Dispatches (Summer 2011) by Doctors Without Borders / Médecins Sans Frontières (MSF) Canada

MSF CANADA MAGAZINE

Volume 14

Edition 2

Summer 2011

DISPATCHES IVORY COAST Turmoil and its aftermath

LIBYA: Evacuation of war-wounded from Misrata, p. 05 JAPAN: Emergency response after earthquake and tsunami, p. 08 | SUDAN: A second chance, p. 10 INDIA: Mumbai slum fire victims lose everything, p. 12 | MSF PROFILE: Logistician, p. 14 REFUGEE CAMP IN THE HEART OF THE CITY: Coming to eastern Canada in fall 2011, p. 13

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IVORY COAST

02 The hopes and limits of war surgery arrived in Abobo Sud, a neighbourhood in Abidjan, at the beginning of March. The first day in Ivory Coast we drove through the city to reach the hospital. It was a beautiful modern city but as we got closer and closer to the hospital the driver had to negotiate his way through roadblocks of burnt beds, old crates and the shells of burnt-out cars. I was there to relieve an anesthetist who had been stuck in the hospital for five days. I started work that afternoon and we continued until 3 a.m. That set the pace for the next three weeks. There were countless bullet wounds, and even cesarean sections to deal with as we also provided support for the fantastic

midwives who stayed to care for women giving birth. I had dealt with shootings and stab wounds before, in Canada, but nothing like the ones inflicted by a Kalashnikov rifle. Muscles and blood vessels were ripped from the bone. It was not just the fighting sides who suffered but women and children as well. Many died en route to the hospital. The part of the city the hospital was in had a curfew so there were never patients arriving in the middle of the night. But the emergency department, which also became our intensive care unit and our recovery room, was always quickly filled in the morning

if it wasn’t already packed from previous days. Our small hospital quickly doubled in size. After Haiti, my French vocabulary included the words for buildings, bricks and various structures. After the Ivory Coast, it now includes words for a wide array of weapons and tanks. Travel through the roadblocks became more and more difficult so we stayed at the hospital. The nurses, the surgeons and I all slept on mattresses wherever we could find a quiet space. When I could, I slept – but that soon became a luxury. The families of patients learned quickly

It happened like clockwork: We would see a helicopter in the sky and then afterwards the fighting would start. We knew what time the cars should move and when we should move inside because of the pattern. Just as my French vocabulary is specific to my time working in Ivory Coast, so too is my appreciation for the local people who work for MSF. Our drivers were fantastic. There was one, Bosco, who when we had to leave during crossfire on more than one occasion, remained calm and quickly got us to safety. As the semi-automatics fired he drove as if we were on a Sunday outing, even with a sense of humour.

Then one day the clockwork changed and there was no helicopter, only the shelling of a market immediately beside the hospital. The first patients were brought in wheelbarrows from the market to our emergency department of only four beds. The beds were already occupied, so we put the wounded on mattresses on the floor and into wheelchairs. The nurses and I, all wearing flip flops, got to work and waded through the blood on the floor to get to the patients. Intravenous lines were started. The tetanus vaccine was given. There was a crowd of people yelling at the door as we worked but my head was down and I could not see them, only hear them. As the first patients were stabilized I just remember running to the pharmacy for this and that. Then I wanted fresh air that was not heavy with the odour of blood so I went outside and I saw what I hope never to see again. The entrance to the hospital, a covered area, was a sea of patients and behind them their anxious and panicked families as far as the eye could see. They had arrived by foot, by wheelbarrow normally reserved for the produce at the market,

a lucky few even by car. The first patient for surgery was pointed out to me with his intestine outside of his abdomen. He could not have been more than 21 years old. His eyes were huge and filled with pain and fear. He was the first to die, his aorta torn by a bullet. There was nothing we could do. I was unable to learn his name. Sadly, this young man was not the last to die that day, people we tried but failed to save – there were many others. And like those in Haiti after the earthquake, I will always carry with me these victims of the violence in Ivory Coast.

Fiona Turpie Anesthetist

Fiona Turpie is an anesthetist from Toronto. In 2010 she worked with MSF in Haiti after the devastating earthquake. This spring she spent three weeks working with MSF in Ivory Coast during violent uprising stemming from the country’s contested 2010 presidential election. Turpie was part of a team treating people wounded in bombings and fighting, many of them civilians.

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where I slept and when they could not find a nurse they knocked on my door. One night we finished early in the operating theatre at about 11 p.m. The operating theatre nurse and I were in bed when the shelling started. It looked like lightning and sounded like thunder. We lay in bed for an hour listening as it got closer and closer. We heard it only for an hour because we were so exhausted we fell asleep. The fighting lasted another five hours, we later learned.

several neighbourhoods. A team helped reopen the hospital in Anyama, a northern suburb of Abidjan located not far from Abobo Sud. Staff also provided outpatient consultations and pediatric care in Houphouët-Boigny general hospital in Abobo. In Duékoué, an MSF team supported the general hospital and increased secondary healthcare activities.

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update: ivory coast

Though the post-election violence that wracked Ivory Coast in 2011 largely ended in April in most of the country, emergency medical needs remained at critical levels. In the city of Abidjan, health centres and hospitals were still overwhelmed with patients, including some newly wounded, and medical and drug supplies in the city were still dangerously low. In the west of the country the situation remained extremely tense as many villages were still empty and people continued to hide in the bush. While some Ivorians slowly began to return to their homes to try and resume their lives, more than a hundred thousand people remained as refugees in Liberia and thousands more were still displaced in overcrowded camps in western Ivory Coast.

as surgical and post-surgical activities. In one three-week period in April and May, 307 new patients were admitted, 125 of whom had gunshot or shrapnel wounds as a result of continuing violent clashes.

The second week of May, MSF received between five to 10 people with gun shot injuries in the hospital in the northern Abidjan neighbourhood of Abobo Sud each day. The numbers of medical and obstetrical cases rose dramatically in the hospital at this time. On average, the teams provided 350 consultations and assisted with 40 deliveries of babies each day. In addition, staff carried out between 80 and 90 blood transfusions a week because of high numbers of anemic children with malaria.

As of mid-May, Médecins Sans Frontières (MSF) continued to support several hospitals and clinics across Abidjan, providing drug donations, as well as running primary and secondary healthcare projects. MSF teams treated patients with fresh wounds from ongoing violence in a number of communities. They also dealt with a serious backlog of medical emergencies, as many people wounded during the fighting as well as people suffering from different diseases had been unable to seek treatment for days, even weeks.

In the Treichville area of Abidjan, MSF took over the 25-bed Nana Yamoussa clinic in mid-April. In the first two weeks staff conducted 531 consultations. The surgical team worked 24 hours a day to try to meet the needs, performing 10 to 12 surgeries per day. In the Koumassi general hospital, in the southeast of the city, medical staff conducted 2,000 primary healthcare consultations the first week of May, part of a total of 6,140 consultations conducted since the beginning of April.

In the general hospital in Yopougon Attié in western Abidjan, an MSF team handled emergency admissions as well

To decrease some of the pressure on struggling health facilities and to treat more patients, MSF increased activities in

In Guiglo, MSF worked in two health centres providing primary healthcare to the 4,800 displaced people living in a camp around the Nazareth Church. In the inpatient medical ward of the Nikla hospital, staff treated children suffering from acute malnutrition or severe anemia linked to malaria, and delivered primary healthcare to the 25,000 displaced people in the Catholic Mission camp. To reach isolated groups of people who had fled the conflict and continued to live in fear in the bush, MSF increased the number of mobile clinics across the western part of the country.

There were still an estimated 120,000 refugees in Liberia by the second week of May, though numbers were difficult to confirm. A vast majority of these refugees were hosted within Liberian families and communities, particularly in two counties near the Ivorian border – Grand Gedeh and Nimba counties. MSF set up 16 mobile clinics in Grand Gedeh county, where there were approximately 60,000 refugees. Staff provided 4,500 consultations during these clinics in April alone. These teams also vaccinated 835 people for measles. In neighbouring Nimba county, where another estimated 50,000 Ivorians sought refuge, teams ran mobile clinics in 11 different locations along the border area, providing an average of 220 consultations per day.

In addition to the mobile clinics at the border, MSF ran a health post in Bahn refugee camp, where 4,500 Ivorians sought refuge. Here staff conducted an average of 50 to 65 consultations per day, the majority for malaria and respiratory tract infections. In addition, MSF supported the outpatient department of the nearby Ministry of Health clinic, and carried out screenings at the transit camps in New Yourpea.

Evacuation of war-wounded from Misrata to Sfax On April 3, nurse Alison CriadoPerez was onboard a boat organized by Médecins Sans Frontières (MSF) that evacuated 71 war-wounded people from Misrata, Libya to Sfax, Tunisia. She and other MSF medical staff provided emergency care to patients while the boat sailed back to Tunisia. Less than two weeks later, Criado-Perez was on a second boat as MSF evacuated 64 wounded from Misrata. Here, her story of the first of the two trips. t’s 11:30 on Sunday morning, and we are sitting in international waters, more than 30 kilometres off the Libyan coast, trying to make a vital contact to give us the all-clear to enter the port of

Misrata. The tension is rising, as we only have enough fuel to wait for another half hour or so. We’ve been here on stand-by for several hours – where has our contact disappeared to? Earlier this morning, in a briefing, we’re told of precautions to take in a war zone... Am I really doing this? It’s all rather surreal. We are a team of 13, a mixture of international MSF staff and Tunisian volunteer medics, who have opted to come on this mission to rescue war-wounded from Misrata and transport them to the safety and medical care of Sfax in Tunisia. The trip has been discussed and planned for a couple of weeks, following a plea from overwhelmed medical staff in the hospital of Misrata for assistance, but the final

green light only came a day or so ago. We left early yesterday evening, aboard the 216-seater ferry, converted to carry about 60 patients on mattresses and 30 walking wounded. We don’t know what the exact patient list will be, especially as Misrata was shelled last night, but the potential list of 90 includes a couple on ventilators, many open fractures and amputations and those with multiple organ injuries, head injuries and post-gunshot chest injuries. We’ve done our best to medicalize the boat, but the conditions will limit us. The boat has been pretty rocky since we boarded, and we roll around like drunks as we work flat out, shifting boxes of drugs and medical materials, intravenous

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LIBYA

fluids, bottles of oxygen and vital signs monitors to create a small intensive-care space as well as two separate wards, one for critical and severely-wounded patients, the other for the less critical. All the material needs to be readily accessible as there’ll be no time to hunt for things, and moving around in the limited space will be difficult. Our logistician, Annas, has tied thin rope between all the pillars, so we can hang up intravenous infusions where they’re needed.

6.5 tonnes of medical equipment and drugs (a mama elephant and a baby I’m told would be a pretty good visualization), which MSF is donating to Misrata. At the moment the cargo takes up one half of the ward spaces.

But the final organization can only take place once we’ve off-loaded the

A pilot boat guides us into the harbour. We’ve refused offers of military pro-

The trickle quickly becomes a flood as the patients pour in through the doors, on stretchers, on crutches, with intravenous lines and drips and drains, young and not-so-young. There’s a boy, a child of 13, with horrific burns to his face from the explosion of a petrol bomb. His father is beside him. There are young men – many young men – who will never walk again, paraplegic from gun-shot wounds to the spine. And there are those who’ve had amputations, who’ll need prosthetic limbs. Some of them are very recent; I hope they don’t start to hemorrhage. A couple of them have blood transfusions running. There are open fractures, terrible abdominal injuries, chest injuries causing pneumothorax (lung collapse) and needing chest drains. One young man, with a tracheostomy because of severe burns to his face and neck, can see nothing as his face is covered in gauze. He has no caretaker with him to explain what is happening, but I see that the wonderful Egyptian nurse who has joined us in Misrata is talking to him. There’s another young boy, only 16, who fell from a fleeing pickup and has sustained severe head injuries. He was in a coma for six hours and is barely conscious now. And a patient who needs one-on-one help in our small intensive care area has suffered bullet wounds all over his body, an amputation to one leg, open fractures on the other, with severe blood loss. Misrata has been utter carnage.

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Finally, at midday, Helmy, the emergency coordinator comes. “We’ve made contact. We have the green light!” Helmy announces with relief and excitement. We all cheer. It looks like we’ll finally make it.

tection on the grounds of MSF’s neutrality and policy of no weapons in or near our medical facilities. But Misrata seems quiet as we pull into the dock. The whole team and crew form a human chain and we off-load the hundreds of heavy boxes onto the quay as quickly as possible so we can get mattresses onto the floor of the two wards and position our equipment before the patients start to arrive, which they do within a few minutes: two doctors on the quay are carrying out a triage, and I’m waiting inside with Kate, the other expatriate nurse on board.

How are we going to cope with this devastation? There are 71 patients in total, and our medical staff, although officially 13, is mostly down to four or five on the

I hardly notice dawn approaching. But suddenly we hear: “Docking in 30 minutes!” The crossing to Sfax has taken nearly 12 hours. I am stunned by the welcome sight on the quay: 36 ambulances, and scores of Red Crescent volunteers ready to carry stretchers off the boat. The immigration authorities are thankfully very unobtrusive and we manage to start disembarking the patients quickly. Kate’s patient in the intensive care unit takes her hand. “Was it worth it?” he asks her. “Yes,” she says quietly. What else can she say? Tears come to my eyes as these tragic young men, with whom we have spent such an intense 12 hours, are put into ambulances and taken off to hospitals in Sfax. The Tunisian doctor organizing the transit is calm and helpful. Suddenly it is all over. The ambulances and film crews have all left, and only the boat crew and mission staff remain on the dock. The bubble we have been living in for the past 72 hours is slowly dissolving into the real world. As we drive back to our base in Zarzis, five hours south of Sfax, our driver Said suddenly says, “They are talking on the radio about Médecins Sans Frontières, about the evacuation from Misrata to Tunisia. And they want to send you a present – a song of thank you from the Libyan people.” A haunting tune, with words of love and loss, fills our ears as we drive back home.

Alison Criado-Perez Nurse

update: libya In April, Médecins Sans Frontières (MSF) carried out two medical evacuations by boat of war-wounded from Misrata, Libya to Tunisia. The first evacuation took place on April 3, with 71 injured people on board. On April 15, 64 patients were evacuated from Misrata to Zarzis, Tunisia.

On March 21, MSF sent a first shipment of surgical kits for 300 wounded to the hospital in Misrata where large numbers of injured persons and severe shortages of medicines had been reported. As of the end of April, six tonnes of emergency medical supplies had been donated to the Libyan medical committee.

In Al Abbad Medical Trauma Centre, northeast of Misrata, the Libyan medical team was not used to dealing with war casualties. MSF sent a surgical team – composed of two surgeons, two anesthetists, three nurses, a doctor and a logistician – to address the centre’s request for training in triage for the wounded, in sterilization and in general hygiene techniques.

In Ras Thuba clinic, near Misrata’s port, MSF medical staff supported emergency obstetrical surgery and labour and delivery services, and provided pediatric and neonatal care.

Between Feb. 24 and the end of April, MSF staff ensured the arrival of more than 50 tonnes of medicines and medical equipment in the eastern city of

Benghazi, including equipment for war surgery, general surgery and burn treatment. MSF is supporting the Libyan medical committee to implement sexual and gender-based violence programs in several clinics in the Benghazi area. Dispatches Vol. 15, Ed.2

We have to crawl on the floor in the narrow space between mattresses to reach the patients: the boat is so rocky that if we try walking we run the risk of falling on a severely-injured patient, a frightening prospect. The work is incessant, exhausting, as we work through the night.

ground. Seasickness was an unlooked-for hazard and has knocked down the medics. But we just get on with it, doing what we can, checking patients are stable, their intravenous infusions are running, administering analgesia and antibiotics as needed, emptying urine bags, changing drainage bottles, trying to keep patient notes up to date. I worry we are not meeting everyone’s needs.

One team provided continual technical support to the two central pharmacies needing medicines and assistance in waste management and stock organization. Sessions were organized to provide training to manage conflict-related injuries. MSF medical staff also worked in Al Jalaa Hospital providing organizational support to intensive care and emergency services.

The Libyan medical committee requested help to provide healthcare to patients with chronic diseases, and donations were made to continue the treatment of tuberculosis, diabetes, heart disease and hypertension. HIV/AIDS drugs were also ordered.

In Ras Ajdir, Tunisia, at the border with Libya, MSF teams provided psychological support to people fleeing the conflict. They also worked in the transit camp at Choucha, where thousands of people waited for repatriation or resettlement.

From the onset of violence in Libya, MSF’s priority was to access areas with the largest medical needs.

emergency response: japan

o many of you, our loyal donors, looked to Médecins Sans Frontières (MSF) as an outlet for your compassion for the people of Japan after March’s cataclysmic earthquake and tsunami. It may have been confusing – knowing MSF had sent medical teams to support the Japanese government-led response immediately following the disaster, and after seeing the dramatic images in the media – when MSF said we were not accepting earmarked donations. We requested instead that you give to our general emergency fund. After all, if our doctors’ acts of vaccination and surgery are their humanitarian tools, then the donations that you, our supporters make, are yours. Rest assured, MSF so appreciates when you want to reach out to help people caught in crisis.

What is consistent for MSF during emergencies is our decision-making process on whether or not we can accept restrict-

ed funds for a specific crisis. This always comes down to our assessment of medical needs, and to MSF’s specific ability to respond to those needs. In Japan, for example, buildings were constructed to be resilient to a benchmark-setting code, and there was already a strong healthcare infrastructure. Japanese authorities and local aid organizations also responded wholly and admirably to the needs of their country. And so MSF’s medical role was determined: we’d run mobile clinics, care for people with chronic disease, and provide psychological support for those traumatized by this tragedy. All critical, but relatively inexpensive services as compared with, say, the vast surgical programs we mounted within hours of the earthquake in Haiti (the total operational budget for MSF’s actions in Japan as of writing this is less than $1.4 million, whereas MSF’s budget in Haiti in 2010 alone was $138 million).

The emergency medical needs were huge in Haiti. Government capacity was wiped out and even the UN was decimated, so there was a big role for MSF to play as a medical organization. This was not the case in Japan. The huge development and reconstruction needs in Japan are being addressed by the government and Japanese aid agencies on the ground, and MSF continues its focus on delivering medical humanitarian assistance to the Japanese people. And so MSF asked Canadians who made a restricted donation for Japan for permission to use their contribution to support MSF programs around the world, and to help us be prepared to quickly respond to current and future emergencies. When you make a gift for general emergency response instead of restricting it, you are helping replenish and build the fund and, in effect, are directly participating in all

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JAPAN

At the end of the day, we hope you view MSF as a prudent organization that demonstrates it budgets, raises and spends money responsibly, so that one context is not overfunded at the expense of another. We hope you see that we try to save as many lives as possible in acute situations, while simultaneously preserving the continuity of the existing healthcare programs we have in nearly 60 countries around the world. MSF remains compassionate and willing do what we can in Japan as makes sense; and we know we can’t do it without our Canadian donors.

Rebecca Davies Director of fundraising

In the ﬁrst month after the quake, MSF teams: • conducted 2,075 patients consultations in Minami Sanriku and Taro. The main health issues were hypertension and upper respiratory tract infections. • organized counselling for close to 600 people to talk about things such as stress management, memory and concentration difficulties, concerns about possible dementia among elderly people, and sleep disorders from crowded evacuation centres. • supported construction of a semipermanent building outside an evacuation centre in Baba-Nakayama near Minami Sanriku to reduce overcrowding and accommodate 30 people.

• distributed 4,030 blankets, 6,500 litres of water, one generator for a shelter in Baba-Nakayama and 10,000 hygiene kits comprising soap, toothbrushes, toothpaste and towels. Other kits containing batteries, candles, matches and towels were distributed to 4,000 people. • donated two buses to local health services in Minami Sanriku to travel between evacuation centres, patients’ homes and medical facilities, as well as a vehicle designed for wheelchair passengers. MSF plans to support local authorities in construction of two temporary medical clinics, one in Minami Sanriku and one in Taro.

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MSF’s interventions at that time (including Japan, Libya, Ivory Coast and others, for example). We appreciate and never take for granted your need to show solidarity, and thank you for understanding how your generosity can help MSF respond so quickly and effectively to disasters.

LIVE the experience09

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SUDAN

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a second chance 10 hear a distinctive cry from a mother who has just lost a child. It is a drawn out wail from a woman exhausted after days of leaning over a sick child. The strained and muffled scream holds no hope. The weep almost takes on a personality of its own, as if the howl itself is running, hunting for a hint of guidance on what the mother should do next. Her face is tense, her eyes, nose and mouth leak profusely and her legs wobble, loosely balancing on weak knees.

It is 7:30 in the morning. I came early to the Médecins Sans Frontières (MSF) hospital in Leer to finish some work and was confronted again by the fact that we work in a place where not everyone who enters will walk out again embracing their second chance at life.

People arrive at the clinic very late in their fight against disease or injury, held back by distance, insecurity and limited options. This was the third death this week, and it was only Thursday morning. At times like this, and despite doing aid work for more than eight years, I am newly confronted by the desperate circumstances found in places like this, places where these things happen, often. The regular occurrence of children dying of treatable illnesses should not happen, nor should it be accepted. The harder reality of this situation is that the significance of this death and the hundreds of other preventable deaths that occur in Southern Sudan every month was eclipsed by the up-

coming Southern Sudanese referendum, held three months later, in January 2011. That date became the largest Sudanese news event of the year, if not in recent history. The world’s big media attentively reported several times a day about the prospect of a return to war, or a process towards peace, but the widespread neglect of the health needs of the Southern Sudanese people was largely overlooked. The referendum in Southern Sudan was for the most part peaceful. In the MSF primary healthcare centre project in the town of Leer, we experienced a slight lull in the daily activities, but then within a couple of days a return to the regular numbers. These numbers are significant. In an average month we perform 6,000 outpatient consultations, care

Steve Dennis Project coordinator

MSF has worked in and around Leer since 1989 and continues to offer lifesaving healthcare services there.

coming home after having lived elsewhere – moved to camps around the town of Aweil in 2010. MSF helped the hospital cope with increased demand for medical care, and staff held more than 37,000 prenatal consultations, assisted more than 3,000 births, and treated some 2,600 children for malnutrition. In August 2010, a team began working in the extremely isolated Raja county, focusing on emergency preparedness, emergency surgery and maternal and pediatric care.

MSF in Sudan A peace agreement in 2005 between the government in Khartoum and southern rebels ended 22 years of brutal civil war in the country, but conflict persisted in Southern Sudan as major economic and political changes made after the agreement meant continued violent struggles for power. Nonetheless, in anticipation of the January 2011 referendum on secession, hundreds of thousands of people made the journey back to Southern Sudan, adding to the two million who had already returned since the peace agreement was signed. The health system is weak here. Few people have access to adequate health-

care. Insecurity and violence – and people’s ongoing movement – facilitate the spread of diseases such as malaria, diarrhea, respiratory infections, intestinal parasites, sleeping sickness (human African trypanosomiasis) and kala azar, and there is little capacity to deal with the consequences. Preventable diseases – malaria, acute diarrhea and measles – are common causes of death. Médecins Sans Frontières (MSF) has been working in the emergency, maternity and pediatric departments of Aweil Civil Hospital, in Northern Bahr El Ghazal state in Southern Sudan, since 2008. More than 18,000 returnees – Southern Sudanese

In Western Equatoria state, which borders Democratic Republic of Congo, MSF has been treating injuries and disease, in addition to providing mental health services to people who have experienced violence, such as children who have escaped captivity. MSF staff work in mobile teams to reach both remote settlements and displaced people living in camps. A team also works in Yambio hospital. Many patients have been injured in attacks carried out by the Uganda-based rebel group, the Lord’s Resistance Army. Working in seven states in Southern Sudan as well as the territory of Abyei, MSF carried out a total of more than 588,000 outpatient consultations in 2010, providing prenatal care to some 96,000 women and treating more than 25,900 patients for malnutrition.

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The spotlight which illuminated the political plight of the people in Southern Sudan at the beginning of 2011 has passed and, though it may return briefly in July when the region is set to become a new country, the dire health

needs still remain in the shadows. Diseases continue to proliferate largely unchecked. Local clinics are more often than not under-resourced, leaving the sick without skilled staff or the medicines to adequately fight their sickness. Those who make it to our facility have better chances, though still from time to time, and at least several times a month, mothers cry out at the loss of their children from treatable illnesses.

for 100 medical, surgical and maternity inpatients, deliver 35 babies, treat 165 tuberculosis patients, conduct 80 surgical operations and provide therapeutic feeding for 200 malnourished children. This MSF healthcare centre, along with the other overwhelmed health facilities in the state, provide some, but by far not enough, essential health services in an area with approximately 600,000 people. Many of these people will never see a doctor in their lives. Others will need to walk for a day or more to ask for their second chance.

INDIA

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mumbai slum ﬁre victims lose everything

On March 4, 1,500 families in the Garib Nagar slum in Mumbai saw everything they own go up in flames when a devastating fire ripped through their neighbourhood. Médecins Sans Frontières (MSF) helped people affected by the fire by distributing 4,800 emergency kits to meet survivors’ most immediate needs. oorjhan, 37 years old, has a grim expression on her face as she looks at the heap of sooty wooden planks, half turned into charcoal. This is all that is left of the house where she lived up until a week ago, when a fire reduced her home and belongings to a pile of rubble.

“It was a normal evening, like any evening,” she says. “My children were playing around in our house. Suddenly I heard somebody yelling from outside that a fire was breaking out. I understood that we were in danger, so I rushed to get my children out of the house. I didn’t manage to rescue any belongings. Our community leaders called the fire brigade, but in the end the firemen couldn’t stop the flames from destroying the houses. Now everything is burnt, and I have lost everything I own. I feel afraid.” The cause of the fire is still unconfirmed, although suspicions have been raised

among local residents that the incident was an act of sabotage. The scramble for land in Mumbai is fierce, where more than 50 per cent of people live in slum areas that occupy just seven per cent of the city space. “We cannot speculate about the cause of the fire,” says Thierry Mavungu Manwa, who is coordinating MSF’s assistance to those affected. “Our concern is that people here have many immediate needs that are not fulfilled. The people here are hungry, they have lost everything they own and are sleeping under plastic canvases without any protection. The 1,500 families all have to share the two latrines that are here. There is a serious lack of access to adequate water and sanitation.” Since the fire, the media have been doing many stories about the fact that 12-year-old Rubina Ali, who acted in the Hollywood blockbuster Slumdog Millionaire, had to dash out from her Garib Nagar makeshift shack to escape the flames. This somewhat unconventional celebrity lost all her awards and her collection of newspaper clippings and photographs from the 2008 film. A long dwindling queue of people are waiting for their turn to receive assistance from 20 MSF staff who are handing out emergency kits containing plas-

tic sheeting, blankets, hygiene products and kitchen utensils. There is screaming, shouting and shuffling about as the queue starts moving forward. The frenetic sound of horns from the busy traffic nearby adds to the intense atmosphere, but each person eventually receives their kit orderly and in turn. By midday all kits have been distributed, and some people have already started to make use of the contents. Forty-fiveyear-old Salma is squatting on a piece of white plastic. She is particularly happy with the kitchen utensils she received. “This is good quality equipment,” she says with a smile. “I will also use the plastic sheeting to improve the shelter so I can get more privacy.” But for somebody who has lost all possessions, the relief that MSF is delivering today is far from a replacement for what’s been lost. Like many other slumdwellers, Salma makes a living running small-scale businesses from home, such as sewing small bags and pouches to sell in the market. Now, after the fire, her means of earning an income have been taken away. Emergency interventions like this one are run in parallel to MSF’s regular activities in India, which include providing treatment to HIV/AIDS patients, offering nutritional therapy for malnourished children, delivering primary healthcare to marginalized people in rural areas and offering treatment to victims of kala azar – a deadly disease transmitted by sand flies. “We hope that our relief efforts today will restore some of the dignity of these people,” says Manwa, MSF’s coordinator. “But the plastic shelters are only a temporary solution, and access to adequate water and sanitation is very limited. Also, stagnant water from leaking pipes creates breeding grounds for mosquitoes carrying diseases such as malaria. I really hope that the affected population soon receives the full support they need, so that they can go back to living their lives as normal.”

Niklas Bergstrand Communications officer

MSF IN CANADA

what if this was home? ou’ve been driven from your home. The place you lived was no longer safe, so you took your family and fled. Now, where will you sleep? How will you feed your children? What will happen if you get sick? Today, 43 million refugees and internally displaced people around the world struggle to answer these questions.

shelters, food distribution points and many of the other elements or services found in real refugee camps. Guided tours, lasting 45 to 60 minutes, are given by returned MSF field workers – doctors, nurses, logisticians and others who have often worked in camps and share their firsthand experiences throughout the tour.

“A refugee camp is not something that is ready and waiting when people might need it. People flee, and they go to a place where they feel safe, not necessarily somewhere with access to water and healthcare,” says Karel Janssens, who has worked as a logistician and coordinator with Médecins Sans Frontières (MSF). “Often, people have to live there for a long time – some camps have existed for more than 60 years. People are born in the camps, grow up in them, get married in them.”

As visitors go through the different parts of the camp they learn about the challenges of accessing shelter and getting food and water. Guides explain about sharing latrines with hundreds of others, and what happens if people get sick and staff need to set up a cholera treatment centre. Several parts of the camp focus on the limited medical services people might have access to, including a primary care centre to treat disease outbreaks such as measles and malaria, a therapeutic nutrition centre for malnourished children and a vaccination clinic.

Janssens has worked in more than a dozen projects with MSF, including in refugee and displaced persons camps. This year, he’s responsible for bringing MSF’s Refugee Camp in the Heart of the City exhibit to eastern Canada. Over four days in each city, people in St. John’s, Halifax, Moncton and Quebec City will learn from aid workers like Janssens what life is like for millions who have fled their homes because of conflict or violence.

Janssens’ organizing team, including volunteers and interns, are busy coordinating tours for schools. “One of the biggest strengths of this exhibit is that it brings something from TV right downtown,” says Janssens. “Some of the aid workers giving the tours are from that city itself, so you can meet someone who is your neighbour who has worked in these places. There’s a direct link.”

The free exhibit has toured Europe, Australia and the U.S. and is back for its fourth visit to Canada. MSF logisticians set up the football field-sized camp, which includes

The exhibit is also a great way for those interested in working in field projects with MSF to learn more about the work before applying. The exhibit came to nurse

Tammy McIntyre’s hometown of Vancouver in 2008. She attended, and what she saw and heard solidified into a plan to work overseas with MSF. This spring McIntyre completed her first mission with MSF, working in Zimbabwe. “It wasn’t just talk,” McIntyre says of the exhibit. “It was the visual aspect of it, and the tour guides giving their personal stories.” After her tour she knew this was what she wanted to do. McIntyre’s MSF experience comes full circle this fall as she joins the Refugee Camp exhibit as one of the approximately 60 guides volunteering during the exhibit. Danielle Conolly Communications officer For more information, including photos of previous Canadian tours as well as live blogs and photos from the 2011 tour as it happens, please visit www.refugeecamp.ca.

2011 Refugee Camp tour ST. JOHN’S Sept. 8 - 11 . . . . . . . . . Bannerman Park HALIFAX Sept. 15 - 18 . . . The Garrison Grounds MONCTON Sept. 22 - 25. . . . . . . . . Riverfront Park QUEBEC CITY Sept. 29 - Oct. 2 . . . . . Place d’Youville

Dispatches Vol. 14, Ed.2

THE refugee camp in the heart of the city travels to eastern canada

MSF PROFILE

logistician amien Moloney joined MSF as a logistician in 2008. He has worked in Mozambique, Sudan, Kenya, Haiti and Niger. He recently finished an assignment in Chad, providing logistics support ahead of the anticipated ‘hunger season.’ Here, he talks about how an episode of ER changed his life forever. Dispatches Vol. 14, Ed.2

Why did you decide to work with MSF? I’m probably one of the only people in the world to say an episode of ER changed my life. I was watching a rerun of the show and two doctors were off working with MSF. It was all very dramatic: running from rebels, dodging exploding grenades and bullets. I’d done a lot of rescue and first aid work in the United States, and thought maybe the organization might be looking for someone with my skills. So I looked at the website and the more I read, the more impressed I was. I applied, was interviewed, and waited. And waited. When I finally got a letter I was so nervous, I couldn’t bring myself to open it. Eventually I did and I remember doing my happy dance around my living room. I’m still smiling about how happy I am to be working for MSF. You have just completed your sixth field placement with MSF. What has been the most challenging aspect and why? There are lots of hard things about working for MSF: dealing with unforeseeable delays, country bureaucracy and red tape as we wait for lifesaving equipment and medication; walking around a refugee camp of 90,000 people knowing we live a life of luxury and privilege; going to

work all day in 50 degree heat; digging ditches and putting up tents, only for the rain and wind to destroy them overnight, and having to do it all again the next day; watching children die from preventable diseases like tetanus; and watching them suffer from malnutrition when we have an over-abundance of food in the developed world. All these things, and about a thousand others. But – and it’s a huge but – I wouldn’t change what I do for anything. What has been the most enjoyable aspect for you? There are a thousand difficulties working for MSF and a million joys. Possibly the most amazing thing is the staff, both international and national. We have the honour and privilege of going into a country torn apart by war, disaster or maybe drought and hunger, and together with local staff we make a small but significant difference. When I see a desperately sick kid come into the hospital, and see the mother’s worried face while the doctors and nurses treat her child, I know we will all do our best, just for that mother and child. The result isn’t always happy, but when, whether it’s three weeks or three months later, that mother and her child walk out of the hospital, I know everyone – from the doctors and nurses, to the logisticians who made sure the oxygen was working, to the cleaner who swept the floor, and all the way back to the office staff in headquarters who sent us to the field and the generous donors who make our work possible – contributed to the health of that child. And while we may not be able to save the world, we saved the life of that one child, and for that mother, we saved her flesh and blood, her world. And that joy is impossible to replicate.

What exactly does a logistician do? Imagine a doctor or nurse or surgeon in the field treating a patient. What do they need to help that patient? A building, to start with, so I work with local staff to build one. I’ve helped put doctors in tents and under trees with nothing but shade cloth over them, and I’ve worked to build a massive container hospital and complicated operating theatres. They need medication, instruments, beds, fans, so I order them. The logistics team makes sure cars, radios and computers work, makes sure there is electricity and clean water in the hospital and the house and that medication is kept cold. Sometimes I cook a barbeque and we all sit and chat and laugh over a beer and for a couple of hours, remember where we came from and why we do what we do. And the next day we do it all again! What personal skills does someone need for this type of work? Patience – lots and lots of patience. We have lots of patients; it’s the other kind you need! The ability to work hard, in the heat, in the dust, a long way from home. The ability to deal with frustration and despair. The ability to work and live in a team with different people and tolerate their foibles. You need understanding and tolerance, and at the same time the ability to stand up for what you believe in. Speaking multiple languages – English, French, Arabic, Spanish – is an asset. For a logistician, knowing anything about electricity and construction will help. Mostly, you need to be able to search for, then at least offer a solution to, any number of problems that arise. Are you planning to continue working with MSF? I can’t imagine doing anything else. I’ll be a logistician until I’m too old to bang a nail or crawl under a Land Cruiser. I get a physical sensation of joy from what I do. Not every day, and not all the time. But this is the most rewarding job I can imagine. Ever considered working with MSF in the field? Check out www.msf.ca for upcoming live webcasts as well as in-person information sessions across Canada, or go to the recruitment section of our website to learn more about how you can put your ideals into practice.

DISPATCHES Médecins Sans Frontières (MSF) 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

CANADIANS ON MISSION

INDIA Etienne Blais Montreal, QC Logistician Andrew Bohonis Thunder Bay, ON Logistician Dave Croft Squamish, BC Project coordinator Andrew Cullen Toronto, ON Logistician Hamid Echihabi Montreal, QC Logistician Arif Hasan Toronto, ON Surgeon Rehana Permall Ottawa, ON Liaison officer Roberta Wynne Vancouver, BC Nurse IRAQ Karen Abbs Vancouver, BC Reshma Adatia Vancouver, BC

Mental health officer Project coordinator

IVORY COAST Edith Fournier Cabot Quebec City, QC Fiona Turpie Toronto, ON

Karen Friesen Vancouver, BC Nurse Ruby Gill Vancouver, BC Nurse Patricia Gould Courtenay, BC Nurse Paulo Rottmann Toronto, ON Human resources coordinator Darryl Stellmach Calgary, AB Head of mission PAKISTAN Jaroslava Belava Vancouver, BC Nurse Erwan Cheneval Montreal, QC Deputy head of mission Richard Maunsell Waterloo, ON Nurse AnneMarie Pegg Yellowknife, NT Anesthetist Thierry Petry Gaspé, QC Anesthetist

Nurse Anesthetist

PAPUA NEW GUINEA Richard Dube Vancouver, BC

Logistician

Doctor

SIERRA LEONE Dinsie Williams Toronto, ON

Logistician

SRI LANKA Garth Johnson Ottawa, ON

Surgeon

KENYA James Maskalyk Toronto, ON

LIBERIA Martha Gartley Toronto, ON Water and sanitation specialist Isabelle Jeanson Toronto, ON Logistician Michele Lemay Montreal, QC Doctor Anne Mackinnon Fredericton, NB Nurse Tara Newell London, ON Project coordinator Leanne Olson Sainte-Cecile-de-Masham, QC Medical coordinator Kirsty Robertson Toronto, ON Nurse LIBYA Frank Boyce Belleville, ON Thierry Oulhen Montreal, QC Kathleen Skinnider Victoria, BC

Doctor Nurse Nurse

MALAWI Mariam Kone Montreal, QC

Doctor

SUDAN Kevin Coppock Toronto, ON Head of mission JL Crosbie Toronto, ON Project coordinator Megan Hunter Prince George, BC Logistical coordinator Elizabeth Kavouris Vancouver, BC Nurse Wendy Rhymer Winnipeg, MB Midwife Letitia Rose Vancouver, BC Nurse Nancy Semkin Toronto, ON Human resources coordinator Brenda Vittachi Calgary, AB Nurse Michael White Toronto, ON Project coordinator SYRIA Berthier Bourque Gaspé, QC

MOZAMBIQUE Isabelle Casavant Montreal, QC

Nurse

MYANMAR Marilyn Hurrell Winnipeg, MB

UGANDA Joanne Cyr Montreal, QC

Nurse

UZBEKISTAN Susan Adolph Dartmouth, NS Jan Hajek Vancouver, BC

NIGER Myriam Berry Vancouver, BC Human resources coordinator Alphonsine Mukakigeri Quebec City, QC Administrator Tricia Newport Whitehorse, YT Nurse NIGERIA Mubeen Aslam Ottawa, ON Epidemiologist Rink De Lange Sainte-Cecile-de-Masham, QC Water and sanitation specialist Jodi Enns Burlington, ON Nurse Editor: linda o. nagy Editorial director: Avril Benoît Translation coordinator: Jennifer Ocquidant Contributors: Niklas Bergstrand, Danielle Conolly, Alison Criado-Perez, Rebecca Davies, Steve Dennis, Fiona Turpie Cover photo: © Peter DiCampo / Pulitzer Center

Doctor Psychologist Nurse Doctor

ZAMBIA Charles Gadbois Saint-Rédempteur, QC Nicolas Verdy Montreal, QC ZIMBABWE Colette Badjo Laval, QC Richard Crysler St. Catharines, ON Sandra Stepien Vancouver, BC

Doctor Mental health officer Financial coordinator

Circulation: 117,500 Layout: Tenzing Communications Printing: Warren’s Waterless Printing Inc. Summer 2011 ISSN 1484-9372

Logistician Logistician

Dispatches Vol. 14, Ed.2

CAMEROON Serge Kaboré Quebec City, QC Medical coordinator Peter Nijssen Calgary, AB Logistician John Orr Vancouver, BC Financial coordinator CENTRAL AFRICAN REPUBLIC Joseph Baugniet Montreal, QC Logistician Carol Bottger Montreal, QC Doctor Kanadi Ibrahim Gatineau, QC Logistician Margaret Johnston Toronto, ON Nurse Jean-Baptiste Lacombe Montreal, QC Logistician CHAD Grant Assenheimer Edmonton, AB Project coordinator Pascal Desilets Saint-Eustache, QC Logistician Sabrina Gobet Toronto, ON Human resources coordinator Clea Kahn Toronto, ON Head of mission Chantelle Leidl Edmonton, AB Water and sanitation specialist Paul Nguyen Montreal, QC Doctor Elaine Roy Charlemagne, QC Nurse Heather Thomson Ottawa, ON Project coordinator COLOMBIA Raquel De Quieroz Smithers, BC Nurse Nadia Tjioti Toronto, ON Logistician DEMOCRATIC REPUBLIC OF CONGO Lucie Barré Quebec City, QC Nurse Sharla Bonneville Toronto, ON Logistician Monica Chaudhuri Toronto, ON Surgeon Michelle Chouinard Saint-Quentin, NB Head of mission Oonagh Curry Toronto, ON Project coordinator Elif Ercan Montreal, QC Nurse Fabienne Gilles Toronto, ON Human resources coordinator Breno Horsth Toronto, ON Logistician Marie-Michele Houle Victoriaville, QC Nurse Shannon MacDonald Halifax, NS Midwife Jean-Guy Simard Lavaltrie, QC Logistician Bayu Sutarjono Toronto, ON Logistician Jennifer Turnbull Ottawa, ON Doctor EGYPT Eva Adomako Montreal, QC Administrator ETHIOPIA Justin Armstrong Toronto, ON Project coordinator Greg Camirand Mission, BC Logistician Sarah Lamb Ottawa, ON Project coordinator Judith Letellier Montreal, QC Logistician Marjorie Middleton Vulcan, AB Nurse GUATEMALA Luis Neira Montreal, QC Doctor GUINEA Nikki Rink Montreal, QC Doctor HAITI Cassandra Arnold Calgary, AB Doctor Nicolas Bérubé Quebec City, QC Logistician Daphne Hemily Toronto, ON Logistician Clémentine Leduc Montreal, QC Nurse Laura Madsen Vancouver, BC Logistician Andre Munger Rivière-du-Loup, QC Doctor Martine Verreault Rivière-du-Loup, QC Pharmacist

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