of several hundred malnourished children. The community decided not to wait for a distant government to take action any longer. It took the initiative to build its own health centre to meet its needs. This made Babalme look so much greener than on my first visit.

Othmar arnold Nurse

Othmar Arnold is an advanced practice nurse from Carmacks, Yukon. He has lived and worked with aboriginal popu-lations in Canada’s north since 1993 and has done humanitarian work in Uganda, Rwanda and Pakistan. This was his first mission with MSF.

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“Look! He’s one of my babies!” Vancouver nurse Jaroslava Be-lava says as she waves a white

outpatient card in the air. Behind her an Af-ghan man carries a sleeping two-year-old. “Khalil was admitted to our inpatient unit last year,” she continues, while her two Pakistani Médecins Sans Frontières (MSF) colleagues take the little boy and settle Khalil’s father into a chair in the MSF clinic’s newly renovated ambulatory therapeutic feeding centre. The clinic is in Kuchlak, 20

minutes outside of Quetta, the capital of Balochistan province. The project serves Af-ghan refugees, migrants, as well as nomads and the local Baloch community. I have come here to work with MSF as a physician.

Belava is finishing her year-long work in Quetta. Her extensive MSF experience and the knowledge she’s gained running feeding programs in other projects has been of enormous help to me as I settled into my first field assignment with MSF. She has come to Kuchlak to spend the day

reviewing and offering advice on how to ensure our two outpatient nutrition pro-grams are meeting MSF standards.

Kaka and Sidra, the two Pakistani staff who are the backbone of Kuchlak’s nu-trition program, take a history from the father. They measure little Khalil’s middle upper arm circumference and weigh and measure the boy. Thankfully he is doing very well with his nutrition, but his father has brought him in for follow up because Khalil has developed a cough and fever.

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The first time Khalil came to the Kuchlak clinic he was soon transferred to the MSF pediatric hospital in Quetta because he was severely malnourished and anemic. He was an inpatient in Quetta for several weeks, given therapeutic ready-to-use food and transfusions, then returned to Kuchlak to continue treatment in the out-patient nutrition program.

Belava arrived in Quetta in March 2011 to build a pediatric hospital meant to house an inpatient therapeutic feeding program as well as offer care for severely ill infants and children needing 24-hour medical attention. She was unstoppable. She took a rough building site littered with bricks and cement and turned it into a clean, bright hospital with an in-patient feeding program, neonatal inten-sive care and a nursery.

Her husband, Miroslava Stavel, is a pe-diatrician and has worked with her in Kuchlak for the past six months. Together they built a dedicated team of nurses and physicians who offer excellent pediatric medical care.

Although I have been practicing medicine for 25 years and have worked for many months in other projects in Asia and Af-rica, I was nervous about my first time working with MSF. I had so much to learn when I arrived. I didn’t even know what my staff were talking about when they described a malnourished child as having a “red MUAC.” But, like so many other things, I learned. (I quickly discovered

that MUAC refers to middle upper arm circumference, one of the measurements taken to determine if a child is malnour-ished. If the measurement is in the red zone it can indicate severe malnutrition.)

Belava’s guidance was invaluable as I delved into the educational resources, learned from the Pakistani staff and brought home a list of questions about malnutrition to re-view at the end of the day.

However, the intangible support of a new friendship under difficult living and working conditions was almost more im-portant than the medical advice. One har-rowing day an Afghan refugee brought in her very sick 10-day-old baby. The baby boy had been born at home, but hadn’t nursed well. By the time he was brought in gasping and with bluish skin (from lack of oxygen in his blood), he was already too far gone and we couldn’t save him.

I can still see in my mind’s eye the image of the heart-broken mother tucking her dead infant into the baby blanket and holding him gently as she arranged her burka to shield him from prying eyes.

I had never lost a newborn before and I asked Belava to debrief with me as we re-viewed the steps I’d taken. Together we concluded there was nothing else anyone could have done. It was consoling to talk it over, clearing the emotions to return to work the next day ready to deal with the very malnourished children, but also with children with measles and pneumo-

nia, burns and runny noses, and with the dozens of women who also come in need of assessment and treatment in the out-patient department.

Little Khalid was sorted out with an appro-priate antibiotic and other medication for what turned out to be an ear infection. His father bundled him back into the wheel barrow for the journey home. We shared a happy moment taking photos with the father’s delighted permission.

At the end of the day Belava and I returned to our house in Quetta to meet up with her husband and the other eight people – nurs-es, a midwife, a mental health officer and logisticians – who made up our little group of expatriate staff. We sat around the dinner table sharing the stories of our day, sorting out problems and unwinding together.

With only a few days left before their de-parture, we are already sad about losing Belava and Stavel. But when I see and feel the confidence and enthusiasm of the new staff, I know the project will con-tinue successfully. My fellow Canadians have laid a strong foundation and passed on their dedication and commitment to a project that is making a difference in the lives of so many people.

lanice JonesDoctor

Lanice Jones is a family physician from Calgary. This was her first mission with MSF.

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in January 2012, Médecins Sans Fron-tières (MSF) sent an emergency team of medical and logistics staff to Pibor,

South Sudan after violent intercommunal attacks sent thousands of people fleeing into the bush. Two MSF health centres were looted of supplies in the hostilities and their equipment destroyed.

People remained in hiding in the bush, many of them injured with minimal or no shelter, and limited access to food. The team wanted to identify the whereabouts and needs of people from the community and provide them with medical aid.

Since 2005, MSF had been running the local health centres and providing care for the 160,000 people in Pibor county, as well as working in other parts of Jonglei State. During violent intercommunal dis-putes in the state in 2011, a deeply wor-risome pattern emerged. Violence was deliberately directed at civilians and their scarce resources. Hospitals, health clin-ics and water sources became targets for armed groups on all sides, suggesting a tactic of depriving people of their essen-tials for survival.

“It was pretty difficult to see how our medical infrastructures had been targeted in the violence,” says Karel Janssens, proj-ect coordinator for the MSF emergency team that went to Pibor. “Our team was not there when the clinics were attacked and the compound in Pibor town was ransacked. We came after and we found a total mess.”

South Sudan became the world’s newest country following a referendum in Janu-ary of 2011 and then secession from the rest of Sudan in July 2011. More than 300 kilometres away from the country’s capi-tal Juba, Pibor and many outlying villages experienced violent attacks in 2011.

“South Sudan is an incredible place, despite the desperate situation and vio-

lence. People are incredibly strong,” says Janssens.“The last gunshot wound that we got from the violence, at beginning of February, was a lady whose brother found her near a river. She had been shot in the back and she had basically managed to crawl to the river. She was left for dead by the attackers, her children had been killed. She hadn’t eaten for a month. Her only means of survival it seemed was drinking the river water.”

At the end of 2011, two MSF medical fa-cilities were targeted in Pibor county. As a result of these attacks, all international MSF staff were evacuated to Juba, and lo-cal staff and their families went into hid-ing along with the other inhabitants of Pibor. “What was difficult and complicat-ed was knowing where the people were and where they were moving to,” Jans-sens says of the work facing the emer-gency team when they arrived. “Some

people were moving into bigger towns where there was some aid provided but most people stayed hiding in the bush. So you had this mixture of people mov-ing about and to give appropriate aid, we had to find the people.”

The emergency team re-launched medi-cal activities in Pibor on Jan. 7, 2012. In the next two and a half weeks, medical staff treated 47 patients with gunshot wounds – 16 women and eight children. A further 43 patients were treated for stab wounds, beatings or wounds sustained while flee-ing in the bush. By the end of the month, MSF had treated 110 patients for violence-related trauma – mostly gunshot wounds – and air lifted some serious cases to the capital Juba for further medical care.

Wairimu GitauCommunications officer

people, health facilities targets of

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SOURCES OF REVENUE EXPENDITURES

$44,233,578 TOTAL REVENUE

PRIVATE FUNDING BY SOURCE PRIVATE FUNDING BY DESIGNATION

$46,424,287 TOTAL EXPENDITURES

78%Private donations: $34,374,233

56%One-timedonations

84%General

emergencyrelief

1%Communityfundraisingand events

8%Legacies

2%Other designatedemergencies

14%Somali crisis

35%Regular monthlydonations

82%Programs: $38,056,090

15%Fundraising: $6,761,774

3%Administration: $1,606,423

12%Support from CIDA: $5,600,000

9%Grants from other MSF sections: $3,905,592

1%Interest and other: $353,753

SOURCES OF REVENUE EXPENDITURES

$44,233,578 TOTAL REVENUE

PRIVATE FUNDING BY SOURCE PRIVATE FUNDING BY DESIGNATION

$46,424,287 TOTAL EXPENDITURES

78%Private donations: $34,374,233

56%One-timedonations

84%General

emergencyrelief

1%Communityfundraisingand events

8%Legacies

2%Other designatedemergencies

14%Somali crisis

35%Regular monthlydonations

82%Programs: $38,056,090

15%Fundraising: $6,761,774

3%Administration: $1,606,423

12%Support from CIDA: $5,600,000

9%Grants from other MSF sections: $3,905,592

1%Interest and other: $353,753

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MsF canada annual report: highlights from 2011

2011 was a year full of new and familiar challenges for Médecins Sans Frontières (MSF). In Somalia, MSF treated more than 95,000 people for malnutrition, vaccinated 235,000 against measles and provided close to 540,000 consultations. But this was far from a success story – MSF arrived late and never reached some critical areas. The situation remains acute, our access is blocked, and our se-curity continues to deteriorate.

As Libya deteriorated into war, opposing groups attacked health facilities and health staff. MSF staff were used to treat prison detainees who had torture-related wounds – only to prepare them for further inter-rogation and torture. MSF was forced to suspend some of its Libyan operations as a result. MSF struggled unsuccessfully to enter Syria to help people wounded there.

World governments backed down from their financial commitments to the Global Fund to Fight AIDS, Tuberculo-sis and Malaria in 2011. This is costing lives. Countries that rely on Global Fund money to address HIV/AIDS are forced to stop admitting patients for treat-ment, and to curtail existing programs. Treatment is among the best forms of prevention. Governments are under-mining opportunities to reduce the spread of HIV.

Other highlights from 2011:

• MSFbegantoincreaseitsfocusonnon-communicable diseases, like diabetes and heart disease. Teams encountered non-communicable diseases more than any other medical need following the Japan tsunami.

• MSFmarked the one-year anniversaryof the 2010 Haiti earthquake by pub-lishing a critical review of our work – an important step in our ambition to more realistically reflect humanitarian aid.

• MSF relocated its operations desk inCanada back to Europe. Staff in Can-ada are striving to provide new kinds of support to MSF missions around the world in the most streamlined and useful ways possible.

Marilyn Mcharg, Executive directorBruce lampard, President

This is a condensed version. To read the full text of this message from the executive director and board president, please go to www.msf.ca/publications.

MessaGe frOM Msf Canada’s exeCutive direCtOr and president

aCCOuntaBility

SOURCES OF REVENUE EXPENDITURES

$44,233,578 TOTAL REVENUE

PRIVATE FUNDING BY SOURCE PRIVATE FUNDING BY DESIGNATION

$46,424,287 TOTAL EXPENDITURES

78%Private donations: $34,374,233

56%One-timedonations

84%General

emergencyrelief

1%Communityfundraisingand events

8%Legacies

2%Other designatedemergencies

14%Somali crisis

35%Regular monthlydonations

82%Programs: $38,056,090

15%Fundraising: $6,761,774

3%Administration: $1,606,423

12%Support from CIDA: $5,600,000

9%Grants from other MSF sections: $3,905,592

1%Interest and other: $353,753

SOURCES OF REVENUE EXPENDITURES

$44,233,578 TOTAL REVENUE

PRIVATE FUNDING BY SOURCE PRIVATE FUNDING BY DESIGNATION

$46,424,287 TOTAL EXPENDITURES

78%Private donations: $34,374,233

56%One-timedonations

84%General

emergencyrelief

1%Communityfundraisingand events

8%Legacies

2%Other designatedemergencies

14%Somali crisis

35%Regular monthlydonations

82%Programs: $38,056,090

15%Fundraising: $6,761,774

3%Administration: $1,606,423

12%Support from CIDA: $5,600,000

9%Grants from other MSF sections: $3,905,592

1%Interest and other: $353,753

SOURCES OF REVENUE EXPENDITURES

$44,233,578 TOTAL REVENUE

PRIVATE FUNDING BY SOURCE PRIVATE FUNDING BY DESIGNATION

$46,424,287 TOTAL EXPENDITURES

78%Private donations: $34,374,233

56%One-timedonations

84%General

emergencyrelief

1%Communityfundraisingand events

8%Legacies

2%Other designatedemergencies

14%Somali crisis

35%Regular monthlydonations

82%Programs: $38,056,090

15%Fundraising: $6,761,774

3%Administration: $1,606,423

12%Support from CIDA: $5,600,000

9%Grants from other MSF sections: $3,905,592

1%Interest and other: $353,753

SOURCES OF REVENUE EXPENDITURES

$44,233,578 TOTAL REVENUE

PRIVATE FUNDING BY SOURCE PRIVATE FUNDING BY DESIGNATION

$46,424,287 TOTAL EXPENDITURES

78%Private donations: $34,374,233

56%One-timedonations

84%General

emergencyrelief

1%Communityfundraisingand events

8%Legacies

2%Other designatedemergencies

14%Somali crisis

35%Regular monthlydonations

82%Programs: $38,056,090

15%Fundraising: $6,761,774

3%Administration: $1,606,423

12%Support from CIDA: $5,600,000

9%Grants from other MSF sections: $3,905,592

1%Interest and other: $353,753

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These two pages present highlights from the 2011 MSF Canada annual report, providing a glimpse of how Canadians helped people in need around the world. The complete report, including audited financial statements, is available on the MSF website at www.msf.ca/publications.

The report is an account of Canadian contributions to the international MSF movement in 2011. These contributions include funds donated by Canadians to support MSF’s mission, and aid workers recruited in Canada for MSF’s field projects abroad.

For detailed information on MSF’s aid work in more than 60 countries, please read the 2011 MSF International Activity Report, also available at www.msf.ca/publications.

FIELD ROLES OF CANADIANS IN 2011

Logisticians (22%)55

12Medicalcoordinators (5%)

54Nurses &

Midwives (22%)

7Water-sanitationspecialists (3%)

Heads ofmission (3%)

7

Other specializedpersonnel (5%)

13

WHERE CANADIANS WORKED IN 2011

18Anesthetists &Surgeons (7%)

249TOTAL

MISSIONS

Doctors (15%)37

23Finance & HR

coordinators (9%)

4Mental healthspecialists (2%)

Projectcoordinators (7%)

19

249TOTAL

MISSIONS

Other Asia (11%)27

Other Sub Saharan Africa (35%)

88

Central & SouthAmerica (2%)

5

Pakistan (6.5%)16

Middle East &North Africa (6.5%)

16

Central AfricanRepublic (6.5%)

16

Ethiopia (6.5%)16Democratic

Republic ofCongo (15%)

38

NOTE: Some staff did more than one field mission. This graphic represents all Canadian field contracts with MSF in 2011.

Haiti (11%)27

FIELD ROLES OF CANADIANS IN 2011

Logisticians (22%)55

12Medicalcoordinators (5%)

54Nurses &

Midwives (22%)

7Water-sanitationspecialists (3%)

Heads ofmission (3%)

7

Other specializedpersonnel (5%)

13

WHERE CANADIANS WORKED IN 2011

18Anesthetists &Surgeons (7%)

249TOTAL

MISSIONS

Doctors (15%)37

23Finance & HR

coordinators (9%)

4Mental healthspecialists (2%)

Projectcoordinators (7%)

19

249TOTAL

MISSIONS

Other Asia (11%)27

Other Sub Saharan Africa (35%)

88

Central & SouthAmerica (2%)

5

Pakistan (6.5%)16

Middle East &North Africa (6.5%)

16

Central AfricanRepublic (6.5%)

16

Ethiopia (6.5%)16Democratic

Republic ofCongo (15%)

38

NOTE: Some staff did more than one field mission. This graphic represents all Canadian field contracts with MSF in 2011.

Haiti (11%)27

FIELD ROLES OF CANADIANS IN 2011

Logisticians (22%)55

12Medicalcoordinators (5%)

54Nurses &

Midwives (22%)

7Water-sanitationspecialists (3%)

Heads ofmission (3%)

7

Other specializedpersonnel (5%)

13

WHERE CANADIANS WORKED IN 2011

18Anesthetists &Surgeons (7%)

249TOTAL

MISSIONS

Doctors (15%)37

23Finance & HR

coordinators (9%)

4Mental healthspecialists (2%)

Projectcoordinators (7%)

19

249TOTAL

MISSIONS

Other Asia (11%)27

Other Sub Saharan Africa (35%)

88

Central & SouthAmerica (2%)

5

Pakistan (6.5%)16

Middle East &North Africa (6.5%)

16

Central AfricanRepublic (6.5%)

16

Ethiopia (6.5%)16Democratic

Republic ofCongo (15%)

38

NOTE: Some staff did more than one field mission. This graphic represents all Canadian field contracts with MSF in 2011.

Haiti (11%)27

FIELD ROLES OF CANADIANS IN 2011

Logisticians (22%)55

12Medicalcoordinators (5%)

54Nurses &

Midwives (22%)

7Water-sanitationspecialists (3%)

Heads ofmission (3%)

7

Other specializedpersonnel (5%)

13

WHERE CANADIANS WORKED IN 2011

18Anesthetists &Surgeons (7%)

249TOTAL

MISSIONS

Doctors (15%)37

23Finance & HR

coordinators (9%)

4Mental healthspecialists (2%)

Projectcoordinators (7%)

19

249TOTAL

MISSIONS

Other Asia (11%)27

Other Sub Saharan Africa (35%)

88

Central & SouthAmerica (2%)

5

Pakistan (6.5%)16

Middle East &North Africa (6.5%)

16

Central AfricanRepublic (6.5%)

16

Ethiopia (6.5%)16Democratic

Republic ofCongo (15%)

38

NOTE: Some staff did more than one field mission. This graphic represents all Canadian field contracts with MSF in 2011.

Haiti (11%)27

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K

ube Mugaza, a farmer from a small village in South Kivu in Democratic Republic of Congo was sick with

tuberculosis (TB) for many years. None of the drugs he took seemed to help. His condition deteriorated rapidly. Finally, a test in the Médecins Sans Frontières (MSF) hospital in the town of Baraka revealed that he had developed multidrug-resistant tu-berculosis (MDR-TB). This deadlier form of the disease does not respond to standard treatments using first-line TB drugs.

There was only one way Mugaza’s life could be saved: by adhering to a very strict, long-term treatment plan. He signed a contract with MSF, promising that he would not drop out before the full course of treatment was completed. This was not easy.

“At the beginning, I spent seven months in the isolation ward of the hospital in

Baraka, without seeing my family. It was really difficult, both for them and for me,” says Mugaza.

Even after moving to the ambulatory or outpatient phase of the treatment he had to stay in Baraka in order to get medica-tion at the hospital every day. Adult mem-bers of his family were allowed to visit him in town, but he was not able to see his children during the treatment period, for fear of infecting them.

Two years after he started treatment for multidrug-resistant TB, at the end of 2011, Mugaza was given a clean bill of health. “I feel strong again,” he says. He is finally allowed to return home where his fam-ily has been struggling without its main bread winner.

Mugaza was only the second patient who successfully completed a full course of treat-

ment for MDR-TB at Baraka hospital. Orla Condren, MSF’s medical coordinator there, says his recovery is a big achievement as it is very difficult for patients – especially those from far-away villages – to live separated from their families for such an extended pe-riod of time and to stick with a very strict, long-term treatment program.

“Adherence is very poor,” says Condren. “People here stop taking medicine if they feel better. They want medicine to work after a few days, and that does not hap-pen with MDR-TB drugs.”

At the end of 2011, the hospital in Baraka was treating seven patients with multi-drug-resistant TB, all of whom had moved to the second, ambulatory stage, as well as more than 120 TB patients.

Aloise Fataki Nondo, a Ministry of Health district supervisor for TB and HIV/AIDS

two years of isolation: surviving the Disease aND the tReatMeNt

MultidruG-resistant tuBerCulOsis

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who works closely with MSF, says the number of patients with drug-resistant tuberculosis has gone up in the area.

“There has been a lot of insecurity and movement of people here and not a lot of medical control,” says Nondo. “People have done a lot of self-medication. They have gone to pharmacies for even the smallest respiratory infections and have sometimes over-medicated. Now we are finding more and more cases of resistance against first-line TB drugs.”

Existing since antiquity, tuberculosis is still the second biggest killer globally, and there are more and more TB cases that become resistant to the first-line drugs used to treat it. An estimated 12 million people world-wide live with TB, and about 650,000 of them have multidrug-resistant TB. Alarm-ing new data MSF recently collected sug-gests many cases have gone un-recorded.

The growing prevalence of MDR-TB is the result of incorrect or sub-standard treatment of tuberculosis. It can develop when patients fail to complete their full course of drug-sensitive TB treatment, when the drug supply is interrupted or when healthcare workers provide incor-rect drug doses or improper, expired or poor-quality medicine. The crisis is being fuelled by over-the-counter availability of prescription TB drugs.

The global multidrug-resistant TB crisis coincides with a huge gap in access to di-

agnosis and treatment. According to the World Health Organization, 95 per cent of TB patients worldwide do not have access to proper diagnosis and only 10 per cent of MDR-TB patients are estimated to have access to treatment.

MDR-TB treatments are lengthy, around two years, with highly toxic drugs, most of which were developed in the middle of the last century and have unpleasant side effects. At the same time, reduced funds – notably the recent cuts in the Global Fund to Fight AIDS, Tuberculosis and Malaria – and a small market with few manufacturers have kept the cost of some of the drugs prohibitively expensive. Exist-ing diagnostic tools are either outdated or unaffordable for poor countries where TB is most prevalent.

MSF is calling on governments, interna-tional donors and drug companies to step up their commitment to fighting the spread of this disease. This includes increased access to diagnostics and treat-ment, urgently needed funding and new efforts to develop effective and affordable MDR-TB diagnostics and drugs.

In 2011, MSF treated 1,062 patients world-wide for drug-resistant TB. Kube Mugaza was one of them.

Claudia BlumeCommunications officer

What is MultidruG-resistant tuBerCulOsis?

Multidrug-resistant tuberculosis (MDR-TB) is resistant to at least two of the best anti-TB drugs. These drugs are consid-ered first-line drugs and are used to treat all patients with TB.

hOW is tB spread?

Drug-susceptible TB and MDR-TB are spread the same way. TB germs are put into the air when a person with TB disease of the lungs or throat coughs, sneezes, speaks or sings. These germs can float in the air for several hours, de-pending on the environment. Persons who breathe in the air containing these TB germs can become infected.

hOW dOes druG resistanCe happen?

Resistance to anti-TB drugs can occur when these drugs are misused or mis-managed. Examples include when pa-tients do not complete their full course of treatment; when healthcare provid-ers prescribe the wrong treatment, the wrong dose, or length of time for taking the drugs; when the supply of drugs is not always available; or when the drugs are of poor quality.

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Not long after sunrise, it’s as if the whole world is already awake. Chickens are clucking, goats are

bleating, kids on their way to school are singing and the morning traffic is already drumming up a cloud of yellow dust. Behind the walls of the Médecins Sans Frontières (MSF) compound, the fleet of white trucks sparkles in the bright morn-ing light.

A man in a blue cap is busy filling up one of the cars with gasoline. His name is Paul Sefoi, and he has worked for MSF in Sierra Leone for close to 15 years. He is one of sev-eral drivers for the three ambulances that transport critically ill patients from rural health centres to MSF’s Gondama Referral Centre, a 220-bed hospital outside Bo, Si-erra Leone’s second-biggest city.

During the country’s civil war, Sefoi wit-nessed many atrocities. He remembers the times when bands of drug-fuelled child soldiers – human killing machines – rampaged through villages and towns. But through the years he has also shared many laughs with colleagues, and has helped save the lives of countless women and children.

“During the war, there were checkpoints all along this road,” he says, driving out of the MSF compound towards Sum-buya, a rural outpost close to the district border. “You would find a lot of dead bodies along the road between Bo and Freetown. Every time I had to take that road, I would not be able to sleep the night before. There would be attacks, and they would kill a lot of people.”

MSF was running projects in numerous locations around Sierra Leone during the brutal civil war that lasted from 1991 to 2002 and claimed more than 50,000 lives – many of them innocent civilians. MSF activities ranged from war surgery to providing primary healthcare to those who were otherwise unable to afford it. Now, MSF focuses on providing obstetric care and treating children with malnutri-tion and malaria in and around Bo. Each month, MSF admits more than 700 chil-dren and assists in more than 100 labour and deliveries in its hospital.

Sefoi steers the car across a bridge, where a group of people are bathing in the blue river below, brushing their teeth and wash-ing their clothes. In the distance, small clay huts with straw roofs dot the landscape.

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“You see this village there? It was all burnt down during the war,” he says. “The local hospital further down this road was also burnt down. MSF helped rebuild it.”

The smiling faces of the schoolchildren, the chit-chat by the roadside street stalls, and the tranquil pace of life makes it hard to imagine that all this happened just over a decade ago.

“Now it’s better. Now you can go any-where, people are friendly with you,” says Sefoi. “When I have a day off, on the weekends, I usually watch football. I’m a Manchester United supporter.”

Although times are more peaceful, the MSF ambulances are still busy saving lives. Sierra Leone has some of the worst health indicators in the world, and people are still dying from diseases that could be easily prevented and treated. One of the main health problems is malaria, which is endemic and kills more than 8,100 people in the country every year.

Many of the pregnant women who arrive at MSF’s hospital are in critical condition. In some instances, traditional birth atten-dants have given the women extremely large doses of potent traditional herbs that cause uterine contractions. But through the referral system to the maternity ward, MSF has managed to bring down the number of maternal deaths in Bo district to half of the average in the country.

“When you have a pregnant woman in the car, you have to drive very carefully. Last time I came with one, she delivered in the vehicle,” says Sefoi. “The lady was really bleeding, but both she and the child were OK in the end.”

In the late morning the radio makes a crackling noise, and the voice of the ra-dio operator calls out for the ambulance driver to quickly come to the Jimi Bagbo health centre. Sefoi puts his foot on the gas and speeds down a narrow dirt track that cuts through the lush greenery, do-ing his best to avoid the worst bumps in the road.

Upon arrival at the health centre, he sees a woman clutching a small boy in her arms. Her eyes are wide open, signaling a mix of fear and confusion. The child’s

breathing is heavy and fast. He is suffer-ing from severe malaria and anemia and needs to be taken to the hospital urgent-ly. The two are led into the ambulance, the doors slam shut, and off they go for a bumpy one-hour ride to the Gondama Referral Centre.

“I really like my job, I like driving.” says Sefoi after he has safely dropped off the boy and his worried mother at the hos-pital’s emergency room. “These ambu-lances are a huge benefit to the commu-nity, because now it’s easy for people to get free transport to the hospital when they’re sick. If the ambulances weren’t

there, how would people afford this money to pay for transport? People are really happy.”

As the shadows lengthen and the day draws to a close, he drives off to pick up one final patient – another boy with se-vere malaria, whose future would have been uncertain without the help of Sefoi and the rest of the MSF team in Bo.

niklas BergstrandCommunications officer

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there’s an adage in Médecins Sans Frontières (MSF) that staff can say goodbye but never really leave. Op-

portunities abound in Canada for field workers to remain engaged as volunteers: serving on the board of directors, joining

the national speaker’s bureau, helping with recruitment and fundraising.

This is what new executive director Stephen Cornish did when he returned to Ottawa in 2005 after 10 years of manag-ing humanitarian projects with MSF. He worked at the Canadian Red Cross and CARE Canada while remaining committed to MSF as a board member.

“I never actually left MSF even though it stopped being my day job,” says Cornish. He describes his attachment to the organi-zation as a vocation “because MSF is where I grew up in humanitarianism.”

Fluent in English and French, Cornish first bonded with MSF as a logistics specialist in Rwanda in 1996. He led teams in Sudan, Af-ghanistan, Russia, Sierra Leone, Georgia and Peru. He holds a masters degree in Global Risk and Crisis Management from the Sor-bonne in Paris. He says MSF’s “added value of accompaniment of people in suffering, and giving voice to their experience” feels right to him.

With Cornish’s arrival MSF says goodbye – for now – to Marilyn McHarg, executive director since 2006. McHarg helped found MSF in Canada more than 20 years ago. She left as a nurse in 1991 to dedicate 15 years working in various humanitarian crises, eventually managing operations from MSF headquarters in Geneva and Amsterdam.

Under McHarg, the Canadian branch of the international movement has under-gone transformative change. Private do-nations rose from $17 million in 2006 to $34.5 million in 2011. Fifty staff mobilized volunteers across the country to mount three successful touring exhibits of the Refugee Camp in the Heart of the City. In 2012, MSF hopes to send 300 Canadians on field assignments – a record number.

“We have benefited from Marilyn’s field and operational experience as well as her innovative ideas on long-term directions, which are now a part of our strategic think-ing and activities,” wrote physician and MSF President, Bruce Lampard. “Marilyn will be missed.”

New executive director at the helm

LiVe the experience

We are reCruitinG: Administrators, surGeOns, Water and sanitation experts, physiCians, Nurses, MidWives, Supply chain specialists, Epidemiologists, Mental health specialists, anesthesiOlOGists, GyneCOlOGists, teChniCal lOGistiCians, finanCial speCialists, Pharmacists, HR coordinators, Laboratory specialists, Nutritionists

Msf reCruitMent events in yOur reGiOnwww.msf.ca/recruitment/recruitment-events/

Contact us for more informationToll free: 1-800-982-7903 or Email: applications@msf.ca

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Msf in Canada

Marilyn McHarg and Stephen Cornish

arMenia Alexandra Vanessa Ascorra Torres Quebec City, QC Anthropologist

BanGladesh Jodi Enns Hamilton, ON Nurse

CaMerOOn Tamiko Andrews Montreal, QC Project coordinator Christine Bouffard Sorel-Tracy, QC Nurse Serge Kaboré Saint-Augustin-de-Desmaures, QC Medical coordinator Jean-Baptiste Lacombe Lavigne Montreal, QC Logistician Claudy Vaillancourt Saint-Lin-Laurentides, QC Biomedical analyst

Central afriCan repuBliC Franciscus Blom Westmount, QC Financial coordinator Hamid Echihabi Montreal, QC Water and sanitation specialist

Chad Sara Badiei Coquitlam, BC Logistician Fabienne Gilles Toronto, ON Human resources coordinator Tricia Newport Whitehorse, YK Nurse Peter Nijssen Calgary, AB Logistician Nicolas Perez Montreal, QC Logistician

COlOMBia Carol Gira Bottger Garcia Montreal, QC Doctor Nadia Tjioti Toronto, ON Logistician

deMOCratiC repuBliC Of COnGO Cassandra Arnold Calgary, AB Doctor Cindy Barbe Farnham, QC Nurse Laurence Beaulieu Montreal, QC Logistician Patrick Boucher Quebec City, QC Logistical coordinator Gregory Camirand Mission, BC Water and sanitation specialist Eve Charbonneau Sainte-Flavie, QC Nurse Meagan Cooper Edmonton, AB Nurse Sébastien Gay Montreal, Quebec Logistician Isabelle Haché Sainte-Madeleine, QC Human resources officer Daphne Hemily Toronto, ON Logistician Marie-Eve Isabel Montreal, QC Nurse Sarah Lamb Kanata, ON Project coordinator Judith Letellier Montreal, QC Project coordinator Louis-Philippe Lubino Vanier, ON Financial and human resources coordinator

Patrick McConnell Toronto, ON Logistician Todd Phillips Winnipeg, MB Logistician Letitia Rose Vancouver, BC Nurse Elaine Roy Montreal, Quebec Nurse Claudette Seyer Outremont, QC Nurse Mimonde Théagène Montreal, QC Nurse

ethiOpia Myriam Berry Vancouver, BC Human resources coordinator Richard Currie Salmon Arm, BC Doctor

Nicholas Gildersleeve Montreal, QC Logistical coordinator Nathalia Guerrero Velez Montreal, QC Human resources officer

Guinea Lysanne Lafetière Laval, QC Nurse Chantale Leduc Madoc, ON Midwife

haiti Lindsay Bryson Beaconsfield, QC Medical coordinator Isabelle Jeanson Toronto, ON Project coordinator Oliver Schulz Toronto, ON Head of mission

india Étienne Blais Montreal, QC Logistician

kenya Christina Cepuch Fonthill, ON Medical coordinator Geoffrey Koontz Brampton, ON Nurse Barnabas Njozing Lasalle, QC Epidemiologist

leBanOn Patricia Simpson Sooke, BC Doctor

MOzaMBique Paulo Rottmann Toronto, ON Human resources coordinator

MyanMar Marika Daganaud Compton, QC Medical team leader

niGer Alphonsine Mukakigeri Quebec City, QC Logistician

niGeria Nicolas Bérubé Quebec City, QC Logistical coordinator Ivan Gayton Nelson, BC Head of mission Krystel Moussally Montreal, QC Epidemiologist Michael White Toronto, ON Resource manager

OCCupied palestinian territOry Sybille Rulf Victoria, BC Psychologist

pakistan Loretta Ann Beaulieu Vancouver, BC Human resources coordinator

Jaroslava Belava Vancouver, BC Medical team leader J.L. Talbot-Crosbie Toronto, ON Project coordinator Michael Talotti Bowmanville, ON Logistician

papua neW Guinea Peter Heikamp Montreal, QC Deputy logistical coordinator

paraGuay Alonso Alberto Forero Sanchez Gatineau,QC Doctor

repuBliC Of COnGO Fiona Turpie Dundas, ON Medical coordinator

sierra leOne Hani Hadi Calgary, AB Doctor

sOMalia Brice Garnier Montreal, QC Financial and human resources coordinator

sOuth sudan Sharla Bonneville Toronto, ON Logistician Jennifer Butler Vancouver, BC Doctor Nancy Graham Toronto, ON Nurse Mariam Kone Montreal, QC Medical coordinator Sally Kupp Revelstoke, BC Nurse

sudan Kevin Coppock Toronto, ON Head of mission

taJikistan Jean-François Lemaire Sainte-Julie, QC Biomedical analyst

uzBekistan Susan Adolph Renfrew, ON Nurse Jayne Dykstra Toronto, ON Logistician J. Mariko Miller Vancouver, BC Nurse

yeMen Richard Anthony Maunsell Waterloo, ON Nurse

ziMBaBWe Colette Badjo épse Assamoi Laval, QC Doctor Jennifer Yeo Guelph, ON Human resources officer

Canadians On MissiOn

DispatchesMédecins Sans Frontières (MSF)720 Spadina Avenue, Suite 402 Toronto, Ontario, M5S 2T9Tel: 416-964-0619Fax: 416-963-8707Toll free: 1-800-982-7903Email: msfcan@msf.ca

www.msf.ca

Editor: linda o. nagy Editorial director: Avril BenoîtTranslation coordinator: Jennifer OcquidantContributors: Othmar Arnold, Avril Benoît, Niklas Bergstrand, Claudia Blume, Wairimu Gitau, Lanice Jones, Bruce Lampard, Marilyn McHarg

Cover photo: © Catherine Robinson / MSF

Circulation: 111,000 Layout: Tenzing CommunicationsPrinting: Warren’s Waterless PrintingSummer 2012

ISSN 1484-9372

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MsF Legacy Giving

When people lose everything in disasters, wars and conflicts, they cannot plan. But we do. With your future support, MSF can respond quickly and effectively, often within hours of an unexpected medical emergency.

By planning your estate today, you can care for people in life-threatening situations tomorrow.

To learn more, please call us at 1-800-982-7903 and ask to speak directly to someone about legacy gifts, or email canadaplannedgiving@msf.org.

1999 Nobel Peace Prize Laureate

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