Dispatches (Summer 2008) by Doctors Without Borders / Médecins Sans Frontières (MSF) Canada

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Dispatches CANADA

NEWSLETTER

IN THIS ISSUE A special edition devoted to displaced people

Refugees and IDPs

Gaining acceptance for mental healthcare in Darfur

Letter from the field: Central African Republic

Cycle of displacement

Earthquake relief in China

Diary from Myanmar

Ollie’s Field Journal: A 9/10ths Happy Story From Africa

Canadians on mission

1999 Nobel Peace Prize Laureate

LIFE ON THE RUN 42 MILLION STRUGGLE TO SURVIVE © Roger Turesson

MSF

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ÂŠ Spencer Platt/Getty Images

Refugees and IDPs

straggling line of people comes into view on the horizon. They are walking slowly, their feet dragging. They are carrying their smallest children on their shoulders or backs, clutching little bundles containing their belongings. Older children shuffle alongside, the sharpness of their bones jutting against the skin. They look weary, like people who have moved through panic to somewhere beyond, craving safety and rest.

almost 10 million more than the entire population of Canada.

be deadly, leading to outbreaks of serious diseases like measles or cholera.

The images are all too familiar, though the landscape and the nature of the crisis may change. The number of people who have been forced by conflict, violence or disaster to flee their homes continues to grow each year, and today totals a staggering 42 million refugees and internally displaced persons (IDPs) worldwide -

People who have been forced to flee their homes generally have no notice, no time to pack or plan, and no clear destination. Camps are established to help provide a place where these people can settle temporarily and receive food, shelter, water and medical assistance in safety. Often they will arrive in a state of high vulnerability after days of walking, and may well have been affected by the conflict long before they fled their homes. Children may be malnourished, or be suffering from diarrheal disease. They may be suffering from endemic tropical diseases, like malaria, that are fatal without treatment. In the camp, crowded conditions and inadequate sanitation can

Refugees and IDPs are also often traumatized by their experiences, which may include having witnessed the death of a family member or violence inflicted on someone they love. Sexual violence is a particularly brutal and common occurrence, and too often is used as a deliberate weapon against civilians. Even when they have not been the target of violence, however, as in the case of natural disaster, coping with the devastating loss of people and homes leaves a terrible burden to bear.

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This edition of Dispatches focuses on the plight of refugees and IDPs around the world, but particularly on those displaced

ÂŠ Sven Torfinn

NO ONE CHOOSES TO BE A REFUGEE

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by conflict - the majority of those with whom Médecins Sans Frontières (MSF) works. In situations of conflict humanitarian organizations play an essential role not only in responding to immediate, vital needs for food, water, shelter and medical care, but also by simply being there. International presence can afford a measure of protection to those at risk, but perhaps most crucially, it provides a reassurance to those who have suffered enormous losses that their plight has not been forgotten. For millions of refugees and IDPs living in protracted situations, the fear of having been forgotten is very real. No matter how well-supplied with food, water and healthcare, camps are only ever intended as a temporary solution. In many countries, however, the conflict shows no sign of abating, and places of temporary displacement have become lifelong traps. On the borders of Sudan, Somalia, Myanmar and Afghanistan, for example, refugees have passed whole generations waiting for the conflict to be resolved so they can return. Many of Colombia’s internally displaced have lived amid violence for 45 years. Five years after the start of the conflict in Darfur, millions are still displaced, and the situation is not improving: In 2007 alone, another

300,000 people fled their homes. For many people displaced in the world today, the question is not when, but whether they will be able to return.

WHAT IS THE DIFFERENCE BETWEEN A REFUGEE AND AN IDP?

There can be room for hope, however. In March 2007 a peace agreement signed in Ivory Coast allowed many people to return home. In Uganda a significant number of IDPs were able to begin making their way back to their communities in the wake of years of fighting. The process of rebuilding will be long and difficult, but for some it is, at last, beginning. The crucial ingredient in all of these situations has been not only assistance, but governments and institutions taking responsibility for the welfare of their people. The one can never be a replacement for the other.

A refugee is a person who, having fled their home, has crossed an international border. In a situation of large-scale displacement, large groups of people may be designated as refugees. Individuals who flee persecution must have their situation assessed in order to determine whether they qualify for protection. International refugee law protects people in this situation, and the United Nations High Commissioner for Refugees (UNHCR) is responsible for ensuring refugees are protected.1 Internally displaced persons (IDPs) do not cross an international border and do not receive any special protections. They remain under the protection of their government, which can be problematic in situations where the government is a party to the conflict or responsible for human rights violations that caused their displacement in the first place. The protections to which IDPs are entitled are outlined in the United Nations’ Guiding Principles on Internal Displacement.

Clea Kahn Humanitarian affairs officer

Clea Kahn has worked for MSF in Sri Lanka, Bangladesh and Chad. She is currently a humanitarian affairs officer for MSF projects in Democratic Republic of Congo.

1 Palestinian refugees are the exception, as there is a special body responsible for their situation under international law.

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Sudan

Gaining acceptance for mental healthcare

IN DARFUR ALMA CAMP, DARFUR - Musa was chained naked to a tree stump for five years as an act of love. In Darfur, Sudan, as in many regions of the world where treatment for psychiatric illness is seldom understood, nor available, protecting a man from injuring himself and others can push families to drastic measures. If they kept him bound, Musa’s parents reasoned, they could feed him. They could give him water. He would stay alive. The conflict did not provoke his mental illness, but it made the burden of his survival all the heavier on his family.

It couldn’t have helped that Musa’s family, along with the estimated 90,000 others living in one of the biggest camps for internally displaced people (IDPs) in Darfur, had to cope with the stress of surviving a humanitarian crisis of devastating proportions. Five years of arson, killings, rape, looting and fear is more than most could bear. Camp dwellers experience the added stress of wondering if peace will ever return so that they can migrate back to their home villages, to their farms. It doesn’t help when

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the camp that is supposed to be their refuge is attacked or becomes the scene of inter-ethnic violence. Over the years, Médecins Sans Frontières (MSF) has expanded its notions of comprehensive medical care in conflict zones to include what are called psychosocial interventions. These include counseling, clinical support, and community education programs for those suffering the impacts of war and displacement. And they’re essential for survivors in Darfur. “Violence does not only cause pain in the body but also pain in the heart,” explains MSF mental health advisor Kaz de Jong. “Survival in emergencies depends not only on physical fitness but also the mental condition of the people. We have seen people in therapeutic feeding centres, for example, not wanting to eat because they did not see a reason for living.” MSF began providing primary healthcare in Kalma Camp in early 2004 and, by 2006, had added a mental health program to help

those experiencing violence-related stress, adjustment problems, psychosis, anxiety and a host of other burdens. Amal Hashim Algack, a Khartoum-trained psychologist, was involved in the earliest days of training a dozen IDPs in the camp to become outreach workers and psychosocial caregivers. The central idea was, and still is, to offer workshops that help people recognize in themselves and in others the symptoms of psychological stress. The next goal is to give families support as they strengthen their own remarkable coping skills. The overwhelmed can seek therapy for themselves and their loved ones at the MSF clinic. “It was a big effort to change the minds of these people, for them to believe in mental health treatment,” Algack says. “Most will just say it’s devils in people’s minds.” This is what Musa’s parents believed. They first tried with a traditional healer who attempted to expel the demons by inscribing some paper with verses and dipping it into a glass of water until the ink seeped out.

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A relative of Musa’s who knew about the MSF mental health program, who was impressed by its positive results, invited the organization to try its methods on the young man chained up on the far reaches of the sprawling camp. “He was like an animal,” Algack shudders, recalling what they witnessed. His hands and feet were chained together to that stump, amidst the stench of years of excrement and urine. “He was aggressive towards everyone - beating his father and mother when they came near.” The MSF counselors urged Musa’s parents to release him into their care. The father doubted their methods, and wanted to see yet another fakhi, or traditional healer. After five sessions with the family, the psychologist was finally permitted to talk to Musa. These sessions went on for months. The MSF team would come back day after day, filled with sorrow at the

young man’s situation. Watching him struggle against the chains. He was delusional, dangerous. A severe psychotic living an inhumane existence. “We even cried,” Algack admits. “Everybody who saw Musa cried, even the MSF drivers.” Over the course of seven months they persisted. There were three failed attempts when Musa’s parents relented and unchained him. Every time, he exacted violent outrage. By January 2007, MSF’s mental health program started including prescription medication. This made all the difference to someone in Musa’s condition. Within a month on neuroleptic drug therapy, Musa was freed. The counseling finally began to take effect. “Now he is a man again,” she reflects. “He’s smart and can function with the help of the medication.” Musa, now 33, works with his father, weaving straw mats that they sell in the South Sudan hub of Nyala, 15 km away. It took drug therapy to trigger Musa’s positive response to the home visits, individual and family counseling that MSF offered.

Psychologist Amal Hashim Algack talks to Musa.

MSF considers mental healthcare an essential element of its primary health program in Kalma Camp. The goal is to help people regain some sense of control over their emotions, their behaviour, their stress levels and their ability to function despite the precariousness of camp living. For most, community education workshops give them the information they need to help themselves and one another survive day after day of traumatic experiences in an IDP camp. Here, families remain totally dependant on a massive humanitarian effort to stabilize their physical health and nutritional status. Yes, their biological survival is important. Some are even benefiting from services, like clinics and schools, that were not available to them before the war. But Kalma’s basic health indicators obscure multiple layers of torment that MSF is committed to alleviating.

Avril Benoît Director of communications

The chains from which Musa was freed after five years.

Musa then drank the blackened liquid, but time and again, the treatment failed.

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Letter from the field

Letter from the Central African R thought I’d send an update on my work here with MSF in the Central African Republic (CAR). Overall, this has been the most amazing experience. Medically, I couldn’t have asked for better. Our work here is so vital to the community. We treat over 100 patients every week for malaria, the biggest killer in Africa. Last week, we transfused five children who had severe anemia from malaria. For four of the transfusions, we had to use our “living blood bank,” one of my pet projects. This involves people from the community who volunteer to be blood donors and who are tested for blood-borne illnesses, blood type, etc. When we need them, we find them at home, retest them, and then they can donate. It’s an amazing system, and involves no refrigeration! Also last week, we did an emergency caesarean on a woman at 2 a.m. The baby was healthy, weighing in at 4.4 kilograms. I know that without MSF

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being here, both mother and baby would have died. There are examples like these every day, which always keeps me going, even during the rough spots. This has been an exceptionally difficult week for MSF here in CAR. On Monday, a lone gunman fired on one of our vehicles as we were heading towards a mobile clinic in one of our neighbouring projects. He was aiming to kill, as he fired three shots, barely missing the driver, and striking a garde-malade in the head. This unfortunate woman was accompanying her child back to her village, and leaves behind five other children. This was a senseless attack, and will likely go unpunished, as the law enforcement all over CAR is sketchy at best - this country is just too poor to afford it. Even in Boguila we have gendarmes and military in the area who are well armed but have no vehicles, not

even a motorcycle. Such lawlessness leaves the entire population open to robberies and violence by bandits (such as the many coupeurs de route who rob villages or passers-by every other day in this area), or Chadian mercenaries (such as the ones who burned down four villages just 80 kilometres from here last week). The terrible incident in Vakaga province on Monday, however, is more significant than just the needless death of a young mother of six. It also means that MSF will have to slow down our work in the area, and possibly close the project altogether. How many people will be lost because MSF is not there? It’s difficult to assess. It is certain, however, that all of the people of Vakaga province will suffer greatly from this attack. Also this week, I met Marguerite, a 16year-old girl who was raped by someone

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n Republic from her village. The incident occurred four months ago but, as with most women here who suffer from sexual violence, she felt she couldn’t tell anyone. She was too afraid of the repercussions - that she would be blamed or ostracized for the attack, that she might be deemed unfit to marry. The physical trauma she suffered became more and more apparent, however, as time went by. Indeed, she could barely walk without assistance by the time she came here for treatment. She had suffered severe vaginal lacerations and ulcerations which had become infected. Luckily, she did not test positive for either HIV or hepatitis B, which are so easily transmitted with sexual violence. We have a really good team here, and I’m proud to say she received excellent treatment on all levels. We even have a psychologist working with us who was able to help the patient cope, at least for the initial phase.

This morning, I just left Edith, who is sitting all alone in the tuberculosis (TB) dorm we just finished building. She was perched on her homemade bamboo bed, with barely enough strength to sit up to eat her bowl of popoto, or corn gruel. Edith is a real fighter, and she needs to be. She has what we call a co-infection, having both HIV and TB. Last week, we saw her during one of our mobile clinics, and she was close to death. She is 25 years old, of average height, and weighs only 26.3 kilograms. After much discussion with Edith’s mother, we elected to transfer her here with her mother and Edith’s eight-month-old baby. The next day, Edith’s mother took her granddaughter away in the middle of the night without telling anybody. I was so angry when I heard this that tears came to my eyes. I just couldn’t believe a mother could do this to her daughter. I’ve run this over in my mind, and the only answer I can come up with is

that Edith’s mother has decided to care for the rest of her children and grandchildren, who still need her help. What an impossibly difficult choice, to leave a dying daughter in order to tend to those who still need you. Unfortunately, this is a decision many people here are forced to make. Sometimes all of this gets to be too much. So when the first rain came this afternoon, instead of seeking shelter, I ran out into our backyard. I stood there shouting at the sky, hoping the rain would wash it all away. A short while later the sun came out, quickly drying any evidence of the downpour. And, with a heavy sigh, I dried off and went back to the hospital, ready to face the afternoon onslaught of patients.

D’Arcy Gagnon Medical doctor

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Colombia

Cycle of D

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f Displacement “Taking the water away from the fish.” his is how Carlos Castaño described his paramilitary campaign targetting Colombia’s rural communities during the late 1990s and early 2000s.

The ultra-right paramilitaries knew they would have difficulty taking on the left wing guerillas in their own territory - the mountains, swamps and forests. They took a different approach, deciding the rural communities were supporting groups like the Revolutionary Armed Forces of Colombia (FARC) and the National Liberation Army (ELN), and so made it their objective to displace these communities, thus removing the guerillas’ “lifeline.” The paramilitaries, famed for their use of chainsaws, used methods of torturing and killing designed to create widespread terror and leave a lasting, traumatic impression on those witnessing such events. They gathered people together to watch the executions of those they regarded as collaborators. Being a shopkeeper was enough to earn this label. Across Colombia hundreds of thousands left their homes in search of safety. Targeted killings, massacres and conflict are the triggers for the first stage in the cycle of displacement. People abandon rural communities and tend to move to

urban areas. There they are often stigmatized and have difficulty finding work and adequate housing. Many decide to return and re-establish their communities. Many communities again find themselves in between conflicting groups and accused by one side of supporting the other. Targeted killings take place and the cycle repeats with further displacement. “They [the armed groups] come to buy things, they chat with you, they ask you things,” said one shopkeeper. “What happens is when they come and see we are badly off, they leave us alone, but when they see that people are getting it together they come and hit you up again. We hope that if they come back they are only going to ask you for a little bit of groceries. What are you going to do?” It is not only violence that is responsible for the displacements. The so-called war on drugs also contributes. The principal tactic used to eradicate cocaine production is crop spraying. The problem is that it kills everything; many farmers with small holdings have had their source of food destroyed and are unable to feed their families. Some opt to move to urban centres, others search out fertile land to start again while continually watching the skies.

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Médecins Sans Frontières (MSF) is present and working with communities at each stage in the cycle of displacement. We have services for displaced communities in urban centres and we support returning communities. Many of our patients have been through this cycle two or three times. One father of four, who fled his community and later returned, said: “When the violence came we had no choice but to leave everything behind and go to the city. We never imagined back then that displacement was going to be a trip with no end, with no point of arrival. We move, but we do not move on. Looking back, we have been in three ‘places’ during this journey the violence at home before we left, the misery of the slums after we fled, and the lack of sleep now that we have returned to what we used to call home. One never ceases to be ‘a displaced person.’ It is a stigma, a way of life.” We recently visited a small group of displaced people in a remote area of Antioquia. Seventeen families had left their village after the FARC had killed three local people. The families were living together in

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one house. The displacement and current living conditions were taking their toll. It was the second displacement for this community. Many were saying they had now made the decision to never go back, others were contemplating the idea of returning and a small number had begun visiting the village to tend to crops and arrange belongings. Multiple displacements leave people in limbo. They seem to be in one place in body and another place in mind. As a psychologist, the biggest challenge I face is assisting people to recover from trauma when they have no stability or security in their lives. This is extremely difficult, if not impossible, in a context of multiple displacements. But the people in this village all wanted to talk and we are here to listen. This cycle of multiple displacements has emerged out of a complex conflict in which nobody knows from where the next threat will emerge. The paramilitaries have been demobilizing but are reforming just as quickly with new names and agendas. There are numerous groups of left-wing

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guerillas, and all armed groups are protecting their investment in the drug trade. For MSF, managing security is problematic when it’s difficult to keep track of all of this, to understand who is likely to be a threat to us. This is exactly the same for the people living in these areas. When you’re sipping coffee in the affluent cafés of Colombia’s major cities, it is easy to forget there are more than three million internally displaced people in this country. Only Sudan, Iraq and Democratic Republic of Congo rival Colombia in the number of people making the decision to leave their homes in search of safety in their own country. This conflict is hidden and very dirty, with one clear loser: Colombia’s rural poor. It would seem you can’t take the water away from the fish.

Simon Midgley Clinical psychologist

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China

EARTHQUAKE RELIEF IN CHINA Snapshot: May 23 he Chinese government is now estimating that more than five million were left homeless by the 8.0 magnitude earthquake that devastated parts of the country’s Sichuan province on May 12. A total of 34 Médecins Sans Frontières (MSF) team members are now in the affected region carrying out assessments, providing surgical and basic medical care, as well as mental health services, and donating tents and medicines to the relief effort.

Today, a convoy of 10 trucks carrying 2,050 large family tents arrived in Deyang and was directed, in close collaboration with the Chinese Red Cross, to Mianzhu and other areas most affected by the earthquake. MSF has now donated 3,800 large family tents worth some $1.7 million, including transportation, to the relief effort. Two cargo flights carrying 1,750 tents arrived last weekend and were distributed in the affected region and damaged healthcare facilities in Guanghan and Hanwang with the help of the Sichuan Red Cross and dozens of volunteers. The Chinese government has estimated that there is a need for approximate-

ly 3.3 million tents to house those left homeless by the quake. “The need for shelter is tremendous,” said MSF emergency logistical coordinator Nicolas Tocqué. “I have been in refugee settings where assisting 80,000 people in one location was overwhelming, but it does not compare to the millions who need shelter in China after this earthquake. They need tents not just in quantity, but of good quality, so that families can live in them for the many months it may take to construct adequate housing and infrastructure.” On May 22, MSF finished its week-long clinical and surgical support to a temporary triage referral hospital in Guanghan, as the majority of patients have been transferred to other facilities and the rest will leave in the coming days. During the past week, MSF provided surgical and post-operative care to some 70 wounded patients who were transported, many by helicopter, to the triage centre from some of the hardesthit areas in the region. MSF has made a donation of medicines and medical sup-

plies to the hospital and will continue its mental health work in the facility until the last patients wounded in the earthquake are transferred. The demand for mental health work remains in hospitals taking care of the wounded and settlements where earthquake survivors are living throughout the region, and there is clear recognition of the need to respond to it. In addition to MSF’s mental healthcare work in the triage centre in Guanghan, MSF is collaborating with the Huaxi Hospital in Chengdu to provide mental health support and training and is looking into the possibility of expanding the mental health component of our program. At the time of the earthquake, MSF staff members were working in Nanning, Guangxi Zhuang Autonomous Region, where the organization has been running an HIV/AIDS treatment program since 2003 in collaboration with the Guangxi Public Health Bureau and the Nanning CDC. MSF has worked in China since 1988.

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BETWEEN MAY 5 AND JUNE 4, MSF TEAMS DISTRIBUTED IN MYANMAR: 1,250 tonnes of rice 410 tonnes of beans

r. Khine Myae, a native of Myanmar, was one of the first physicians Médecins Sans Frontières (MSF) sent to the devastated Irrawaddy Delta to provide assistance after it was battered by Cyclone Nargis at the beginning of May. Below he remembers the first few days after the cyclone struck.

190,000 litres of cooking oil 70 tonnes of canned fish 1,400 kg of salt 125,000 packs of energy biscuits and therapeutic food 120,000 plastic sheets 20,000 mosquito nets 48,000 jerry cans 3,000 blankets 16,500 soap bars

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SATURDAY, 4 MAY 2008 Last night Yangon was struck by a deadly cyclone. The news reached me by radio in Lashio (eastern Myanmar) where I was visiting our HIV project. Throughout the day we received more and more news about the enormous destruction. I am very worried about my family. I am here with two colleagues from Yangon but we can’t reach anyone there. The entire telephone system is down. We tried to book a flight but Yangon’s airport was seriously damaged and no planes can land there at the moment. We have no choice but to take the bus tomorrow. It will

take 24 hours and we can only hope that the bus will make it to Yangon. MONDAY, 6 MAY 8 a.m. We are approaching Yangon and my mobile phone finally works again. My girlfriend, parents and children are all okay. I am extremely relieved. In Yangon, we see the destruction. Not one electricity pole or advertising sign still seems to be standing and almost all of the enormous old trees have been knocked down. Cars and buildings lie buried beneath branches and tree trunks. Our bus can’t go much farther so we walk the rest of the way. When I arrive home, I see my girlfriend. She also works for MSF. “We have to go to the office,” she says immediately, “it’s terrible in the Irrawaddy Delta.” At the office, I hear more details. Whole villages have been wiped off the map by giant storm surges. Probably tens of thou-

Diary from Myanmar

Myanmar

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sands of people lack shelter and thousands have been killed. The medical coordinator and a doctor already left last night for the Delta region and are requesting more help. They need medical teams and materials. As much as possible, as quickly as possible. A few hours later, I’m sitting in a car with two teams. Next we will get into a boat that will take us to the disaster area. We’ll arrive tomorrow morning. TUESDAY, 7 MAY 5 a.m. As we dock in Heyngyi, I see the first people. I notice that many of them have a faraway look in their eyes. It seems as if they are looking right through me and don’t actually see me standing there.

Khine Myae Medical doctor

THE ACCESS ISSUE In relief operations such as this one, with a disaster comparable in scale to the 2004 tsunami, MSF would usually send to the field a large number of experienced international staff - doctors, emergency coordinators, water and sanitation experts. However, initial restrictions imposed by Myanmar authorities officially prevented foreign experts from working in the Delta in the first three weeks after the cyclone. For instance, in the town of Bogale, MSF international staff were tolerated but could not carry out activities in the periphery of the town. MSF could work with its national staff, but has insisted it needed more international staff in the field. On May 23rd, UN Secretary General Ban Ki Moon came to Yangon, and announced that the Myanmar government had agreed to give international aid workers unhindered access to the Delta. A few days earlier, MSF had actually obtained formal authorization for eight international staff to go and carry out activities in the Delta.

A few people help us to unload and ask us why we are there. We explain that we are from MSF and that we’ve come to bring medical help and equipment. Together with the men we go to find a suitable place to start

working. While 80 per cent of the buildings are severely damaged, the population of Heyngyi has been lucky. People and animals were able to save themselves by getting to a section of the city built on higher ground when the water rushed in. That explains why there were so few deaths here. However, many people were injured in the storm and a large number have lost their homes. In a school without a roof we come across a few hundred homeless families. We can start working in a half-destroyed building owned by a women’s group. The local people help me to sweep all the mud out of the building and a few men repair the roof with plastic sheeting. As soon as that is done, the first patients start to arrive. Our first boat carrying food and plastic sheeting and other supplies arrives a few hours later. Today, our first day, I see more than 200 patients.

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“That was a first, but obviously not enough,” said Frank Smithuis, head of mission for MSF in Myanmar. “Given the scale of the disaster, we need more experts in the field. Our national staff are very capable, but they have no experience of working in emergencies. They have done a tremendous job, but they need expertise to support them.” International staff presence is also an added guarantee that aid remains independent and is distributed objectively. One month after the disaster, more travel authorizations for MSF expatriates were received.

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Book review A young girl eats at an MSF feeding centre in Niger.

OLLIE’S FIELD JOURNAL: A 9/10ths Happy Story From Africa orldwide, more than five million children die every year due to malnutrition. Patti McIntosh’s book Ollie’s Field Journal: A 9/10ths Happy Story From Africa, hopes to help children in Canada understand how something can be done about this, and inspire them to act.

McIntosh spent three weeks in Niger, travelling to Niamey, Zinder and Gouchi learning about a ready-to-use food named Plumpy’nut (or the “peanut paste prescription” as it is called in the book) from a Médecins Sans Frontières (MSF) field team. In Niger, a country with one of the worst rates of chronic and acute childhood malnutrition in the world, this food has become a lifesaver. The product is remarkably simple, made of peanut paste, powdered milk, sugar, vegetable oil, dry whey, and enriched with vitamins and minerals. Children seem to love the sweet taste. The food itself is an essential medicine that gives them the life-saving nutrition they need.

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“So many babies have been saved by this and I wanted to write a children’s book that showed how successful this simple solution is for such a big problem,” says McIntosh. Traditional malnutrition therapy involves admitting a child to hospital to receive infusions of nutrients, and then sending her and her family home with powdered milk that must be mixed with water. In Niger, as well as many other places where clean drinking water is scarce, the powdered milk mixture was causing children to become ill because of contaminated water. With this simple, ready-to-use food in its small package, many mothers no longer have to leave their malnourished children in the hospital. They can treat them at home with a weeklong supply of the food. “I wanted a positive story to come out of Africa,” says McIntosh. “One filled with hope, happiness and success.” McIntosh

tells the story through the voice of 10-yearold Ophélie, whom everyone calls Ollie. Ollie’s trip to Niger is inspired by the successful work her mother is doing there to help malnourished children. While in Niger, Ollie becomes friends with other children, sees a giraffe and even learns some new words in Hausa, a regional language. A scrapbook-like journal documents her trip. The bright photos of mothers and their smiling, growing babies put real faces to a real story. The author turns a complex issue, nutrition, into something children can wrap their minds around. “I hope children take away from Ollie an interest in global citizenship and working for the well-being of others,” says McIntosh. To order a copy of the book and for more information, visit www.juniorglobalcitizen.org.

April Sutton

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Canadians on mission BANGLADESH Shannon Lee Fredericton, NB Project coordinator Financial coordinator Julia Payson Vernon, BC BURUNDI Joel Montanez Moncton, NB Mental health specialist CAMEROON Serge Kaboré Québec, QC Medical coordinator CENTRAL AFRICAN REPUBLIC Lindsay Bryson Montréal, QC Medical coordinator Carol Frenette St-Charles-de-Bellechasse, QC D’Arcy Gagnon Toronto, ON Mélanie Lachance Poisson Québec, QC Luella Smith Waterside, NB

Head of mission Doctor Nurse Doctor

CHAD Michelle Chouinard St-Quentin, NB Project coordinator Mental health specialist Steven Cohen Ottawa, ON Logistician Edith Fortier Montréal, QC Andrée-Anne Gauthier La Malbaie, QC Nurse Project coordinator Ivan Gayton Vancouver, BC Head of mission Sylvain Groulx Montréal, QC Guylaine Houle Montréal, QC Logistician Nurse Elizabeth Kavouris Vancouver, BC Paule Kemgni Québec, QC Doctor Jean Marc Kuyper Montréal, QC Logistician Logistician Catee Lalonde Montréal, QC Pierre Langlois Ste-Catherine de Hatley, QC Logistician Nurse Elisabeth Martel St-Pie-de-Guire, QC Midwife Nathalie Pambrun Winnipeg, MB Logistician Luke Shankland Montréal, QC

IRAN Susan Trotter St. Albert, AB

SUDAN Nurse

IVORY COAST Diane Rachiele Montréal, QC

Financial coordinator

JORDAN Maryse Bonel Morin Heights, QC

Nurse

KENYA Lori Beaulieu Prince George, BC Indu Gambhir Ottawa, ON Maguil Gouja Montréal, QC

Logistical coordinator Medical coordinator Financial coordinator

LAOS Richard Poitras Noyan, QC

Logistician

SWAZILAND

MOZAMBIQUE Isabelle Casavant Montréal, QC

Nurse

MYANMAR

Yvan Marquis Québec, QC Project coordinator Doctor Peter Saranchuk St. Catharines, ON

COLOMBIA

NEPAL

Martin Girard Montréal, QC Esther Hsieh Vancouver, BC

Project coordinator Logistician

DEMOCRATIC REPUBLIC OF CONGO Eva Adomako Montréal, QC

Administrator

Rachida Aouameur Montréal, QC Human resources administrator Logistician Daniel Arnold Port Coquitlam, BC Liaison officer Mélanie Bergeron Sherbrooke, QC Training officer Marie Éve Bilodeau Ottawa, ON Logistician Owen Campbell Montréal, QC Steffen De Kok Sydenham, ON Logistician Doctor Christo Kouame Toronto, ON Logistician Miriam Lindsay Irlande, QC Oonagh Skye Marie-Curry Montréal, QC Logistician Logistician Alphonsine Mukakigeri Québec, QC Project coordinator Tara Newell London, ON Nadia Perreault Mascouches, QC Nurse Nurse Dominique Proteau Québec, QC Medical coordinator Heather Thomson Ottawa, ON

ETHIOPIA Vanessa Bailey Victoria, BC Nurse Project coordinator Dave Croft Vancouver, BC Doctor Richard Currie Vancouver, BC Rachelle Seguin Greenfield Parc, QC Nurse Nurse Joli Shoker Prince George, BC Logistician Daniel Nash Ottawa, ON

HAITI Annie Dallaire Montréal, QC Kevin Tokar Ottawa, ON

Financial coordinator Logistician

INDIA Caroline Kowal Winnipeg, MB

Doctor

Isabelle Chotard Québec, QC

Paul Mathers Winnipeg, MB

Doctor

UGANDA

Rink De Lange Ste Cécile de Masham, QC Water and sanitation specialist Logistician Frédéric Dubé Québec, QC Nurse Robert Genest Montréal, QC Logistician Mathieu Léonard Sherbrooke, QC

CHINA

Kevin Berchuk Toronto, ON Nurse Human resources Charmaine Brett Ottawa, ON Nurse Nadine Crossland Spiritwood, SK Logistician Peter Heikemp Montréal, QC Logistician Leanna Hutchins Canmore, AB Brenda Holoboff Advent Bay, AB Financial coordinator Kylah Jackson Unionville, ON Nurse Logistician Sarah Lamb Toronto, ON Doctor Lauralee Morris Brampton, ON Nurse Wendy Rhymer Winnipeg, MB Grace Tang Toronto, ON Project coordinator Michael White Toronto, ON Logistician

Doctor

David Johnston Surrey, BC Kerri Ramstead Winnipeg, MB

Logistician Nurse

YEMEN Peter Mak Toronto, ON

Anesthesiologist

ZIMBABWE Harry MacNeil Toronto, ON

Water and sanitation specialist

NIGER Matthew Calvert Ottawa, ON Logistician Nurse Marisa Cutrone Montréal, QC Nurse José Godbout Blainville, QC Communication officer Frédérik Matte Montréal, QC Joséphine Millet Montréal, QC Nurse Logistician Nicole Parker Stellarton, NS Audrey St-Arnaud Blainville, QC Nurse

NIGERIA Miriam Berchuk Calgary, AB Marilyn Hurrell Winnipeg, MB

Anesthesiologist Medical coordinator

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

PAKISTAN Darryl Stellmach Calgary, AB

Project coordinator

REPUBLIC OF CONGO Ahmed Alas Edmonton, AB Doctor Financial coordinator Duncan Coady Toronto, ON Head of mission Lai-Ling Lee Ottawa, ON Jake Wadland Ottawa, ON Logistician SOMALIA Lori Beaulieu Prince George, BC Coordinator Medical coordinator Luis Neira Montréal, QC SOUTH AFRICA Adrienne Carter Victoria, BC Mental health specialist Doctor Cheryl McDermid Vancouver, BC SRI LANKA Reshma Adatia Richmond, BC Project coordinator Logistician John Crosbie Toronto, ON Doctor Susan O’Toole Barrie, ON Ivan Zenar Brampton, ON Project coordinator

Editor: linda o. nagy Editorial director: Avril Benoît Translation coordinator: Julie Rémy

Contributors: Avril Benoît D’Arcy Gagnon Clea Kahn Simon Midgley April Sutton

Circulation: 104,500 Layout: Tenzing Communications Printing: Warren’s Waterless Printing Summer 2008

ISSN 1484-9372

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2/7/08

7:41 PM

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ÂŠ Guillaume Binet / M.Y.O.P.

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CHOOSE TO MAKE A DIFFERENCE To make a donation, or for more information on our projects around the world, contact us: 1-800-982-7903 | msfcan@msf.ca 720 Spadina Ave, Suite 402 | Toronto, ON M5S 2T9