Dispatches (Winter 2012) by Doctors Without Borders / Médecins Sans Frontières (MSF) Canada

Dispatches MSF CANADA MAGAZINE

Volume 15

Edition 1

Winter 2012

somali CRISIS SOMALIA: Saving lives in a complex reality, p. 02 libya: Recovering from psychological wounds, p. 05 | MYANMAR: Tough choices and a desperate form of triage, p. 06 Haiti: Caring for women at risk, p. 08 | advocacy: Urban Survivors, A journey through the world’s slums, p. 09 this is why i do msf: p. 12 | MSF in Canada: “Thank you for opening my eyes”, p. 14

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somalia

Saving lives

in a complex reality

y years with Médecins Sans Frontières (MSF) have brought me to many places of great suffering and complex humanitarian medical challenges. But none of the places are more challenging than Somalia, where I visited in August of 2011. Subject to two decades of internal conflict, the Somali people are now pawns in an international struggle, as the country is a prime theatre for the war on terror. Public health services are nonexistent, with the most basic healthcare difficult to attain. In 2011, people living in south and central Somalia were pushed over the edge by drought, failing harvests and rocket-

ing food prices. Those who could move tried to find relative security in the capital, Mogadishu, or across the border in Ethiopia and in Kenya. The fate of those who did not flee remains uncertain, as few aid workers have managed to gain access to areas most affected by the current crisis. What stays with me from my visit to Mogadishu are the individual stories. I met a young woman from Lower Shebelle who walked for five days to get to the capital. She had started the journey with her husband and seven children but had to leave half of her family behind along the way. She had found shelter in an overcrowded park. The four remaining children were malnourished and prone to disease. Very

little help was available. And the woman had little hope for her husband and other children, who had been too weak to continue. It’s a story that is replicated many thousands of times in Mogadishu. Last summer I visited the refugee camps around Dadaab, Kenya. Here too, people have been arriving with very little, except for the hope that they will find food, medical care and security for themselves and their families. These camps now house up to half a million Somalis. And my MSF colleagues in the east of Ethiopia, in and around Liben, tell similar stories of despair and destitution. What is hardest to accept is the fact that we and other humanitarian workers are

Our Somali staff have shown extraordinary dedication and courage in staying with the people who rely on them for care and indeed giving them the assistance they are able to provide. Where people have fled to, our teams have mounted large operations, combining medical and nutritional care. But the fragile equilibrium, between negotiated access and acceptable security, can be broken any time. Between mid-May and early November 2011, in Somalia and in refugee settlements across the border, we treated 55,000 children in our therapeutic feeding centres and 26,000 children as well as pregnant and lactating women in supple-

We remain highly concerned about the situation; we know that there are thousands of people we are not able to reach. The complex reality of Somalia today frustrates us greatly and it does feel, at times, as if we are working around the fringes of the crisis. Yet, the aid we are able to provide is massive and saves many lives every day. As we continue to negotiate for access to deeply affected areas and the people who live there, I am constantly reminded of my hard working colleagues in Somalia, Kenya and Ethiopia. And I am grateful for the millions of donors around the world who give so generously so that we can sustain and expand our crucial assistance to the Somali people.

Unni Karunakara Doctor MSF International President

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It is for these reasons that, upon return from Somalia, I felt that we needed to be open about the limitations we deal with in delivering assistance there. The public needs to face the fact that their donations do not necessarily translate to lifesaving medical and nutritional assistance for all the suffering Somalis, but may only reach those areas of the country where MSF has managed to maintain operations and acceptance, sometimes for

I am not implying that nothing can be done. Far from it: even with insecurity and harsh restrictions, my colleagues have been able to respond rather impressively. MSF teams have continued delivering medical care in a dozen locations throughout Somalia, on different sides of the frontlines, as they have been doing for the last two decades.

mentary feeding centres. During the same period, we vaccinated 150,000 children against measles and treated 5,000 who had fallen ill to the disease. We treated around 1,000 people for cholera. Our outpatient facilities were visited by 365,000 patients and another 16,500 found treatment in our inpatient departments. We also assisted in 4,500 deliveries.

ÂŠ Yann Libessart / MSF

Where we are able to work, we find that clan politics get in the way of simple procedures such as hiring a nurse or renting a car. Foreign powers are directly and indirectly present on Somali soil. The Kenyan military offensive launched last autumn makes things even more difficult for independent humanitarian actors such as MSF, whose security and ability to work depends on real and perceived independence by local parties.

more than 17 years. The stark reality of Somalia is that many people remain out of reach for organizations that could help them survive.

ÂŠ Sven Torfinn

often not able to go to places where people suffer the most and provide lifesaving assistance. If we do get there, it is after weeks of negotiations and with increased risk to our team. Those in control may not allow us to bring experienced humanitarian workers into their areas, or impose restrictions such as bringing in supplies or organizing vaccination campaigns.

It is in this context that Médecins Sans Frontières (MSF) provided intensive medical care to more than 10,000 severely malnourished children who were brought to MSF facilities between approximately June and November of last year. MSF has projects in northern Kenya (mainly Dadaab), in eastern Ethiopia (in refugee camps in Malkadida, Kobe, Bokolmayo, Hilleweyn, Dolo Ado) and across much of south-central Somalia itself, in Marere, Beledwayne, Dinsor, Dayniile, Mogadishu, Jowhar, Guri El and Galcayo. MSF enrolled a total of 54,000 children in outpatient feeding programs for the severely malnourished in more than 30 locations in these three countries during the same period. During this time, MSF teams also battled the deadly combination of measles and acute malnutrition, which affects children in particular. A large proportion of the Somali population has not been vaccinated – against measles or any other disease – because years of instability, lack of effective government and a functional state have caused the healthcare system

epidemics, malnutrition and conflict to collapse. Measles, if untreated, can be fatal for children. By mid-November, MSF teams had vaccinated more than 150,000 people in and around Somalia for measles, and treated more than 5,000 patients for the disease in 2011. Much more needs to be done. Vaccination efforts need to be scaled up in Mogadishu, where waves of people continue to arrive seeking assistance. In certain parts of the country, access has been greatly limited by the presence of armed groups. Medical teams have often not been able to reach some people, not even to assess their situation, and mass measles vaccination campaigns have been blocked. The arrival of the rainy season may further worsen conditions for children and adults living in makeshift camps in Mogadishu and elsewhere. In the capital, the proportion of children suffering from waterborne diseases – including diarrhea, which also contributes to malnutrition – was on the rise at the end of last year. At the same time MSF was preparing to deal with possible cholera outbreaks whose effects on hundreds of thousands of already malnourished people living in crowded conditions could be devastating. All of this is occurring against a backdrop of insecurity and fighting, for which the Somali people continue to pay the price. On Oct. 30, 2011, MSF treated 52 wounded people – including 31 children – in the southern town of Jilib, after an attack caused civilian casualties among the displaced people in the area. Ten days earlier, MSF teams in Dayniile, on the outskirts of Mogadishu, treated 83 patients for gunshot and blast wounds, and teams

were forced to suspend the measles vaccination campaign there. Thousands of people displaced by conflict and drought continued to arrive in Mogadishu. For years Somalis have been crossing the border to seek refuge in neighbouring Kenya, with an historical peak in June 2011 when more than 40,000 people were settling there every month. Working in Dagahaley camp since 2009, MSF is offering a comprehensive package of healthcare to people staying there. In Ifo camp, MSF activities came to a halt after the kidnapping of two MSF staff on Oct. 13. In Dagahaley, the insecurity forced MSF to temporarily reduce activities but in November those activities once again began to increase. Fighting in southern Somalia and along the Kenyan border and heavy rainstorms and floods slowed to a trickle the number of people presenting themselves to authorities at the Dadaab camp by the first week of November. Meanwhile, the number of people fleeing into Ethiopia was increasing. MSF’s emergency efforts during the Somali crisis have at times been challenging to translate into concrete actions for the Somali people because of the lack of security both in the country and at the borders, and also due to ongoing restrictions imposed on MSF operations in certain parts of Somalia. Despite this, MSF was still able to scale up its activities and open new projects, in addition to the nine medical facilities that had already been running in south-central Somalia, making it the main provider of free healthcare in the region.

François Servranckx Communications officer

ven for the long-suffering Somali people, the events of the past year have been challenging. The conflict that began two decades ago continues, and its consequences are exacerbated by drought, one of the worst on record in the country. Thousands of people have been forced to flee Somalia and are seeking humanitarian aid in refugee camps in Kenya and Ethiopia. A measles epidemic is spreading. Lack of infrastructure and services are increasing the population’s vulnerability. In October and November of last year, civilians were enduring new military offensives launched in southern Somalia and the capital Mogadishu.

People caught between

igh levels of anxiety and other psychological problems may be among issues that did not get an immediate remedy in Libya as the country tilted toward the end of its revolution.

libya

As a psychological coordinator with Médecins Sans Frontières (MSF) in the small Libyan town of Yesran, south of Misrata, Juliet Donald was a direct witness as people went through traumatizing situations.

Donald says MSF received patients who showed signs of trauma in its hospitals and wherever its teams travelled distributing medical supplies through mobile clinics. There were many stories of people staying underground or whole families crowding into one room because of ongoing insecurity and violence on the streets. “Almost everybody had lost a family member or a relative during the fighting,” she says. Trauma syndromes could result from the fact that they didn’t have time to mourn family or friends, as they often had to flee for their own lives, she says. Addressing mental health in post-conflict Libya is a challenge for the country’s health system. When MSF started its emergency response operation in Libya in February of 2011, the priorities were offering basic medical assistance including surgery to the war-wounded and supporting overwhelmed local hospital staff. There were also deliveries of antibiotics and painkillers as well as drugs for chronic diseases.

Recovering from psychological wounds that mental health needs were becoming immense.

Medical needs expanded when the conflict escalated. MSF started to offer critical obstetric and neonatal care, as pregnant women and newborns were at risk when complications arose and much of the healthcare system had to focus on violence-related injuries.

“At least 15 of the 50 patients, all of whom have trauma-related injuries, are also in huge psychological need, suffering from post-traumatic stress disorder,” Rossi said from Ibn Sina, the main hospital in Sirte. “They suffer from nightmares, flashbacks and depression. Some can’t even speak, but just cry, and one patient is suicidal. All of the patients, particularly the mothers and the children, are in enormous need of support – they’re trying to bear the weight of what’s happened to them.”

People’s vulnerable mental health also started to become apparent. In October 2011 while working with teams in Libya, doctor and MSF emergency coordinator Gabriele Rossi described the situation in Sirte as serious and said

Mental health cases also emerged as a result of internal displacement or being trapped by the fighting. MSF reported in October, for example, that the city of Sirte resembled a ghost town. People had fled and those who couldn’t flee

were staying inside for fear of ongoing fighting between Gaddafi loyalists and the rebels, resulting in a lack of access to medical care. In Sirte alone, MSF estimated that there could be around 10,000 people trapped by the fighting, some of whom might have been injured but were unable to leave their houses for treatment. Even after medical operations had resumed and MSF was able to perform surgeries, security remained a critical concern for ordinary Libyans. For Donald, more is needed when it comes to mental health assistance to make sure Libyans recover as much as possible from their psychological wounds.

Gilbert Ndikubwayezu Communications officer

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“Children were exposed to scenes of violence,” she says. “They could hear gunshots at midnight for so many days and that is really traumatic.”

Myanmar

Tough choices

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and a desperate form of triage

06 For years, Médecins Sans Frontières (MSF) has been calling on institutional donors, nongovernmental organizations and the government of Myanmar to respond to the country’s HIV/AIDS crisis with a rapid scale-up of antiretroviral therapy. The shortfall in treatment remains vast and the task at hand is overwhelming, forcing some MSF teams to make drastic choices. However, MSF is still able to find and treat the sickest patients.

in Oo Shwe is 32 years old. When I reached my hand out to shake his, he didn’t react until his mother physically put our hands together. He

hadn’t noticed because AIDS caused him to go almost totally blind and deaf, but as he himself says he is now “improving.” Shwe was fortunate to reach MSF in time to get antiretroviral therapy (ART) and start his recovery even though he was in the very late stages of AIDS. He arrived with a CD4 count (a test used to measure suppression of the immune system) of 18, a figure that indicates extreme vulnerability and likelihood of imminent death without treatment. According to World Health Organization guidelines, anyone with a CD4 count of less than 350 should receive ART. Shwe seems to be lucky. Many succumb to opportunistic infections such as meningitis or tuberculosis.

Unfavourable odds The United Nations estimates that 120,000 people in Myanmar urgently need ART. MSF provides ART to more than 20,000 of the 30,000 people currently receiving the therapy through the Ministry of Health and other organizations. Faced with such overwhelming numbers, MSF has to make tough choices about who to put on ART, a lifelong treatment. Tackling HIV/AIDS at the national scale is outside the limits of our organization’s capacity. To manage its volume of patients MSF is currently forced to conduct a desperate form of triage.

haiti

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s Haiti approaches the second anniversary of the January 2010 earthquake, the country is still struggling to recover. In addition to tonnes of rubble littering the landscape, hundreds of thousands of Haitians continue to live in makeshift camps. Most people still don’t have access to free healthcare or proper sanitation. Adding to all of this, a cholera epidemic of unprecedented proportions broke out in

MSF in Haiti MSF continues to work in Haiti, primarily in Port-au-Prince. Teams comprised of medical and logistical staff support four hospitals, including: In Port-au-Prince • a 110-bed referral centre for surgical emergencies (to open in January 2012) • a 180-bed medical-surgical centre to treat victims of violence and accidents • a 130-bed referral centre for obstetrical emergencies that provides free services on a 24-hour basis for women experiencing complications In Léogâne • a 160-bed hospital for chronic emergencies, in particular in the areas of gynecology and obstetrics, as well as neonatology and trauma

October 2010, infecting 465,000 people by the end of that year and claiming more than 6,500 lives. In the midst of ongoing struggles and challenges in Haiti, the Referral Centre for Obstetric Emergencies (CRUO) in Port-au-Prince provides free emergency obstetric care to pregnant women at risk. The CRUO, run by Médecins Sans Frontières (MSF), operates around the clock, seeing more than 2,000 mothers for consultations on average per month. Of these women, between 700 and 1,000 are either experiencing complications with their pregnancy or arrive already in labour and give birth soon after. Approximately 30 per cent of the mothers giving birth at the CRUO do so without complications. Belgarde, a patient in the CRUO, is a 34-year-old mother whose story is both touching and painful. She came to the centre during her fourth pregnancy; her first three babies died. The first was stillborn and the other two did not survive. Her high blood pressure is a major factor, says Wina Isidor, a Haitian doctor working in the CRUO. Belgarde talks about her difficult history while keeping her emotions hidden. The affection she expresses for her new baby girl, born prematurely, is hiding an understandable emotional fragility as everything is still uncertain for

caring for women at risk

her newborn who will need special care for some time. Carl Casimir is the assistant medical coordinator at the CRUO. Enthusiastic and full of energy, Casimir’s career path was set early: his father was a doctor and his mother a nurse. Casimir started working for MSF just a month after the earthquake. “For the first month, I helped the injured in the streets, but then I wanted to make a difference on a grander scale, even though my family wanted me to leave Haiti because it was too dangerous. But I stayed by choice, in solidarity with those here. MSF gave me a chance to make this come true every day,” he says. In an informal discussion of the medical situation that currently prevails in Haiti, Casimir is very realistic. “Everything still needs to be done – from infrastructure to human resources. But the government also has to show greater willingness to improve the situation, and if it doesn’t, then it’s the private sector that will take the lead. The people need once again to have improved access to care, according to their situation, which right now is very fragile,” he says.

Frédérik Matte Communications officer

A journey through the world’s slums

o highlight the critical humanitarian and medical needs that exist in urban settings around the world, Médecins Sans Frontières (MSF) is launching Urban Survivors, a multimedia project in collaboration with the NOOR photo agency and Darjeeling Productions. Hopes of shelter and better job opportunities drive millions of people to urban sprawls every year. Currently more than half of the world’s population lives in cities, with more than 800 million living in slum-like conditions. Poor sanitation, heavy pollution and high-density living spaces in these environments breed cholera, tuberculosis and other diarrheal and respiratory diseases.

“Slum residents live in a constant state of vulnerability,” says Loris De Filipe, operational director for MSF. “Not only do they live in places that are unfit for human habitation, they also face discrimination and neglect from other parts of the society. Through the Urban Survivors project, we want to put a human face to the humanitarian emergency that exists in many slums around the world.” In response to such conditions, MSF provides healthcare in more than 20 slums, to residents such as migrants and asylum seekers who often do not have legal rights to healthcare and live in fear of being reported to local authorities. MSF interventions range in scope, from providing care to vulnerable migrants

in inner-city Johannesburg, treating HIV patients in the poorest parts of Nairobi, to assisting displaced flood victims on the streets of Karachi. In many of these slums, MSF is the only organization that provides healthcare free of charge. Through a series of captivating web documentaries, Urban Survivors highlights the daily lives of individuals living in slums in Dhaka, Karachi, Johannesburg, Port-auPrince and Nairobi, where MSF is currently providing medical aid. To hear people’s stories and learn more about life in these slums, visit www.urbansurvivors.org.

Definition of a slum A slum, as defined by the United Nations agency UN-HABITAT, is a run-down area of a city characterized by the lack of one or more of the following five features: durable housing, sufficient living space, easy access to safe drinking water, access to sanitation and secure tenure that prevents forced evictions.

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Urban Survivors

advocacy

The Uganda Railway Line, known locally as ‘The Lunatic Express,’ cuts through the centre of Kibera, in Nairobi, Kenya. The Kibera slum is considered an ‘informal settlement’ by the government, and is ignored by local authorities and the rest of society.

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A five-year-old girl dumps rubbish along a seemingly endless shoreline of waste, which pollutes a small creek in the Machar (mosquito) Colony in Karachi, Pakistan. This former fishing village is now home to more than 700,000 migrants and refugees, all living in illegal slum housing.

In the Kamrangirchar slum in Dhaka, Bangladesh, a woman treads carefully between homes above the polluted waters of the Buriganga River. The Kamrangirchar peninsula was formerly used as a dump site for Dhaka’s trash. Industries still dispose toxic waste into the river, which is used by slum residents for bathing and washing.

Dispatches Vol. 15, Ed.1 ÂŠ Pep Bonet / NOOR

Migrants from the small nation of Lesotho gather to listen to traditional music in the Dark City building in Johannesburg, South Africa. The Dark City is one of the many overcrowded slum buildings in Johannesburg with poor waste and sewage management, targeted for future forced evictions and deportations.

ÂŠ Jon Lowenstein / NOOR

Chantale (name changed) talks to an MSF psychologist in a slum in Port-au-Prince, Haiti. Chantale was raped and assaulted while walking through a vacant lot near her home. Sexual and domestic violence are especially common in slums in Haiti.

This is why I do MSF Raghu Venugopal is an emergency physician based in Toronto. He has worked with Médecins Sans Frontières (MSF) in Burundi, Central African Republic (CAR) and Democratic Republic of Congo (DRC). In August of 2011 he wrote the following in his blog, giving a glimpse into what pulls him to his patients and his medical profession, and what pushes him to work for MSF.

his week we began two HIV-infected patients on antiretroviral medication (ARVs). The first patient was a 34-year-old woman in a coma in our intensive care unit. The second was a 35-year-old man so wasted from HIV that he has been hospitalized since March, unable to walk or sit up. Since I arrived here in May I have been trying to put the

35-year-old man on ARVs and I always thought he’d be our first patient. But then another woman arrived even sicker than him, and so she became our first patient. This was a special moment. We estimate it is one of the first instances of patients managed on ARVs in the troubled Masisi region of North Kivu, DRC. The way this happened helps me focus on why I do MSF. Months ago (long before I arrived) everyone in our team was invited to weigh into a discussion about MSF and HIV treatment in this region. From Mweso to Goma in DRC, to Amsterdam and back, the exchange went. We reflected then, as we reflect now, on our top priorities, our goals and our capacities. We balanced this knowing MSF

feels HIV is an important disease to treat – just like malaria or cholera. People living with HIV are no different than others. What complicates our situation is that we work in a zone of chronic conflict and instability. ‘They’ said that HIV could not be done in Africa. Then ‘they’ said it could not be done in African conflict zones. MSF has proven ‘them’ wrong in country after country, particularly in some tough contexts like DRC and CAR. We started our HIV activities gradually, first with testing those who were survivors of sexual assault, suspected of having tuberculosis (TB) or were severely ill (such as adults with wasting syndrome). Our medical team created a detailed yet balanced plan to gradually scale up our

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WHY MSF

Our medical and logistical teams ordered the right tests, medical materials and drugs for managing HIV-positive patients. They ordered enough ARVs to ensure we could begin a limited number of patients on treatment and ensure a continuous supply of medication for at least 10 months. Our coordination team in the capital worked with provincial government officials in order to get the needed memoran-

Your feedback: Donor survey

hank you to the more than 14,000 supporters who responded to the Médecins Sans Frontières (MSF) Canadian donor survey. This survey was an opportunity for us to learn more about you and the reasons you support MSF, to make sure we’re communicating effectively and to identify those who might be interested in supporting our work in other ways.

MSF brought in seasoned HIV experts to Mweso to advance our HIV program. They came from Amsterdam and London. Our current “HIV implementer” is an articulate, friendly and frankly inspiring Ugandan doctor. He has worked for eight years with MSF across Africa, Asia and Europe, with thousands of HIV-positive patients under his responsibility. He coached our nurses, sat with our doctors and brought experience and wisdom to our project. He and I worked late into the night to order the next international shipment of HIV and TB medications. He brought out elegant yet practical computer tools, which were developed by him and other MSF staff in Myanmar, to model our next international order. MSF is bringing more training to our rural hospital. We plan to run a 10-day course on HIV care for our hospital staff. We will increase the capacity of the Ministry of Health staff and MSF staff. We will then receive more technical support that will enable our medical and nursing staff to be sent for regional and international training. Our professional support, vision and logistical capability make all this happen. We bring many resources to small villages often forgotten by their own governments and the world. The first doctor to sign the prescription for our two patients was a Congolese Ministry

Some of the feedback you provided related directly to this magazine. Supporters told us they are most interested in stories from the field – stories about the places we work and the people, both patients and aid workers, who are there. Most respondents indicated that our publications – Dispatches and News from the Frontline as well as our email updates – are their preferred means of receiving information about MSF. And we were happy to learn how many people share their copies of Dispatches with friends as a way of raising awareness about our work.

We engaged the Ministry of Health in this process of expanding HIV care. They are the first and most important actors entrusted with the health of the Congolese. When they asked us to go slower, and gather more support for starting ARVs, we listened and we worked together. We moved forward in the spirit of empowering their capacity and helping them discharge their responsibilities. Working with the Ministry of Health makes things more complicated but ensures longer-term sustainability for our intervention. Ultimately, it is the Congolese who must treat their patients with HIV, and not nongovernmental organizations. Where we come in and where we can help is in getting professional and humane care for HIV patients off the ground. Part of MSF’s job is to show that it can be done.

dum of understanding before we began ARV therapy. It was one man, wasting in a hospital bed however, that pushed us to get the provincial government to let us move forward.

of Health doctor. I felt above all else, I needed to get the right people in the right room with the right drugs. It was important to us that a Congolese doctor led the way. It might take weeks or months to improve the health of these two patients. Word might then pass to the community that HIV-positive patients don’t need to die, and that there are options. And that maybe there is hope. This is why I do MSF.

Raghu Venugopal Doctor

You conveyed several important messages: our supporters’ deep engagement with our medical humanitarian work, a concern for people in distress and a desire to ensure that money is going where the needs are greatest. We are grateful to those who took the opportunity to send words of support, particularly for the work of our field teams, and those who provided constructive suggestions and feedback. Thank you again, and please feel free to share your feedback at any time during the year by contacting our donor relations team at 1-800-982-7903 or donorrelations@msf.ca.

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HIV activities. We realized that the vast majority of illnesses we saw were not HIV. Rather, our top priorities remained running a large rural general hospital facing 110 to 115 per cent bed capacity, responding to constant epidemics and providing primary care services in small, outlying, neglected communities.

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MSF in Canada

“thank you for opening my eyes”

Refugee Camp In The Heart Of The City’s fall 2011 tour in Eastern Canada To the editor of Moncton’s Times & Transcript newspaper:

before the exhibit – it was very abstract for them.”

Thank you Doctors Without Borders. It was kool at the refugee camp; I really liked it. I would not want kolera and have to go to the bathroom in my bed. I would not want to wear tire shoes either. It would not be fun to live in a tent for 50 years. I am thankful to be living in Canada.

Bringing makeshift shelters, latrines, a cholera treatment centre and many other items typically found in refugee camps into the four cities’ downtown cores helped paint a picture for people of what life is like for more than 43 million people around the world who have no choice but to live in those conditions.

- Ronan Jensen, age 7

onan Jensen was so impressed by his visit to the Refugee Camp in the Heart of the City exhibition in Moncton that he sent this letter to the city’s local paper, the Times & Transcript. Jensen was one of almost 17,000 people who visited the Médecins Sans Frontières (MSF) reconstructed refugee camp in four cities in the fall of 2011. The exhibit set up in St. John’s, Halifax, Moncton and Quebec City. For most visitors, it was an absolute eye-opener, says Karel Janssens, the project coordinator. “The majority only had a vague idea about refugees

“I am a very visual person and walking through this camp I noticed all these details – such as the toys children have made during the long boring hours when they can’t go to school,” says visitor Jan Anderson Toupin. “I could imagine all these people standing in a line to go to a latrine, and how difficult and dangerous it is for a woman to carry water back to her family. It really touched me and I really thank you for opening my eyes.” What brought the living conditions in refugee camps to life was not just the visual display but the guided tours conducted by doctors, nurses and logisticians who have worked for MSF in refugee camps around

the world. All of them were volunteers during the exhibit, and some travelled to all four cities – spending long hours outside, braving wind, rain and cold weather, frequently sucking on throat lozenges to keep their voices intact for the constant stream of visitor groups. Their dedication to MSF and the personal stories they shared with visitors were the heart of the exhibit. The overwhelmingly positive response from the public made participating in the refugee camp exhibit a rewarding experience for the field workers turned tour guides. “I recently returned from a nine-month placement in Chad and it always strikes me how few questions my friends ask or how little interest my family shows,” says MSF logistician Grant Assenheimer. “So for me, the best part of volunteering with the exhibit is to be able to bring a part of this reality to life here in Canada and to have the chance to share my stories and experiences with people.”

Claudia Blume Communications officer

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

Martha Gartley Toronto, ON Water and sanitation specialist Nicholas Gildersleeve Montreal, QC Logistical coordinator Nathalia Guerrero Velez Montreal, QC Project coordinator Peter Heikamp Montreal, QC Logistician Colleen Laginskie Toronto, ON Nurse Alecia Wilson Vancouver, BC Nurse Jennifer Yeo Newmarket, ON Logistical administrator Guinea Anne-Marie Cayer Kelowna, BC Midwife Lysanne Lafetière Montreal, QC Nurse Haiti Myriam Beaulieu Cyr Rimouski, QC Biomedical analyst Nicholas Bérubé Quebec City, QC Logistician Rhiannon Hughes Port Alberni, BC Doctor Jean-Baptiste Lacombe Lavigne Montreal, QC Logistician Wendy Lai Toronto, ON Deputy medical coordinator Helene Lessard Saint-Georges, QC Financial coordinator Patricia Mantoyani Toronto, ON Logistical administrator Frédérik Matte Outremont, QC Communications officer Luella Smith Waterside, NB Medical coordinator Martine Verreault Rivière-du-Loup, QC Pharmacy coordinator India Etienne Blais Montreal, QC Logistician Andrew Bohonis Thunder Bay, ON Logistician Abdelhamid Echihabi Montreal, QC Logistician Alejandro Gomez-Juliao Bathurst, NB Logistician Arif Hasan North York, ON Surgeon Michael Minielly Toronto, ON Logistics team leader Iraq Reshma Adatia Vancouver, BC Project coordinator Ivory Coast Christopher Anderson Vancouver, BC Logistician Patrick Boucher Montreal, QC Logistical coordinator Jean-Marc Kuyper Montreal, QC Logistician Logistician Patrick McConnell Toronto, ON Fiona Turpie Dundas, ON Anesthetist Mathieu Vandal Montreal, QC Administrator Lebanon Steffen DeKok Kingston, ON Deputy head of mission Liberia Brenda Vittachi Calgary, AB Nurse Libya Gisèle Poirier Montreal, QC Nurse Malawi Mariam Kone Montreal, QC Doctor Mozambique Isabelle Casavant Montreal, QC Nurse Editor: linda o. nagy Editorial director: Avril Benoît Translation coordinator: Jennifer Ocquidant Contributors: Joe Belliveau, Claudia Blume, Unni Karunakara, Frédérik Matte, Gilbert Ndikubwayezu, François Servranckx, Raghu Venugopal Cover photo: © MSF

Myanmar Marika Daganaud Quebec City, QC Medical team leader Niger Myriam Berry Vancouver, BC Human resources coordinator Elisabeth Canisius Hamilton, ON Doctor Marie José Fiset Quebec City, QC Administrator Charles Gadbois Quebec City, QC Logistician Alphonsine Mukakigeri Quebec City, QC Logistician Tricia Newport Whitehorse, YT Nurse Nigeria Krystel Moussally Montreal, QC Epidemiologist Michael Talotti Bowmanville, ON Logistical administrator Alia Tayea Oakville, ON Humanitarian affairs officer Michael White Toronto, ON Project coordinator Pakistan Loretta Ann Beaulieu Vancouver, BC Human resources coordinator Jaroslava Belava Vancouver, BC Medical team leader Erwan Cheneval Montreal, QC Resource manager Tyler Foley Oromocto, NB Logistician Michele-Alexandra Labrecque Montreal, QC Doctor Stephanie Taylor Whistler, BC Anesthetist Somalia Gregory Camirand Mission, BC

Logistician

South Sudan Lorna Adams Holland Landing, ON

Doctor

Sri Lanka Pierre Labranche Montmagny, QC Logistical coordinator Thierry Oulhen Montreal, QC Project coordinator Michel Plouffe Saint-Jean-sur-Richelieu, QC Project coordinator Sudan Kevin Coppock Toronto, ON Megan Hunter Prince George, BC Elizabeth Kavouris Vancouver, BC Anne O’Connor Toronto, ON Wendy Rhymer Winnipeg, MB Hilary Shackleton Toronto, ON

Head of mission Logistical coordinator Medical team leader Nurse Midwife Nurse

Uganda Joanne Cyr Montreal, QC Uzbekistan Susan Adolph Halifax, NS Ashok G Chhetri Toronto, ON Jan Hajek Vancouver, BC Altynay Shigayeva Montreal, QC

Psychologist Nurse Doctor Doctor Epidemiologist

Zimbabwe Colette Badjo Laval, QC Doctor Kovarthanan Konesavarathan Guelph, ON Doctor Sandra Elizabeth Stepien Vancouver, BC Financial coordinator Circulation: 132,750 Layout: Tenzing Communications Printing: Warren’s Waterless Printing Inc. Winter 2012 ISSN 1484-9372

Dispatches Vol. 15, Ed.1

Armenia Alexandra Vanessa Ascorra Torres Quebec City, QC Anthropologist Bahrain Edith Fortier Montreal, QC Project coordinator Burundi Carole Smith Ottawa, ON Financial coordinator Cameroon Serge Kaboré Quebec City, QC Medical coordinator Central African Republic Fidele Bana Montreal, QC Doctor Joseph Baugniet Montreal, QC Logistician Eric Beausejour Laval, QC Administrator Diboh Gédéon Bedikou Gatineau, QC Doctor Thomas Haythornthwaite Ottawa, ON Project coordinator Kanadi Ibrahim Gatineau, QC Logistician Stephanie Mayronne Vancouver, BC Nurse AnneMarie Pegg Yellowknife, NT Doctor Jean-Serge Polisi Saint-Hubert, QC Logistical administrator Charlotte Sabbah Montreal, QC Social worker Chad Othmar Arnold Whitehorse, YT Nurse Sara Badiei Coquitlam, BC Logistician Julian Donald Toronto, ON Logistician Sabrina Gobet Toronto, ON Human resources coordinator Isabelle Jeanson Toronto, ON Project coordinator Colombia Carol Bottger Montreal, QC Doctor Democratic Republic of Congo Eboukele Aka Toronto, ON Pharmacist Cindy Barbe Farnham, QC Nurse Sharla Bonneville Toronto, ON Logistician Pascal Desilets Ottawa, ON Logistician Delphine Ferry Montreal, QC Human resources officer Maude Giboudeaux Montreal, QC Project coordinator Fabienne Gilles Toronto, ON Human resources coordinator Jeffrey Grass Toronto, ON Logistician Jean-François Harvey Rivière-du-Loup, QC Project coordinator Marie-Michele Houle Victoriaville, QC Nurse Marie-Eve Isabel Montreal, QC Nurse Antoine Jean-Sébastien Maranda Gatineau, QC Water and sanitation specialist Todd Phillips Winnipeg, MB Logistician Kirby Pickard Vancouver, BC Nurse Kirsty Robertson Toronto, ON Nurse Letitia Rose Vancouver, BC Nurse Claudette Seyer Outremont, QC Nurse Emily Marie Shallhorn Pincourt, QC Nurse Catherine St-Amand Montreal QC Financial coordinator Bayu Sutarjono Toronto, ON Logistician Jennifer Turnbull Ottawa ON Doctor Egypt Abdulqadir Omar Toronto, ON Medical coordinator Ethiopia Rink De Lange Sainte-Cecile-de-Masham, QC Emergency staff

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