One the young children at the therapeutic feeding center at the MSF-run Gondama Referral Center in Sierra Leone.
November 17 2008
By James Blunt
I was a reconnaissance officer in the British army in the Kosovo conflict of 1999. As such, I was the eyes and ears of my commanders, send ahead to give them information about what their main formations might encounter as they advanced. As the Vanguard, we thought we were doing a tough job, but on numerous occasions we would run into a hut or shed in the middle of nowhere with a queue of civilians waiting to see the doctor inside.
These doctors and nurses from all over the world were volunteers for Médecins Sans Frontières (MSF), and selflessly risked their safety to bring medical attention to the civilian victims of man-made or natural disasters. In a celebrity-obsessed world, I clearly remember thinking that these are the people who should be celebrated.
Today in the Democratic Republic of Congo, Médecins Sans Frontières teams are working to meet the immense humanitarian needs of hundreds of thousands of people who have been displaced by renewed fighting in the North Kivu region of Eastern DRC and are living in extremely precarious conditions. The teams are providing water and sanitation services, life saving surgical support, and primary medical care to people injured in the fighting or who have been uprooted and have fled for their lives.
Even at a time of financial crisis, people uprooted by war and conflict and those affected by disease and malnutrition remain just as vulnerable and in need of assistance. That is why it is vital that we maintain support to those in desperate need right now. Doctors Without Borders relies on the generosity of individuals to carry out its essential life-saving work.
Contributions can be made online at doctorswithoutborders.org
Life with the MSF
Metro followed Médecins Sans Frontières onsite as the organization works to improve the conditions for those living in Sierra Leone, one of the worst countries to live in, according to the United Nations.
“This is what I wanted to do for a very long time,” says Monica Thallinger. It’s the 29-year-old Norwegian pediatrician’s first MSF mission.
Monica Thallinger enjoys working for Médecins Sans Frontières even though it’s not quite the same as her job back at the hospital in Fredrikstad, Norway: “It’s interesting, but hard work, but it also gives you a lot back.”
Malaria is just one of the diseases she never treats back home, and child mortality at the Gondama Referral Center outside Bo is much higher. Here, two or three children die every day as many parents wait too long to seek help. By then it’s often too late.
“Back home a child dies very seldom, so it’s quite tough,” Thallinger says.
But things have improved since Medecins Sans Frontieres set up their operation in the area. “You can imagine how it would be if we weren’t here.”
Even though many traditional doctors have seen the number of clients dwindle since MSF started providing free health care, it happens that patients come in with two conditions — even though it ought only be one.
“Traditional herbs are very common. Some of them actually work but some have been given herbs for months and are intoxicated when they come in.”
But still, Thallinger sees her job as very rewarding. “You see children become better even if they are very ill when they come in and it’s very rewarding to see most of them become healthy.”
Malnutrition is also a common problem in the area. “I especially remember one patient. I had seen malnourished children before, but she was just skin and bones. But for some reason she kept her head up. She was too unstable for x-rays, but we gave her TB drugs and two weeks later she was smiling. Now she is this healthy child running around and you cannot see she was sick.”
Patrick Ekstrand, Metro Sweden
Prevention part of the plan
A young girl is treated for malaria in MSF’s intensive care unit at the Gondama Referral Centre. Her condition is aggravated by herbs given to her by a traditional doctor. The case is far from unique, says MSF doctor Monica Thallinger.
In Sierra Leone, malaria is the main cause of death among children under five. Statistics compiled by the World Health Organization (WHO) explains part of the reason: only 5 per cent of children under five sleep under an insecticide-treated net. The percentage is higher around Bo, where MSF has provided communities with 65,000 insect nets. A survey done last year in the area where MSF operates shows two-thirds of children sleep under nets. Also, under-five mortality decreased by two-thirds in 2007 compared to the previous year.
Malaria is a child killer. Out of an estimated 1 million malaria deaths in Africa, 900,000 occur among children under the age of five. It is also a disease of poverty — and a cause of poverty. The WHO estimates that malaria costs Africa $12 billion US annually. Breaking this evil circle is as easy as breaking the life cycle of malaria. There is no vaccine, but insecticides, mosquito netting and medicines are part of the solution.
However, the GDP per capita in Sierra Leone is only $600 US and health expenditure is just over 3 per cent of the GDP — $20 US per person per year — and those without access to adequate health care have to find other ways. Those living around Bo are better off as MSF provides free health care for children and expecting mothers.
Working with community volunteers to fight malaria
MSF volunteer Mohamed Sandi tests a child for malaria.
Mohamed Sandi, a carpenter, rips open a packet of latex gloves, dons them and pricks the finger of Massah, a two-year-old girl with a fever.
A droplet of blood is placed in a paracheck, a malaria test kit similar in appearance to an off-the-shelf pregnancy test. He keeps looking at his battered digital watch. ”She’s positive,” he says after 15 minutes.
By then Massah has forgotten the sting of the lancet and snatches the foil-enclosed strip of anti-malarials from Sandi’s hand as if they were sweets.
Sandi is one of some 140 community malaria volunteers (CMV), trained by Médecins Sans Frontières (MSF) to diagnose and treat malaria. He also knows which patients to refer to a clinic, among them pregnant women.
“Sometimes a person is very weak and at times they are bleeding from their nose and I send them to the clinic,” he says. By the end of next year the number of CMVs will double to nearly 300, as the project has been highly successful.
“Malaria was very plenty here, at times maybe seven or eight per week, but it is better now,” Sandi says. “I’m not a doctor, but people in the village call me doctor.”
Anyone can be a CMV as long as they are committed and literate — writing journals and collecting statistical data is a vital part of the job. In return for their voluntary work, other villagers supply the CMVs with food and help them tend to their gardens.
The most severe cases end up at the Gondama Referral Centre, an MSF-run hospital outside Bo, the second largest city in Sierra Leone. The GRC provides free health care for children and expecting mothers.
“A Cesarean section at the government hospital is 100 dollars and it’s impossible for the patients to pay,” explains Noemie Larsimont, the Belgian doctor responsible for the GRC.
The world’s forgotten crises, according to MSF
• Burma. Humanitarian aid is limited in Burma since the military seized power in 1962. Despite enormous needs there are few relief organizations that work in the country. Only a small amount of the regime’s budget is allocated to health care.
• Central African Republic. The political crisis has caused a collapse of the health care system. Poor living conditions cause illnessess.
• Colombia. After more than 40 years of civil war with the military more than 3 milion people have fled their homes. Children are forced to be soldiers.
• Democratic Republic of Congo. One of the world’s poorest countries. Several hundred thousands have fled their homes the last year. The Congolese have a high prevalence of malnutrition and malaria.
• Somalia. The country has lived through chaos for 15 years. But the humanitarian aid has decreased. Violence makes the situation difficult for aid organisations.
• Sri Lanka. The conflict between the government and Tamil rebels LTTE has struck hard against the civilian population. Bombings, mines and suicide attempts are everyday events.
• Chechnya. The Caucasus is still unstabile after the war against Russia. There is shortage of basic health care.
• Zimbabwe. Political instability, inflation and shortage of food has weakened the country. Three million people have fled the country. Prospects for the future are not good, medical staff is leaving the country.
• Malnutrition. Every year five million children under the age of 5 die from malnutrition. Despite new forms of treatment, starvation is still an enormous problem, especially in Africa.
• Tuberculosis. Every year 11 million people are infected with tuberculosis. Two million die from the disease. Most victims live in poor countries without sufficient health care.