Dispatches (Summer 2005)

Vol.7, Ed.2

Dispatches MSF

IN THIS ISSUE

CANADA

NEWSLETTER

MSF PROVIDES CAMPS IN NORTHERN UGANDA WITH BASIC

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Northern Uganda: A struggle with disease and insecurity

MEDICAL CARE, CLEAN DRINKING WATER, LATRINES AND THERAPEUTIC FEEDING FOR SEVERELY

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Children of Somalia

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Patient power in Zambia

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The dream of access to medicines for all

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MALNOURISHED CHILDREN.

Chagas disease

A struggle with disease and insecurity 13

NORTHERN UGANDA

New drug simplifies malaria treatment

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Goodbye and thank you

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Confronting humanity in Angola

hen I got the call from the MSF office telling me that I would be going to Uganda for my first mission, I had to search to find information about this country and the issues I might be facing. This is because the strife in northern Uganda is one of the top 10 most underreported humanitarian stories, receiving very little media coverage.

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Though in the eyes of the international community Uganda has enjoyed relative stability since Yoweri Kaguta Museveni came to power in

1986, this has not been the case in the warravaged north. For 18 years the people of northern Uganda have endured a brutal conflict that has received minimal attention from the outside world.

Since 1986, the Lord’s Resistance Army (LRA) has terrorized the region with the declared intent to remove Museveni as president. LRA leader Joseph Kony wages his campaign only in the north, attacking the very civilians he hopes to “liberate” from Museveni’s rule. (continued on page 2)

1999 Nobel Peace Prize Laureate

Uganda

CHILDREN ARE PARTICULARLY VULNERABLE TO REBEL ATTACKS AND THE LRA HAS ABDUCTED TENS OF THOUSANDS OF CHILDREN TO POPULATE THEIR REBEL FORCES. THESE CHILDREN ARE FORCED INTO COMBAT AND SEXUAL SLAVERY.

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Carrie Bernard (right) spent five months in Gulu, northern Uganda as a volunteer medical doctor for MSF. Her work included a night commuter shelter for children, a cholera treatment centre, and remote health centres.

Children are particularly vulnerable to rebel attacks and the LRA has abducted tens of thousands of children to populate their rebel forces.

These children are forced into combat and sexual slavery.

Currently, more than 1.6 million people (80 per cent of northern Uganda’s population) have been displaced by this conflict. They live in internally displaced person’s (IDP) camps where the conditions are deplorable. These “protected” camps were officially created in 1996 to be a temporary solution to the conflict – a safe haven for the population to seek refuge while the Ugandan army (UPDF) fought the rebels.

Civilians were forced to leave their homes, their land and their daily lives for these congested protected villages that in reality offer little security, squalid living conditions and insufficient access to health care. This so-called temporary measure has been the reality for the past nine years. Access to safe water in the camps is inadequate and poor sanitation contributes to the spread of disease.

People living in the camps depend on handouts from the World Food Programme to sustain themselves, as it is unsafe for them to make the journey to their fields for farming. Those who try to farm run the risk of attack by the LRA or harassment by the UPDF for being possible rebel supporters.

Though many humanitarian organizations have made northern Uganda a priority, help is limited due to insecurity in the area. Many agencies only offer support to the most secure camps due to fear of attack. Health stations are present but are often abandoned due to the risk of ambush along the roads. As a result, death is a reality from treatable diseases such as malaria, diarrhoea, and respiratory infections. Malnutrition is a ubiquitous issue, with the heaviest toll taken on infants and young children.

I arrived in Uganda in October 2004 at the height of a cholera outbreak in one of the largest IDP camps in the north. MSF had many programmes that required my attention, but initially all I had time for was cholera. We worked non-

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CIVILIANS WERE FORCED TO LEAVE THEIR HOMES, THEIR LAND AND THEIR DAILY LIVES FOR THESE CONGESTED PROTECTED VILLAGES THAT IN REALITY OFFER LITTLE SECURITY, SQUALID LIVING CONDITIONS AND INSUFFICIENT ACCESS TO HEALTH CARE.

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stop for the first three weeks of the outbreak to build the cholera treatment centre, recruit, hire, and train national staff, and to begin the education process of the population regarding preventing the spread of this potentially lethal disease.

I had expected to work hard. I had not expected that I would have to negotiate with the military to be able to treat my patients. This is the reality, however, in a place where people are confined to their huts by the army in an attempt to keep the civilians separate from the rebels.

Our efforts were successful and the cholera outbreak was contained. This allowed me to focus my attention on our primary health centres in the remote areas of the north. MSF runs health centres where the government has been unsuccessful in doing so due to the war. Daily we dealt with cases of severe malaria, malnutrition, and dehydration from diarrhoea.

Though our treatments were often successful, many people died because it was not safe for us to transport them to the hospital. We were unable to get to our health centres for days at a time due to increasing conflict, leaving national staff stranded and our clinic running low on medications. I was amazed by the strength and commitment demonstrated by the national staff when faced with such adverse conditions. They gave me the strength to go on when at times the situation seemed hopeless.

In the evenings, it was sometimes difficult to maintain that hope as thousands of children streamed into our night commuter shelter searching for a safe place to sleep. The children fear attack and abduction by the rebels so they walk up to 10 miles every night in search of safety. Though I was proud of our programme (we offered security, shelter, counselling, nursing care and adult supervision) it broke my heart to see up to 4,500 children (some just able to walk) leave their parent’s homes each and every night to sleep in a crowded tent with strangers.

Our shelter was just one of many as an estimated 50,000 children search for protection nightly in the north.

The needs in northern Uganda are great. Near the end of my mission we were beginning to implement our sexual and gender based violence programmes. Sexual violence is a growing problem and MSF is there to address the need for treatment, counselling and education. The night commuters are not going away, and the people in the remote camps are in desperate need of health care. Though peace is what northern Uganda needs most, MSF is there for the time being to provide critical assistance to the most vulnerable.

Carrie Bernard Medical doctor, Gulu, northern Uganda

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Letter from the field

Children of Somalia omalia, one of the poorest countries in the world, remains virtually ignored by the rest of the globe. Eight million people are estimated to live here in a country with only a fledgling government, constant insecurity and 20 preceding years of civil war.

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There are high numbers of internally displaced persons in all areas of Somalia.

These people have fled from one part of the country to another fearing for their safety because a clan to which they do not belong controls the area in which they had lived. These people live in great poverty and have neither food nor the necessities of basic living. Internally displaced persons are not classified as refugees by the United Nations and they do not receive any international assistance. Hundreds of thousands of such people in Somalia live with their children in encampments on the edge of the larger towns with no employment, no water, little food, overcrowding, no sanitation and all the health problems that come with these conditions.

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There is no national health service, no social welfare system and much poverty.

The Somali people have little access to health care (eight doctors for one million people was one estimate). Many families will walk hundreds of miles with a sick child to the nearest health facility. There is free polio vaccination but not all children are able to get it and there is only limited availability for vaccination for whooping cough, tetanus and diphtheria.

There are many camels, many goats and many children in this country of sunshine and desert and most Somali people are nomadic, living in the bush. The weather is hot and the geography desert with few bushes and rivers which dry up in the dry season.

Large families are the norm, and some men have more than one wife. Each woman has on average six children. But one child in four will not reach the age of five, according to the most recent esti-

mates, and the infant mortality rate is one of the highest in the world.

Many children live in the bush with their parents in a way that has not changed for thousands of years. Animals are the family’s wealth and the family drinks the milk of the goats and the camels. Children’s songs are often about the camels.

As soon as they are old enough children will care for the animals, the goats and the camels, and find greenery and water for them to eat and drink – children as young as five years old help with the animals. There is little formal schooling for those children and only about 45 per cent of adult males and 25 per cent of adult females are able to read.

At the age of five or six, many little girls are still subjected to female genital mutilation or circumcision, a practice which may be less frequent than before but which still occurs and causes great discomfort and suffering to the female population.

A child who pricked a foot with a thorn is now in hospital fortunately recovering from tetanus, which is almost unknown in Europe or North America because of mass vaccination. The most devastating childhood diseases are diarrhoeal disease and tuberculosis. Statistics are not available on the prevalence of HIV/AIDS but it is likely lower than other subSaharan countries.

Children are seen with landmine injuries and even gun shot wounds. Traffic accidents on roads are common. Tragically, it is not uncommon to see a child brought from a distant place who dies before treatment can begin. The death of a child is always tragic but it is even more so when it is from a disease that is preventable and curable given adequate health resources.

MÊdecins Sans Frontières (MSF) is one of only a few nongovernmental agencies actively working in Somalia to provide desperately needed health care to

this impoverished country and its children. It has also taken over the management of the Galkayo Hospital in Puntland, which includes paediatric and maternity wards.

THE DEATH OF A CHILD IS ALWAYS TRAGIC BUT IT IS EVEN MORE SO WHEN IT IS FROM A DISEASE THAT

In addition, MSF has established a therapeutic feeding centre in North and South Galkayo in Puntland for malnourished children. It is not uncommon to admit children who are less than 60 per cent of the expected weight for their height.

Often they have serious diseases such as measles, diarrhoea and tuberculosis.

They are treated and introduced back to a normal diet in a very specialized way.

The children of Somalia deserve better education, better health care and a better chance to live a longer and more peaceful life.

Irene Turpie Medical doctor, Galkayo, Somalia

IS PREVENTABLE AND CURABLE GIVEN ADEQUATE HEALTH RESOURCES.

Irene Turpie is a medical doctor from Dundas, Ontario.

In 2005 she spent four months volunteering with MSF in Galkayo, Somalia. The town of Galkayo is divided in two and each side is controlled by a different group. There are many internally displaced people in Galkayo, as is often the case in areas of civil war and unrest.

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Zambia

patient power in ZAMBIA ften, advocates for global equity in health preach to the hallelujahs of the already converted. It is a facile task to convince, for instance, the readers of this magazine that those infected with HIV need better access to testing and treatment, and that their communities need comprehensive education to prevent further transmission. It is much more difficult to reach those less inclined to appreciate the importance of world health, their minds necessarily on matters of greater individual importance. It is a challenge of Medécins Sans Frontières (MSF), as it is for the likes of the WHO or the Red Cross, to provide persuasive arguments for why health, like disease, should know no borders.

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Often MSF argues on behalf of individuals, and their nations, whose voice is muffled by poverty or war. Eventually, it is hoped, these people will find words of their own. In Zambia, they are.

The MSF project in northern Zambia is centred in the rural area of Nchelenge, a revised remnant of the programme that treated the flood of refugees from the nearby Democratic Republic of Congo

(DRC). The war in DRC has moved on, and so has MSF. HIV education, testing, and counselling of Zambian people began in 2001. The first patient received antiretrovirals (ARVs) in January of 2004.

People come from hundreds of kilometres away to access the programme.

HIV has been part of Zambian life for decades. But like so many other southern African countries, its effects have been seen and not heard. Most countries have not had as much foresight as Uganda in making their struggle with the disease plain and part of an open dialogue between patients, their government, and the media. Until now, a similar discourse in Zambia has been hampered by poverty, stigma and misinformation. With the help of MSF, and a growing, empowered group of patients committed to living “positively,” this is changing.

In support groups in Nchelenge, along with their corollaries in an MSF project in central Zambia, people are finding their voice. Each day, dozens of people sit together, positive and negative, and discuss their community’s struggle with HIV and how to win it. They talk about stigma, misinformation, how best to educate their friends and families. They talk about business ideas that will provide for the

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sickest among them. They talk about what their government needs to do for them. The discourse is informed, and often passionate. They leave the small room committed to change and armed with ideas.

HIV in Zambia is now front page news.

Nearly every day, the Lusaka dailies feature a story about access, or a prominent spokesperson. Politicians, including the president, are harangued for not being openly tested. According to the head of mission of the Nchelenge project, Riekje Elema, the visibility of the Zambian HIV community is growing by the month.

With elections pending in 2006, theirs is a group that the politicians are paying close attention to. It is suspected that the government will soon announce its plan to make ARVs freely available throughout the country. Together Zambian people have done something that MSF could only aspire to. Instead of trying to convince a reluctant audience that their arguments are worth listening to, they are proving that they cannot be ignored.

James Maskalyk Medical doctor visiting MSF projects, Zambia

Access to essential medicine

THE DREAM OF ACCESS TO MEDICINES FOR ALL hen Jean Chrétien’s Pledge to Africa Act finally came into force in April of 2005, Canadian companies were allowed to produce generic versions of medicines for export to developing countries facing public health crises.

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As discussed in the last edition of Dispatches (Vol 7, Ed.1), Médecins Sans Frontières (MSF) is placing an order under the legislation to see whether, in practice, it really can bring medicines to patients in need.

Since Parliament passed the law in May 2004, not one single pill has left Canada.

There is, however, hope on the horizon.

Apotex, a large Canadian generic company, has agreed to develop a fixed-dose combination (three medications combined in one pill – 3FDC) for HIV/AIDS treatment. Their product is now being developed and the approval process with Health Canada is underway.

The Canadian legislation (formerly named bills C-56, C-9 then C-29) is the first attempt to implement paragraph 6 of the Doha Declaration. The World Trade Organisation (WTO) in its Aug. 30, 2003 decision temporarily allowed generic companies to produce versions of patented originator drugs with a compulsory licence provided the drugs were only destined for export. No-one knows how it will work in practice or where problems will be.

may result in the process being unworkable in practice.

List of medicines: A restrictive list of medicines has no place in the legislation, and yet it exists. Half of the medicines on the list are no longer under patent or are old and rarely used drugs, while the other half is severely limited. The 3FDC MSF has asked Apotex to produce is not on the list and its inclusion could be refused or blocked or cause a delay.

Corporate goodwill required: There is no guarantee for generic companies that a drug will pass the approval process in Health Canada and no guarantee patent holders will not litigate.

Limited financial incentives for companies: Some generic companies claim the government should provide better financial incentives (such as tax breaks or grants) which would encourage the generic companies to engage in the process of producing a drug under the legislation.

WHAT NEXT? The accessibility of just one basic firstline HIV/AIDS treatment is a success in itself. The fact that it will be a Canadian drug is a point of pride for Canadians.

But, we must look at the bigger picture.

Since the Doha Declaration in 2001 promoting “access to medicines for all,” no medicine has been produced under the declaration. If this Canadian drug reaches people in developing countries, it will have taken five years to get one generic company in one WTO member state to produce one AIDS drug under paragraph 6. In five years, how many people have died of HIV/AIDS? UNAIDS estimates over three million in 2004 alone.

This pace is simply not acceptable. And with few countries jumping to follow Canada’s lead and generic companies in Europe clearly stating their disinterest in the process, the hope that this paragraph 6 style legislation will change the direction of the AIDS crisis is fading.

So Canada can be pleased it has done something. But we cannot allow ourselves to believe it is the answer. Access to medicines for all is still a dream…and Doha still empty words on paper.

Rachel Kiddell-Monroe Access campaign coordinator

Canadian social, political and administrative goodwill indispensable: Without the goodwill and determination of people such as civil society organisations, some Canadian public servants and politicians, and UN AIDS Envoy Stephen Lewis, the 18-month process to-date would likely not have happened.

Technical hurdles: The complexities and restrictions included in the legislation

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Chagas disease

BEYOND

cultures

MEETINGS BETWEEN HUMANITARIAN AID GROUPS AND ABORIGINAL PEOPLES ARE AN EXCELLENT OPPORTUNITY TO BETTER UNDERSTAND

spent the year of my 20th birthday immersed in the lives of the families of Egyptian kings and the Massai, walking barefoot through the Himalayas like an Indian guru, fascinated by the many different cultures. Upon returning to Canada in 1989, I began my studies in anthropology, a path that has led me to my current unusual status as a post-doctoral doctor in anthropology.

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HUMAN HEALTH ISSUES IN DIFFERENT CONTEXTS.

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Somewhere at the beginning of this path I got to know Médecins Sans Frontières (MSF); the vision, the people and the practical side of the organiza-

tion attracted my attention. I dedicated the past seven years of my professional life to trying to understand MSF’s humanitarian culture and its relations with aboriginal groups. This has been the subject of my doctoral thesis and a book, and has influenced my personal approach to applying anthropology. I am especially interested in the combining of these two medicines: humanitarian biomedical medicine and traditional Aboriginal medicine, a combination that requires cooperation from both parties. This has brought me to my story today.

MSF recently invited me to Itaka Guasu, home of the aboriginal Guarani people in southern Bolivia. These survivors of slavery, missionary conversions and many other forms of exploitation by the Spanish colonizers are now faced with serious health problems, including a disease that has caused the sudden death of many men and women in their 40s.

Today this disease is known as Chagas disease, named after the scientist Carlos Chagas, who, in 1909, discovered the parasite responsible: tripanosoma cruzi.

Chagas disease has reached epidemic proportions. This disease is insidious; it develops slowly and progressively for up to 30 years. Since it has no apparent symptoms, it is difficult to detect and recognize, until, suddenly, the person dies. It has especially devastated poor and marginalized areas where aboriginal people live.

When I received this invitation, an MSF team was already intervening with people in southern Bolivia to try to control Chagas disease and hopes to soon be working with the Guarani, offering them the drug benznidazole. However, using the pharmacological treatment in an iso-

lated manner is not sufficient for controlling this disease. The cause must be eliminated — the insect (vinchuca), which carries the parasite and spreads it to humans, is abundant in the homes here.

This is where things become complicated because the active participation of each Guarani household is essential. To prevent re-infection, the houses must be destroyed, rebuilt, sprayed and cleaned using a specific hygiene process; pets must live outside. These measures would entail major changes to their lifestyle and the Guarani are resisting. The MSF project coordinator sent me a special invitation so that we could both go see the reasons for this lack of interest on the part of the Guarani in implementing the public health recommendations. There had to be an explanation with this dignified and knowledgeable people. We went to see the traditional doctors, who often compete with the new therapeutic knowledge being brought in.

First we met with the aboriginal and international representatives already working in the area to obtain their approval to be able to talk with the people currently taking care of these populations’ health. We

then went to meet with these people. The first representative we met, Don Felix, was both a health care assistant and a herbologist. He worked simultaneously with pharmaceutical products and plantbased products, and had worked with the upurupuanos (healers/diviners) for many years already. No one from an international health care organization had ever come to ask him about his traditional therapeutic knowledge, and he was pleasantly surprised that we were interested in his knowledge of medical plants and his role as mediator between the cultures.

Don Felix and everyone with whom we spoke insisted on the crucial role that upurupuanos play with the Guarani.

These healers diagnose ill health by reading coca leaves; their advice is highly appreciated and they still have a major social impact. They do not talk about Chagas disease as such, but have the skills and knowledge likely to provide explanations of it, explanations that would be meaningful to the Guarani. This may be where the answer lies to help aboriginal populations integrate methods of preventing re-infection by vinchuca and to fight against Chagas disease.

Therapists from the local social setting

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can provide social and cultural tools so that biotechnology is useful. Thus, the chances of controlling Chagas disease could be increased, and pharmaceutical treatments could be made more effective.

Scientific discoveries can only be useful and effective once they are a significant part of everyday life. Instead of unilaterally “educating” the target populations, in this case, the Guarani, on the medical principles and technology on which humanitarian knowledge is based, MSF, through my visit, launched the idea of bringing together these “discoveries” with those uncovered by the local people regarding health care and human disease. This allows a more understandable, flexible multidirectional approach, which works and cooperates with the existing therapeutic potential. Communication and the exchange of significant knowledge between the two groups

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should bear fruit. Without this dialogue, an opportunity is missed.

Meetings between humanitarian aid groups and aboriginal peoples are an excellent opportunity to better understand human health issues in different contexts. My prior research on an MSF project with the aboriginal peoples of the Brazilian Amazon rainforest showed that the so-called “neutral” biomedical approach adopted overall

by MSF becomes political and culturally distinct when used in projects involving the local and national populations. We need to be flexible, adaptable and understanding to work in different cultural environments. My stay in Bolivia essentially involved giving the Guarani people and their traditional medicine the time to take their place in the discussions on Chagas disease. The national context of Bolivia, in which the Guarani are currently living, is more favourable to these contributions.

Bolivia is a multi-ethnic society with a long tradition of living with Chagas disease. This parasite can be traced back to mummies from the ancient Inca civilizations (1400 BC) and the country’s Wankari (AD 400). The tradition of Kallaway aboriginal herbologists, which once was as organized in the upper Andes as the medical tradition is today at the international level, is still concerned with the health issues surrounding Chagas disease and has developed certain treatments and methods to minimize its scale.

Bolivia has had many experiences of cooperation between traditional and medical approaches to health, which can greatly contribute to the fight against Chagas disease.

Julie Laplante Anthropologist, MSF consultant

Medical developments

NEW DRUG SIMPLIFIES MALARIA TREATMENT he Drugs for Neglected Diseases Initiative (DNDi) has announced the development of a new formulation of combination drug therapy for the treatment of malaria. Every year, malaria kills 1-2 million people. Ninety per cent of deaths occur in sub-Saharan Africa.

The disease is present in over 100 countires and threatens 40 per cent of the world’s population.

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This new fixed-dose formulation is the combination of two drugs, artesunate and amodiaquine (AS/AQ), in one tablet. The adult dosage has been simplified to two tablets once a day for three days (six tablets total), drastically reduced from the current regimen of four tablets twice a day for three days (24 tablets total). DNDi has also developed a paediatric co-formulation – small, easy to swallow, water-soluble tablets for children.

DNDi is a not-for-profit drug development initiative established in 2003 by four publicly-funded research organizations: Kenya Medical Research Institute, Indian Council for Medical Research, Oswaldo Cruz Foundation Brazil, Malaysian Ministry of Health; a private research institute, the Institut Pasteur; an international research organization, WHO’s Tropical Diseases Research programme; and Médecins Sans Frontières.

DNDi also recently signed an agreement with Sanofi-Aventis to complete the development of the AS/AQ fixed-dose formulation and prepare the dossier that is mandatory for registration as well as for WHO drug pre-qualification.

The drug will be available at a target price of less than $1 US for an adult treatment and $0.50 US for children to the public sector, international organisations, and nongovernmental organizations (NGOs). Sanofi-Aventis has agreed to give three per cent of private sector sales revenue to DNDi, which DNDi will use to reduce the price of treatment.

Sanofi-Aventis will be in charge of the first registration, production and distribution of AS/AQ and has agreed to do this at cost for the public sector, international organisations, and NGOs. The new drug should be available in mid 2006.

DNDi’s agreement with Sanofi-Aventis is non-exclusive. However, DNDi has guaranteed exclusivity to Sanofi-Aventis for the duration of the product development programme and until the first registration is obtained.

DNDi aims to develop new, improved and field-relevant drugs for neglected diseases such as leishmaniasis, human African trypanosomiasis (sleeping sickness), and Chagas disease that afflict the very poor in developing countries. It raises awareness of the urgent need to develop drugs for these diseases and uses DNDi projects to strengthen existing capacity in diseaseendemic countries.

To learn more about DNDi and the crucial impact of developing drugs for neglected diseases, visit www.dndi.org.

From DNDi Newsletter No10 April 2005

TAKE ACTION ON NEGLECTED DISEASES On June 8, 2005, DNDi launched an appeal – with events around the world – which calls on governments to provide significant sustained support to bring essential new vaccines and diagnostics to people suffering and dying from neglected diseases.

The date marks the beginning of a year-long campaign to mobilize likeminded organizations and individuals, including the scientific community, media and high-profile opinion leaders, to sign and present the appeal at the World Health Assembly in 2006.

Every day over 35,000 people die from infectious diseases such as AIDS, malaria, and tuberculosis, as well as the most neglected diseases such as leishmaniasis, Chagas disease and sleeping sickness.

Without bold new steps, disease will continue to ravage the developing world, with global consequences.

Governments should act NOW. To find out more about the campaign and how you can become involved, and to see a list of who has already signed the petition, please go to www.dndi.org.

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MSF Canada news

GOODBYE AND THANK YOU fter over seven years as Executive Director of MSF Canada, I am leaving my position this summer. I have learned a great deal with MSF.

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Much has happened over these years, but some people and events stand out in my mind: • The contribution Canadian doctors like Richard Bedell, David Tu, Cheryl McDermid, and Sumeet Sodhi have made in the fight against HIV/AIDS; • The vital role of the Access to Essential Medicines Campaign in bringing down the cost of AIDS medications and changing the way malaria is treated in many parts of the world; • The dedication of our national staff in Republic of Congo, with whom I had the pleasure to work last year when I served as head of mission in that forgotten, war-torn country; • The commitment of so many Canadian volunteers whose ongoing dedication has made such a difference to so many – Jane Little, Steve Cornish, Vincent Echavé, Michael Hall, the Skinnider sisters, Reine Lebel, Leslie Shanks – I

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could fill the page with the names of the people who commit to easing the pain of the world’s forgotten people; • The understanding of Canadians who continued to support MSF even when we have spoken against the common understanding of the day – be it our concern over the mixing of military and humanitarian actions in Afghanistan, the use of humanitarian workers for political activities in Kosovo, or, most recently, our decision to stop fundraising once we had met our requirement for tsunami relief.

MSF is a wonderfully energetic organization, and I feel privileged to have had the chance to work with an excellent staff here in Canada. We have grown into one of the most effective and well-known international agencies in the country.

Once I leave this role with the organization, I will be working on a book about MSF for youth, commissioned by a Canadian publisher.

Without the remarkable support of you, our donors, we would not have the independence and ability to do the work we do

– to go behind rebel lines and bring medical care to the poor; to pioneer antiretroviral treatment for people with AIDS in forgotten corners of Africa; to stand up to government and international bodies who put their own interests ahead of those of the world’s poor.

But I cannot be triumphalist when there is so much still to be done. Only 10 per cent of the people in the developing world who need AIDS medication get it. In Darfur, in Republic of Congo, in Somalia, our volunteers do wonderful work – but the scale of suffering sometimes overwhelms us. We cannot even work in Afghanistan right now, as the murder of our five colleagues there last year remains unresolved.

But a strength of MSF is that we will not allow ourselves to become paralysed in the face of daunting and overwhelming odds; we do whatever we can to find ways to help. And your support helps make that possible. Thank you.

David Morley Executive Director, MSF Canada

MSF Canada reads

Confronting humanity in Angola S et in central Angola during the final stages of the country’s 30-year civil war, No One Can Stop the Rain is the true story of two ordinary Médecins Sans Frontières (MSF) volunteers – a surgeon and his wife, leaving behind their comfortable lives in mid-career. In doing so they are confronted by both the best and worst aspects of humanity.

Based on correspondence and diary entries, the book chronicles the couple’s journey to Kuito, deep in the heart of Angola. The remnants of this provincial capital had the unenviable reputation of being one of the world’s most heavily land-

CANADIANS ON MISSION

Sophia Kapellas Patrick Robitaille Heather Thomson SIERRA LEONE Johana Amar Priscilla Brooke Chentale de Montigny Nancy Graham SOMALIA Steve Dennis Bruce Lampard SOUTH AFRICA Peter Saranchuk

ANGOLA Miriam Lindsay BURUNDI Eugénie Granger Gabriela Phal Diane Rachiele Jennifer Weterings CHAD Kevin Coppock Vance Culbert Frédéric Dubé Darcy Gagnon COLOMBIA Darryl Stellmach DEMOCRATIC REPUBLIC OF CONGO Nicolas Barrouillet Frédéric Beaudoin Paul Blasig Émilie Frédérick Sylvain Groulx Serena Kasparian Dawn Keim

Jean-Sébastien Matte Andrew Morton Marlene Power Mireille Roy Patrick Ulrich ETHIOPIA Martin Alpert Isabelle Aubry HAITI Sylvain Charbonneau Robert Parker Jean Sander INDIA Lynne Chobotar Sajida Hussain Claude Trépanier INDONESIA Sasha Bernatsky Michelle Chouinard Brigitte Larose Gurnam Sodhi Karin Sutherland

IVORY COAST Jessika Huard Kurt Jansen KENYA Sylvain Deslippes David Michalski Tiffany Moore LIBERIA Asit Mitra Carrie Morrison MYANMAR Nancy Dale Carol Frenette Jim Newton Manisha Rajora NIGERIA Adam Childs PAKISTAN David de Bold REPUBLIC OF CONGO Maryse Bonnel Tyler Fainstat

SUDAN Reshma Adatia Mario Fortin Ivan Gayton Megan Hunter Zayd Majoka Nasser Salam Arun Sharma Sheila Stam Hassan Valji UGANDA Donald Chambers Asha Gervan Maïwenn Henriquet Thomas Kelly Thierry Oulhen Tom Ripley UZBEKISTAN Catherine de Ravinel ZAMBIA Bonnie Fournier Eva Lam Sima Patel

mined cities. The events witnessed by the authors as they worked alongside civilians – victims of landmines, the malnourished, and the displaced – provide a unique insight into life in this vast humanitarian citadel. Through the couple’s eyes, the reader not only experiences something of the expected, the trauma of war, but also gains a rich insight into the less expected: the ordinary life of both local residents and field volunteers.

No One Can Stop the Rain is written by Karin Moorhouse and Dr. Wei Cheng and published by Insomniac Press. It is now available in bookstores.

Dispatches Médecins Sans Frontières/ Doctors Without Borders 720 Spadina Avenue, Suite 402 Toronto, Ontario, M5S 2T9 Tel: 416.964.0619 Fax: 416.963.8707 Toll free: 1.800.982.7903 Email: msfcan@msf.ca www.msf.ca Editors: linda o. nagy Dominique Desrochers Editorial Director: Tommi Laulajainen Contributors: Carrie Bernard, DNDi, Nancy Forgrave, Rachel Kiddell-Monroe, Julie Laplante, James Maskalyk, David Morley, Irene Turpie Circulation: 90,000 Layout: Artshouse Communications Inc. Printing: Warren's Imaging and Dryography Summer 2005

ISSN 1484-9372

Photo credits: Jet Belgraver, Chris de Bode, Jean Marc Giboux, Julie Laplante, Sebastien Le Clezio, Greg Locke, Stefan Pleger, John Reardon, Julie Rémy, Gilles Saussier, Stephen Shames, Serge Sibert/Cosmos, Kenneth Tong

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MAKING A LEGACY GIFT TO MSF

Nancy Forgrave Personal giving officer