Chan, E

English

MSF Field Research

Hong Kong Med J Vol 9 No 1 February 2003      67
DOCTORS AND SOCIETY
Médecins Sans Frontières experience in the provision of
health care in complex settings
Since 1970, Médecins Sans Frontières (MSF) has been
providing medical care to vulnerable populations. This
article aims to show the role of MSF as a medical non-
governmental organisation and its impact on the health of
populations. Médecins Sans Frontières is best known for its
emergency interventions, providing assistance to victims of
natural disasters, epidemics, and armed conflicts. The ex-
pertise of this group includes setting up medical and health
services that range from surgical and nutritional to psycho-
social care in difficult settings. The determination of med-
ical and non-medical volunteers has brought them to work
in war-torn countries such as Rwanda, Congo, Sierra Leone,
Sri Lanka, and Afghanistan, as well as in less well-known
areas of conflict such as Mindanao in the southern Philippines,
Moluccas in Indonesia, and Colombia. At the moment, MSF
is working on approximately 400 projects in 80 countries.
Apart from emergency settings, MSF has also developed
protocols for complex diseases such as HIV/AIDS for
populations that have neither the means nor the technical
knowledge to deal with these health calamities. Médecins
Sans Frontières is the first medical organisation to apply
simplified antiretroviral treatment protocols to treat AIDS
in resource-poor areas in South Africa. Currently, MSF has
experienced medical teams in nine developing countries
using the simplified treatment models for AIDS patients.
Médecins Sans Frontières also carries out epidemiologic-
al programmes for rare diseases such as Ebola. In 1995,
there was a major outbreak of haemorrhagic fever in the
town of Kikwit in the south-west of Zaire, now called the
Democratic Republic of Congo. A team of MSF medical
volunteers went to investigate and help the local authorities
set up control measures. It was an elaborate operation as the
team had to address several issues at once—strengthening
treatment facilities at the local hospitals and dispensaries,
confirming the nature of the epidemic, and instituting con-
trol measures. In principle, the clinical features of the Kikwit
disease could have been caused either by yellow fever or
Ebola. The severity and high case fatality rate seemed to
point to Ebola, however, as did the pattern of transmission—
initial epidemiological surveillance of cases appeared
to implicate person-to-person transmission, rather than
transmission by a mosquito vector. Indeed, the groups most
affected were pregnant women and young children. A par-
ticular risk factor was living within close proximity of a
health centre or hospital. Closer questioning of the people
affected revealed that many of the patients had received an
injection during the previous days or weeks—the women
against tetanus in the context of their antenatal care, and the
children as part of their regular immunisations. This infor-
mation led to urgent investigation of sterilisation techniques
by local medical staff and it was found that needles and
syringes were being reused without proper sterilisation. The
first intervention, therefore, and the most effective step in
bringing an end to the outbreak, was to provide adequate
supplies of sterile equipment and to provide training for the
staff on how to prevent contagion. Another task in which
MSF has gained tremendous expertise in the past decade is
the response to massive epidemic outbreaks in countries that
have little or no capacity to manage them. In January 2001,
MSF had to handle a major yellow fever outbreak in Guinea.
During that time approximately 100 000 refugees from
Sierra Leone and Liberia trapped in a war zone had no
possibility of fleeing and no access to health care. Together
with the local population, a total of one million people needed
to be vaccinated. The Guinean government simply did not
have the resources to deal with such a health disaster and,
as a result, MSF successfully intervened with a large-scale
vaccination campaign.
The above examples serve to illustrate how MSF attempts
to complement formal health sectors. But there are also moral
dilemmas involved in providing health care to vulnerable
populations. Dependence on external assistance can have
detrimental effects since it can hamper and minimise gov-
ernments’ responsibilities to improving the well-being of
their populations. External assistance can even be manipu-
lated to support systems that might have caused the failure
in the first place. For example, MSF was the first independ-
ent humanitarian organisation to enter the Democratic
People’s Republic of Korea in 1995, yet teams were often
unable to have full and unfettered access to the population
and to independently monitor the nutritional and medical
status of vulnerable groups. Despite individual reports of
major famine in some areas, MSF feeding centres had low
numbers of malnourished children, who could not be as-
sessed without the presence of authorities. For these reasons,
MSF left in the fall of 1998 to avoid its medical and food
assistance being manipulated.
At the heart of its humanitarian principles, MSF does
not wish to substitute formal health structures in countries
where it works. Médecins Sans Frontières believes that it is
the governments’ responsibilities to provide health care to
their people, which is why MSF so often speaks out and
seeks to provoke change and catalyse initiatives. Wherever
possible, MSF will pass on its knowledge to populations
and institutions that may benefit from the group’s years of
experience in patient care and treatment.
E Chan
President, Médecins Sans Frontières Hong Kong
Shop 5B, Laichikok Bay Garden, 272 Lai King Hill Road,
Kowloon, Hong Kong

Médecins Sans Frontières Experience in the Provision of Health Care in Complex Settings.

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