Friday, March 12, 2010

Médecins Sans Frontières

Founded in 1971 by a group of French journalists and doctors after the Biafra War (1967-70) that devastated the West African nation of Nigeria, Médecins Sans Frontières (MSF) has evolved as an internationally recognized humanitarian aid organization that provides emergency medical assistance to populations in danger in more than 70 countries.[1] It works with people threatened by aggression, neglect or calamity, primarily due to armed conflict, epidemics, undernourishment, and exclusion from healthcare or natural disasters.

Initially, MSF came to fore after the incorporation of Groupe d'Intervention Médicale et Chirurgicale en Urgence ("Emergency Medical and Surgical Intervention Group") that meticulously provided aid in Biafra in 1970 and the Secours Médical Français ("French Medical Relief") that responded to the Bhola Cyclone of 1970 which took the lives of almost 500,000 people in the former East Pakistan (now Bangladesh).[2] MSF was founded on the basis that all people have the right to medical care regardless of race, religion, creed, or political affiliation. It works to remain nonaligned, is imperturbable, and free of bureaucratic restrictions.

The principles of MSF are outlined in the Charter and the Chantilly Principles together with La Mancha Agreement. [3][4] In France it is known by its French name Médecins Sans Frontières or simply by the contraction MSF while in the United States, Canada, and Australia it is widely known as Doctors Without Borders. The operational decisions of MSF are made by largely independent centers located in Paris (France), Geneva (Switzerland), Brussels (Belgium), Barcelona (Spain), and Amsterdam (Holland). The international office responsible for overseeing international activities is located in Geneva, Switzerland.

The current President of MSF is Dr. Christophe Fournier.[5] Dr. Christophe Fournier graduated from the University of Clermont-Ferrand in France where he received his Doctorate in Medicine. Besides, he holds a degree in Epidemiology, Tropical Medicine, and Biostatistics. He previously worked as a doctor or was head of mission in Burundi, Uganda, Honduras, and Chile and as well conducted emergency exploratory missions in Mexico and Venezuela. In 2000, he became MSF's Operations Manager in the United States while at the same time managing field programs in Guatemala, Haiti, Nigeria, Sudan, Cambodia, Myanmar and Thailand.

Like the International Committee of the Red Cross (ICRC), World Vision, Oxfam, ActionAid International, and other international organizations scattered all over the world, the presence of Médecins Sans Frontières (MSF) or Doctors Without Borders is visible almost everywhere where human conflict and natural disasters exist. The national offices of MSF are solely responsible for the recruitment and coordination of volunteers. The organization was awarded the Nobel Prize in 1999 "in recognition of the organization’s pioneering humanitarian work on several continents."[6] It was Dr. James Orbinski , president of MSF at that time, who accepted the prize on behalf of his organization. Besides the Nobel Prize, MSF was awarded the Seoul Peace Prize in 1996.[7]

Teams of medical experts conduct evaluations on the ground to determine a population's medical needs before opening programs. Experts also carry out epidemiological surveys to determine the effect of a disease on a population. For example, MSF measures mortality rates by observing burial rates in a community. By working in concert with governments, cases like genocide, human casualties, and exodus of civilians can be computed by using surveys. Astonishingly, Doctors Without Borders has at times courageously and independently delivered medical assistance to some parts of the world without consulting or working with civilian or military authorities. Because of its commitment to impartiality, Doctors Without Borders remains independent of governments and is a reliable partner in the delivery of humanitarian supplies where others dare not. During the Rwanda Genocide of 1994, together with the International Rescue Committee (IRC), Doctors Without Borders withdrew from camps inside Rwanda to avoid complicity as the camps were used as military sanctuary by the genocidal militia that was behind the massacre of a million Tutsis and moderate Hutus (Pease, 274).

The earliest recorded humanitarian relief operations by MSF was in 1972 when the city of Managua in Nicaragua experienced a devastating earthquake that killed between 10,000 and 30,000 people and razed most of the city’s infrastructure. After Hurricane Fifi inundated the nation of Honduras on September 18 and 19 in 1974, leaving behind massive flooding in its wake, MSF established its first long-term medical relief mission in the country. The fall of South Vietnam to North Vietnam and the subsequent exodus of Cambodians fleeing the ruthless Khmer Rouge saw MSF establish the first refugee camp missions in Thailand. The withdrawal of Vietnam from Cambodia in 1989 necessitated the formation of MSF’s long-term operations meant to resuscitate Cambodia’s dilapidated health care system and also provide care to the survivors of the mass killings.

Arguably, MSF’s first encounter with turbulence would be when the brutal civil war of Lebanon broke out in 1976 while its mission was providing surgical procedures in Lebanon’s major city hospitals thus establishing reputation for nonaligned status and eagerness to work under hostile fire. After caring for Christian and Muslim religious groups in the midst of a long and arduous war that dragged on for almost a decade, rampant attacks on its personnel and the deteriorating security situation in Lebanon finally forced MSF to shut down its operations in 1984.

For the first time in its history, the organization has been able to make a breakthrough in the mapping of the “Meningitis Belt” in sub-Saharan Africa which typically happens between the months of December and June. Sub-Saharan Africa has the highest rate of Meningitis in the world. Psychological programs track down massacres, kidnappings, rapes, and killings so that security can be enforced by the government-of-the-day. In 2004, MSF conducted a wide-ranging mortality survey in Darfur, Sudan.

MSF has been actively involved in the elimination of diseases caused by lack of proper nutrition. The organization has a marvelous practice of setting up Therapeutic Feeding Centers for victims of marasmus who show signs of severe emaciation and weakened immune systems.[8] The same applies for patients of kwashiorkor who are known to appear physically and mentally retarded. Both diseases cause malnutrition leading to fatal opportunistic infections if not treated right away. Drought, war, and mismanagement of economies by corrupt governments may be attributed to be the major causes of marasmus and kwashiorkor in patients.

Sub-Saharan Africa has been grossly affected by myriads of diseases caused by lack of healthy and sufficient nutritional foods because totalitarian and callous good-for-nothing regimes and ridiculous pseudo-democracies headed by leaders who are outrageously brigands in outlook have surreptitiously retarded the development of agricultural technology and scientific technology leaving areas in their control to be prone to contagious diseases.

Often, children are the most vulnerable in situations where basic necessities are nonexistent. To resuscitate such famished patients, MSF has introduced two phases of treatments: Phase 1 and Phase 2. In Phase 1, F-75, therapeutic milk with low energy, low fat/protein powder mixed with water is given to patients to transition them to Phase 2. In Phase 2, F-100, also a type of therapeutic milk but containing more energy/fat/protein content along with peanut butter mixture called plumpy’nut is served to patients. Enriched flour, porridge, and PB5-which is a high protein biscuit-are used for treating populations. In situations where dehydration and diarrhea remain widespread, MSF administers Oral Re-hydration Salts (ORS) as replacement for lost body fluids since ORS contain glucose and electrolytes. For cases showing signs of diarrhea coupled with dysentery and cholera, the application of antibiotics best serve to bring about complete convalescence.

Since water is necessary for hygiene, MSF water experts ensure there is enough water for human consumption-water that is free from sedimentation. Depending on the availability of resources, engineers may build water storage facilities or dig water wells that are free from water-borne diseases. Where applicable, these experts employ chlorination or filtration techniques to contain the spread of water-borne diseases spread by pathogenic microorganisms like bacteria, protozoa, and viruses-many of which are intestinal parasites. MSF water engineers train local medical staff in the fields of simple waste-water treatment by applying physical, chemical, and biological processes. This is done in order to reduce the effects of waste on the health, environment, or aesthetics. Also, volunteers and local medical staff learn proper waste disposal, personal hygiene, and garbage disposal and treatment techniques from MSF engineers.

Nations most afflicted by war and natural disasters seem to benefit the most from the free services provided by MSF. In Africa, countries that have been once afflicted by war or are on the road to recovery such as Liberia, Sierra Leone, Somalia, Rwanda, Sudan, Uganda, Congo, and many others in Sub-Saharan Africa remain the major beneficiaries of the services provided by this internationally renowned organization whose services know no boundaries. Regardless of whether it is an outbreak of a pandemic or an epidemic, MSF continues to serve the needy afflicted by the most debilitating outbreak of diseases. Whether it is Ebola, Bubonic Plague, cholera, sleeping sickness, polio, Marburg Fever, or Tuberculosis, the forces of MSF continue to intermingle with the most vulnerable and the most wretched of the earth including refugees and Internally Displaced Persons (IDPs) without regard to race, color, creed, gender, sex and political and religious affiliation.

Besides the funds provided by donor nations, MSF has to its credit millions of voluntary donors and volunteer workers who dedicate their money, time, and efforts solely for the preservation of human dignity and sanctity of human lives. Those who wish to see the survival and well-being of MSF are not drawn only from the nationals of founding member-states but from the combined citizens of the Global North and Global South whose philanthropic endeavors revolve around the continuation of a collective global effort for the betterment of humanity’s overall existence. In 1982, Malhuret and Rony Brauman who would become the organization’s president the same year introduced fund raising by mail leading to financial independence and increased the speedy establishment of new centers worldwide.

The organization remains in the forefront in its fight against contagious diseases in many parts of the world especially in developing countries in Asia, Africa, and Latin America. Concerted efforts in the collective vaccination of populations against diseases like diphtheria, meningitis, measles, tetanus, pertussis, yellow fever, tetanus, polio, and cholera remain top priority for MSF’s field missions. The bulk of MSF volunteer employees who include physicians, surgeons, nurses, and others with specialized trainings in various fields usually have considerable knowledge as regards the management and containment of tropical and epidemiological diseases. In Africa where HIV/AIDS is wrecking havoc to entire populations due to shortage of medications and the absence of sex education, MSF is playing a leading role in the provision of the much-needed and extremely expensive antiretroviral drugs (ARVs) needed by patients to boost their weak body immune systems.

In Central America, especially in the nation of Nicaragua, MSF is providing public education awareness seminars aimed at curbing the spread of venereal disease and other types of reproductive infections. In areas devastated by civil wars, natural disasters, or endemic diseases, MSF psychologists or psychiatrists provide considerable support to affected communities. In addition, the organization plays central role in alleviating stress in victims confounded by depression, domestic violence, and substance abuse. At times qualified MSF personnel may train local mental health staff to fill the void.

Often, MSF keeps a watchful eye on all forms of injustices or violations committed against defenseless populations by states and armed resistance groups by issuing rejoinders, press releases, and communiqués in the strongest language so as to attract the attention of the international community. By voicing its concerns, MSF is signaling warring parties to show self-control so that remedial measures can be implemented to avoid a repeat of past risky actions not only for the present but for posterity. “MSF reserves the right to speak out to bring attention to neglected crises, to challenge inadequacies or abuse of the aid system, and to advocate for improved medical treatments and protocols.”[9] The latest MSF press release appeared on January 26, 2010 in which the organization strongly condemned the forceful evacuation of 7,000 displaced persons from Munda (Lower Dir, North West Frontier Province) by Pakistani armed personnel.

In some regions of the world where the rule of law is either shaky or preposterously outlandish, some nongovernmental organizations might find their humanitarian efforts hampered by states and other religiously-inclined fanatics and MSF is no exception. The prospects of dispensing humanitarian supplies to the disadvantaged millions living in countries like Somalia, Sudan, Iraq, the Democratic Republic of Congo, Afghanistan and other beleaguered, impoverished, and war-ravaged nations, at times remain absolutely discombobulating for MSF’s compassionate commitments.

Despite its hard work and dedication and its unreserved service to the cause of humanity, MSF employees have not been immune from the absurdities of political instability and civil wars. Constant intimidation by armed groups, kidnappings for the sake of ransom and attacks on volunteers for political reasons, and unjustifiable arrests and abductions of volunteers and international workers cause disillusionment in the dissemination of humanitarian services to the neediest. The War on Terrorism has generated profound mistrust for MSF by nationals whose countries remain under U.S. occupation and the end result leads to apprehension and abrupt evacuation of MSF personal and hasty abandonment of humanitarian activities. The organization evacuated its personnel from Afghanistan’s Badghis region after five of its employees were killed in an ambush near Khair Khana by unidentified gunmen in July of 2004.[10] The victims were identified as Afghans Fasil Ahmad and Besmillah, Belgian Hélène de Beir, Norwegian Egil Tynæs, and Dutchman Willem Kwint. In June 2007, a MSF-France volunteer was killed in the Democratic Republic of Congo while in January 2008, two expatriate volunteers and one national staff member were killed in Somalia resulting in the closure of the project.[11]

The number of non-governmental organizations calling themselves “without borders” is seemingly growing out of proportion. They include Lawyers Without Borders, Farmers Without Borders, Architecture Sans Frontières, Bikers Without Borders, MBAs Without Borders, Pharmacists Without Borders, Librarians Without Borders, and Reporters Without Borders just to mention a few. Despite superficial psychology of imitation and phony proliferation of names identical to that of MSF in the global arena, it is only Doctors Without Borders or MSF that has the potential to ensure the ball rolls when it comes to the delivery of humanitarian services worldwide without the least hesitations.


No comments: