Doctors Without Borders

Doctors Without Borders/Medecins Sans Frontieres (MSF) is an international medical humanitarian organization that assists people whose survival is threatened by violence, neglect, or catastrophe. Its mission is to provide medical relief to the victims of war, disease, and natural or man-made disaster, without regard to race, religion, or political affiliation. The organization's work is based on the humanitarian principles of medical ethics and impartiality. MSF does not take sides in armed conflicts, provides assistance on the basis of need alone, and advocates for independent access to victims of conflict and other disasters.
Dec 2, 2014

"The Last Few Days Have Been Extremely Chaotic"

Jean-Pierre Amigo/MSF
Jean-Pierre Amigo/MSF
October 31, 2014

Dr. Erna Rijnierse is currently working with Doctors Without Borders/Médecins Sans Frontières (MSF) in Bentiu,South Sudan, which has been the scene of heavy fighting for several days now. Here she discusses the situation on the ground.

We’ve been able to provide emergency medical care to 12 people so far since heavy fighting started several days ago, stabilizing patients with gunshot wounds and related injuries. We’ve carried out nine surgical interventions. Several patients arrived in a critical condition, including a pregnant woman, who had a gunshot injury to the chest. We inserted a chest tube, and, for the moment, she and her unborn baby are stable. One nine-year-old boy was shot in the chest and he died upon arrival at our hospital.

The last few days have been extremely chaotic. It’s difficult to move around safely inside the camp or even in the hospital, stray bullets are flying around from all directions. We’ve seen empty shell cases in our hospital. At any time the shooting and shelling can start, which means we have to run to the bunkers.  We don’t really know what is happening outside or who controls what. The atmosphere is tense and very unpredictable.

It’s hard to provide meaningful medical care when you’re worrying about stray bullets and having to spend long periods of time in the bunker. As a doctor, I feel helpless, very frustrated, and even angry hearing the heavy pounding of shelling outside but being unable to reach those who are injured.

For the time being, we’ve been forced to suspend our mobile clinics outside the area under UN control. It’s simply too dangerous to go outside the camp due to heavy fighting. The primary health care clinics inside the camp have been closed for the last two days, but we hope they will be able to open again today.

The outreach team suspended activities for one day but the next morning they were there, ready to go and spread health messages in the camp. We have a positive case of hepatitis E in the camp so it’s vital that the outreach team continues to spread the message about hand washing and refers sick people to our hospital.

We’ve been able to continue staffing the hospital and aim to do so for as long as it is possible, security-wise. There are currently around 40 patients, 15 of whom are children.

MSF teams are providing health care to tens of thousands of people sheltering in the UN "protection of civilians" site near Bentiu, a town in South Sudan’s Unity state, one of the areas most affected by the ongoing conflict. MSF currently runs a hospital within the camp with maternity, pediatric, and tuberculosis wards. There’s also an emergency department and surgical care. Outside of the camp, MSF runs twice-weekly mobile clinics into Bentiu town itself.

Nov 12, 2014

Treating Malnutrition in Mali

Mali  Aurelie Baumel/MSF
Mali Aurelie Baumel/MSF

Your support of MSF helps fund projects like our medical-nutritional program in the West African nation of Mali, which is one of the poorest countries in the world and a place where one in five children do not reach their fifth birthday.  In 2013, MSF teams in Mali treated over 7,200 severely malnourished children, supported the care of 83,000 children with other illnesses at public health clinics, and hospitalized 5,300 children with serious illnesses in MSF’s pediatric unit.

Nutritional and Medical Treatment:

In 2014, MSF teams—made up of 12 international staff and about 252 locally-hired staff—are running the program, in collaboration with the Malian Ministry of Health, at five public health centers and the district hospital in Koutiala.  Severely malnourished children are treated as outpatients unless they have other illnesses.  The children requiring hospitalization are transferred to Koutiala hospital where MSF runs a 300-bed pediatric unit that includes an in-patient therapeutic feeding center for severely malnourished children with complications and a pediatric ward for other sick children.  The remaining children are treated entirely as outpatients at five outpatient feeding centers located at public health centers in Koutiala and Konséguéla, the largest rural health zone in Koutiala district. 

Children with malaria, pneumonia, diarrhea, and other illnesses are treated at the health centers unless they require hospitalization.  The health centers are trained to refer severe cases of any of these illnesses to the hospital where MSF’s pediatric ward is located.  This year, MSF logisticians are building permanent facilities for the pediatric ward, replacing the temporary structures on the grounds of the hospital.  The new structure will provide 205 beds and will be completed by the end of the year.   The team is also working to implement a system of early detection of pediatric complications, increase training of hospital staff, and reorganize the supervision structure in the pediatric department to improve the quality of care.  MSF will also expand its activities at the hospital to include neonatal care.

Malaria Prevention:

Malaria, a parasitic disease transmitted by mosquitoes, is still the leading cause of child mortality in Mali and one of the main reasons for hospitalization of malnourished children.  This year, MSF is running its third and final year of its malaria prevention pilot program in the Koutiala district.  The 2014 program is targeting the entire population of 170,000 children between three months and five years of age in the Koutiala District and helping them stay healthy during the three-month malaria season. 

Early Intervention:

MSF is expanding its successful pilot project that promotes early intervention activities to help children lead healthier lives.  This project incorporates prevention into a comprehensive health care program targeting the main causes of child mortality. 

Initially implemented in Konséguela from 2010-2013, the program is being rolled out to the entire district from 2014-2017 in partnership with the Malian Ministry of Health.  This program is designed to offer a complete package of free preventative care for every child that starts soon after birth and continues until they reach age two.  Teams vaccinate all infants and children under age two according to the approved vaccination calendar in Mali, including new additions of PCV 13 (pneumonia closely follows malaria as the second leading killer of children in Mali) and rotavirus vaccine once approved by the Ministry of Health.  Healthy infants and toddlers will be examined at regularly scheduled “well baby check-ups” with their growth closely monitored.  These children will also receive SMC, insecticide-treatedmosquito nets to help prevent malaria transmission, and highly nutritiousfood supplements to prevent malnutrition. 

Participation in the early intervention program has been extremely high in Konséguela and has had excellent results: the prevalence of severe acute malnutrition was reduced by 69 percent among 12-23-month-olds (1.7% vs. 5.4% in the rest of Koutiala District), stunting was reduced by 34 percent at age two, and 97.2% of children had received all vaccinations at age two (compared with 50% in Koutiala). We expect to achieve similar results in other parts of Koutiala District. 

By expanding early intervention activities to the entire district, MSF seeks to save more children’s lives while demonstrating that preventative care can be implemented effectively and affordably on a large scale in a resource-poor rural area like Koutiala district.

Sep 15, 2014

South Sudan: MSF Treats 3,300 Cases of Cholera

Monica Burns/MSF
Monica Burns/MSF

A significant decline in the number of new cholera cases in South Sudan in recent weeks has prompted Doctors Without Borders/Médecins Sans Frontières (MSF) to scale down its cholera operations. Instead it will redirect resources towards other unmet health needs in the country, where more than 1.7 million people have been displaced by the ongoing conflict.

Since the cholera outbreak was declared on May 15, MSF teams have provided treatment to 3,300 patients in the capital, Juba; in Torit in Eastern Equatoria state; and in Wau Shiluk in Upper Nile state. This is more than half of the 5,561 total cholera cases officially recorded countrywide in the current outbreak.

MSF teams responded to the outbreak by rapidly constructing treatment centers in Juba and setting up oral rehydration points across the city and in other affected locations. At the same time, MSF worked closely with South Sudanese authorities and other partners to improve people’s access to safe drinking water and to train health staff in dealing with the outbreak.

At first the disease spread quickly, exacerbated by unsanitary and overcrowded conditions in the camps where people were sheltering. “Deteriorating living conditions for hundreds of thousands of people, combined with the lack of functioning health facilities, created a perfect storm for the spread of the disease earlier this year,” says Brian Moller, MSF’s head of mission in South Sudan.

The recent decline in the number of new cases of cholera suggests that the outbreak is now under control. “While MSF will remain vigilant, it looks like the efforts of the Ministry of Health and other organizations, including MSF, have helped bring the epidemic under control,” says Moller.

As part of its cholera response, MSF teams carried out the first mass cholera vaccination campaigns ever done in South Sudan, immunizing a total of 200,000 displaced people and host families in Malakal, Minkaman, and Juba against the disease. MSF teams also vaccinated a further 150,000 South Sudanese refugees in Gambella camp, Ethiopia, to prevent the outbreak spreading beyond South Sudan’s borders.

Cholera vaccinations provide vulnerable communities with a better chance of avoiding an outbreak. While the vaccination itself only provides an estimated 65 percent chance of protection, it is one of a number of measures that can help reduce the spread of the disease, alongside improving people’s living conditions and ensuring they have proper sanitation and clean drinking water.

Over its 40 years of existence, MSF has developed significant expertise in the management of cholera. Cholera is endemic in South Sudan but is easily treatable if tackled early. While MSF is reducing its cholera response in South Sudan, ongoing health promotion and community awareness activities will be essential to prevent a recurrence of the disease.

After fighting broke out in Juba on December 15, 2013, and subsequently in several other South Sudanese states, MSF increased its capacity to rapidly respond to emergency medical needs in the country. More than 3,800 MSF staff now run 26 medical and non-medical programs, as well as outreach activities, in nine of South Sudan’s ten states, providing basic health care, nutritional support, surgery, vaccinations, and clean drinking water to people who have fled their homes.

MSF is committed to providing lifesaving medical care in South Sudan, offering aid to people affected by the current crisis as well as to many others who are vulnerable due to lack of access to health care in the country and within the region. In Kenya, Ethiopia, and Uganda, MSF has set up emergency projects to provide assistance to thousands of South Sudanese who have taken refuge across the borders.

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