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Vol.11, Ed.1

Dispatches MSF

IN THIS ISSUE Fleeing the violence

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Congo’s lost people

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Water everywhere, but not a drop to drink

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Malnutrition in Uganda: Pushing back against a chronic struggle

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Meeting healthcare needs amid mountains and desert

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15,000 come to Refugee Camp in the Heart of the City

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Suddenly… a book

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Canadians on mission

1999 Nobel Peace Prize Laureate

NEWSLETTER

DEMOCRATIC REPUBLIC OF CONGO: CONDITION CRITICAL

© Dominic Nahr / Oeil Public

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CANADA


© Dominic Nahr / Oeil Public

Democratic Republic of Congo

FLEEING THE VIOLENCE s fighting in North Kivu, Democratic Republic of Congo is making the headlines, the neighbouring district of Haut-Uele is also affected by violence. Rebels from the Lord’s Resistance Army (LRA) are terrorizing people, looting, burning villages, abducting children and killing adults. Médecins Sans Frontières (MSF) went to the town of Dungu, which was attacked by the rebels on Nov. 1, 2008 to assess the needs of the population. An MSF medical team began activities in Dungu on Nov. 10.

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J. (name withheld) is a carpenter working in the convent in Duru, a village many hours’ walking distance from Dungu. J. has a wife and five children and also cares for a young niece. He told a member of the MSF team what happened to his family. His story illustrates the distress suffered by civilians who fall prey to the rebels’ brutality and have to flee their villages.

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It all started around 1 p.m. I had just finished cutting a cluster of palm nuts some 250 metres away from the market and the convent and was just about to get back when a child from the village gestured in my direction warning me not to get closer. According to him, the LRA had surrounded the mission and had even abducted children from the secondary classes. I immediately went home and got the six children and my wife together; as our neighbour was away I took his four children too and we fled to the bush, two kilometres away from the village. There we stayed two days, next to our plot. We could feed on beans and aubergines that I got from our field and that my wife cooked in empty cans as we didn’t have any saucepan. A boy who had been captured by the LRA but had managed to escape after three days

joined us. He said that the LRA had left the village at around 3 a.m. and had crossed the river. Together with our neighbour who had joined us in the bush, we decided to return to the village to see what had happened and also to get some essential things. It was quite distressful to see that my entire compound had been burned down: the three small huts, the straw hut, the kitchen and the goats’ shed. Everything had been burned down. My six goats were lying on the ground, shot dead. “MY NEIGHBOUR DECIDED TO CROSS THE FOREST INTO SUDAN WITH HIS FAMILY” Overcoming our pain we rapidly cut up a goat and shared it between us. I added the rest of two burnt chickens and carried the lot on my back, returning to our hiding place. My neighbour decided to cross the forest into Sudan with his family. As for us, as my wife didn’t want to go to this


© Dominic Nahr / Oeil Public © Vanessa Vick

© Sven Torfinn © Espen Rasmussen

country which she doesn’t know, we decided to go the next day to Dungu where we have relatives.

and I could hear him scream, but it was too late, impossible to turn back without risking to get caught, all of us.

The next day, a Sunday, we set out for Dungu at around 4 p.m. to get to Kpaika, a village, the same day. When we got to Kpaika my eight-year-old son had swollen legs after this long walk, so we decided to rest for the night in the chapel and to leave early the next morning.

A MIRACLE

Around 4 a.m. we were woken up by gunshots and people screaming. We fled – my wife put our youngest daughter on her back and carried our eight-year-old son; I grabbed our three-year-old son. My wife fell into a hole, so I put the toddler down on the ground to help her get out. That’s when an LRA soldier spotted us and gave chase. I barely managed to get my wife out of the hole and to flee with her. I then realized, too late, that I had left the toddler behind

From the forest, where we hid, we tried to get some news. People said that many had been killed in Kpaika. Around 11 a.m. it was completely silent. We then heard the faint noise of leaves being trampled by many people. We approached carefully and saw that the noise was coming from the road, where many people were fleeing. We asked everyone if they had seen a little boy, alone on the road. Eventually, someone told us that he had seen an LRA soldier carrying our son on his back. This news drove us to despair. My wife and I decided to save the remaining five children by taking them away as quickly as possible, knowing that by

doing so we were getting ever further away from the little one. So we joined the flow of fleeing people and arrived in Kiliwa on Tuesday. Then, through some miracle we learned in Kiliwa that our little boy had been freed, that a well-meaning person had taken care of him and was taking him to Dungu. We spent the night outside under a mango tree on the road side, dehydrated and exhausted, but with a lighter heart when thinking of our son, hoping he might already be on his way. We left Kiliwa at around 4 a.m. and walked all day. We reached Dungu after 6 p.m. We were given refuge by the priests and we have been with them for four days now. We’re waiting for our little one.

Claude Mahoudeau Communications officer

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© Teresa Sancristobal

© Tara Newell

CONGO’S LOST PEOPLE outh Kivu, Democratic Republic of Congo (DRC) is infamous for its history of violence, especially acute during the war periods of the 1990s and early 2000s. People here are torn by conflict. They’re worn out. They’ve been suffering for so many decades, with no chance to recover. They’re weary. The public institutions, government structures, and infrastructure – none of them function in these mountains.

there were, what was causing the most prevalent diseases as well as deaths.

In Baraka, Médecins Sans Frontières (MSF) runs the only functioning hospital in a zone where many people have to walk five days from where they live to reach it.

It was the greatest misery I’ve ever witnessed. They were here in isolation with no outsiders ever knowing. The first had escaped here seven months earlier, and subsequent waves had joined them as village after village was destroyed in fighting. It was shocking. We were the first muzungus (white people) to have ventured to that area. The displaced people just stared at us in disbelief, and we at them.

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Some months ago, a man came in from the bush to ask MSF to help some families that had escaped fighting between two rebel groups. To reach those who had fled meant a nine-hour drive on a dirt road, then nine hours by foot on barely visible jungle footpaths. I journeyed there with an MSF doctor, a translator and a guide from the community. We were covered in mud as we crossed rivers in the pouring rain and fought our way through tall grasses. Each of us was carrying heavy backpacks with food and water rations for four days, plus a blanket, a change of clothes and an emergency medical kit. We wouldn’t be able to treat everyone, but we needed to assess how long it took to get there, how many people

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As we reached the top of a plateau which opened up to rolling green hills, we were struck by the beauty of the region. Huts of sticks and mud with straw roofs soon came into view. The numbers were shocking: there were surely about 10,000 displaced people hidden away here.

They were originally from a good distance to the north where a historical conflict left them living on a battle ground. The conflict has involved the looting of villages, the raping of women, the setting of fires, the slaughtering of animals, and random shootings. This is what happens in these wars; it’s nasty. It’s no wonder families flee for their lives. You hear things in the news about how the United Nations or aid agencies come to the rescue to establish camps for inter-

nally displaced people, supplying them with plastic sheeting, water and food. But here was an isolated group suffering in silence. It was cold, windy and wet in these mountains. As many as a dozen people lived in each hut, huts so awful you wouldn’t deign to put farm animals in them. No mattresses or blankets – people had no choice but to lay in the mud. There was potential farmland in the area but due to a lack of seeds to cultivate, food was scarce. Some reported they only ate two to three times a week. They received this food usually through what we call transactional sex, wherein the women would have sex with local men in order to receive food, if only a little rice to feed their families. Women were often raped by resident men or local military patrols. The health of this lost group of 10,000, a five-day walk from our hospital, was equally shocking. Women were delivering babies in isolation, with up to 30 per cent dying in childbirth. There were many complex obstetrical cases because the women are very small hipped, and when already malnourished and weak, childbirth can be dangerous. Too many women were dying this way, and the infant death rate was also unacceptably high. Most women said they had lost at least one child, usually due to chronic diarrhea


(likely cholera) and malnutrition. All told, there were multiple symptoms of general weakness meaning people were too ill to cultivate their fields or do much of anything to sustain a livelihood. Water and sanitation were abysmal. They would use the same water for bathing as for cooking. This is typical in a refugee camp before nongovernmental organizations arrive – complete disorder and no support system. During this first visit, we did a lot of focus groups with men and women, separately, to better understand what they needed. With their beliefs in traditional medicine and evil spirits, they believed they were cursed because 100 children had suddenly died. The symptoms they described – visible red spots and the curse passing from one child to another – sounded like a measles outbreak. All around us there were sick and dying people, but we didn’t have the medical capacity to test and treat everyone on this visit. The priority was to report back on what we were seeing in order to galvanize longerterm support for them. Still, Julie, the doctor, would often throw off her backpack and start treating the severe, life-threatening cases. We were there for three days only, with a gruelling walk ahead of us to return to our MSF base for the necessary supplies to treat them properly. Upon our return to Baraka, we presented the needs to other aid organizations to convince them to go and start helping these people. The problem for MSF is that we are completely stretched in North Kivu, where full-scale war has erupted once again.

There are so many internally displaced people harmed by conflict, so many needs, and so many impossible choices for us as an organization with limited resources. The best that MSF could do in this case was to bear witness and to lobby. Now things are moving forward. We have convinced the ministry of health to set up some clinics in this area. So if we can take any sense of accomplishment from this, it is that we were the first to find this area, the first to witness what they are experiencing, to give them a voice, and to make decisionmakers care about their suffering and longer-term health needs. Other organizations will help provide things like shelter and food. Materials for houses, medicine, all will be brought by foot. There is no other way to do it right now.

AN UNRELENTING

CRISIS

There is so much need in DRC, particularly in the Kivus with war raging in the North, and the South recovering from decades of war that could re-ignite at any moment. This is one particular instance where I helped give voice to a community of people, and I am very proud I did. Tragically, there is too much happening here to assist just this one community – as one of so many that are suffering in this region.

Tara Newell Project coordinator

Tara Newell, from London, Ontario is a project coordinator with MSF. Newell is a former federal public servant and has been working for MSF since 2004.

The humanitarian crisis in Democratic Republic of Congo (DRC) is not new. For more than 15 years, armed groups and national armies have been fighting each other here. Millions of Congolese people have suffered and died in successive wars. The conflict has been particularly unrelenting in DRC’s eastern provinces. Here, hundreds of thousands of people have spent years running from war. For these men, women and children, there seems to be no hope for a normal life. In late August 2008, the conflict began escalating once again, causing more displacement and misery. MSF has been working in DRC since 1981, trying to relieve suffering in places where others are unwilling or unable to help. Currently, MSF is serving displaced people and local residents throughout the conflict zone. The organization is providing primary and secondary healthcare, including surgery, at hospitals and health centres. MSF is also running mobile clinics and cholera treatment centres, and providing mental healthcare, as well as distributing clean water and basic relief items.

We can’t all go, but we can help those who do. We’ve reached some, but there are many, many more. The people of eastern DRC are in critical condition. See their plight and learn how you can help MSF reach them. Visit www.msf.ca

© Cédric Gerbehaye / Agence VU

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© Klavs Christensen

Haiti

Water everywhere, but not a drop to drink In early September 2008, hurricanes Gustav, Hanna and Ike ravaged Haiti. early 800 people died, and tens of thousands were left homeless. Roads and infrastructure were destroyed. The landscape in the northwestern city of Gonaives was desolate.

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Before the hurricanes, the inhabitants of Gonaives had access to many wells, and an aqueduct system served certain neighbourhoods. It took just a few hours for everything to be destroyed. Torrents of mud smashed the drinking water pipes and buried and contaminated hundreds of wells.

Flying over Gonaives, Haiti’s fourth largest city, one is struck by the sheer quantity of water still remaining in and around the area, even five weeks after hurricanes ravaged this city in northwest Haiti in September 2008. The sea still covers much agricultural land (some of the region is below sea level), but the Artibonite River and its many tributaries also brought torrents of mud down from the nearby mountains.

A city of 300,000 inhabitants suddenly found itself completely without drinkable water. The first medical consultations organized by Médecins Sans Frontières (MSF) showed an incidence of diarrhea of nearly 100 per cent in certain neighbourhoods, as well as many skin infections – extremely alarming indicators. The residents, having no alternative, continued to draw their water from wells contaminated by polluted mud. In addition to setting up an 80-bed hospital and organizing mobile clinics to reach the area’s most isolated inhabitants, MSF quickly established a major program for the treatment and distribution of drinking water.

Gregory Vandendaelen Press officer

Photos © Gregory Vandendaelen / MSF unless otherwise noted.

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One of MSF’s 41 water supply points. This large blue envelope is a 15,000 litre water bladder. Made of PVC, it is placed in an elevated position and filled every day. From this, approximately 3,000 people have access to about five litres of water each to meet their basic daily needs, including cooking, cleaning and washing. In Canada, people use on average 300 litres of water per day.


The quantity of mud in the streets of the city is such that it is estimated it will take about 18 months and the use of some 50 trucks working constantly to restore the city to its former state. In some places, the mud was more than two metres deep.

Transporting water to the four corners of the city is a daily challenge. Not a day goes by without one of the six MSF trucks getting stuck in the mud. When this happens, its contents are transferred to another truck using a pump. Thus lightened, the truck can get moving again.

All the water distribution facilities are only temporary. Soon MSF will begin the renovation of more than 200 existing wells. The best performing wells and those located in the most affected areas will be selected. Since these wells are contaminated, it will be necessary to clean them up and repair the many damaged pumps.

At the time this article was written, MSF estimated it could provide drinking water to one third of the inhabitants of the city of Gonaives, more than 100,000 people. This is one of the most ambitious water management projects in the history of MSF.

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Uganda

MALNUTRITION IN KARAMOJA: Pushing back against a chronic struggle n Karamoja, Uganda, malnutrition is chronic. In 2008, this remote region of northeast Uganda began suffering its worst drought in five years, creating a humanitarian crisis. The last two years saw back-to-back dry spells followed by unusually heavy rains. Rising food prices make what food is available in the market simply unaffordable. Inadequate rain in 2007 and late rains in 2008 have led to late and insufficient planting of peanuts and sorghum. There are also rising numbers of animal losses.

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Karamoja is home to about one million people, people who are mostly dependent on animals for their livelihoods. The region is well known for conflicts connected to cattle raiding. Pastoral-nomadic lifestyles and insecurity make it difficult for people to access the region’s few health facilities. Médecins Sans Frontières (MSF) opened a therapeutic feeding program for children under the age of five in the worst-affected districts of Moroto and Nakapiripirit. Teams go directly to the villages, bringing healthcare to the nomads of Karamoja.

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“The best way to assist and treat children, the most vulnerable, is to travel out to the villages to find the malnourished kids while providing them with two-week rations to get them through the worst,” explains Kodjo Edoh, MSF head of mission in Uganda. In Karamoja however, adds Edoh, “we fear the worst is still to come.”

arm circumference (MUAC) bracelet. “Any child measuring between 11 and 13.5 centimetres on the MUAC has his weight and height taken,” says Mbaluto. “Those measuring less than 11 centimetres as well as those with bilateral oedema [swelling due to fluid accumulation] are admitted directly as they are considered to have severe malnutrition.”

The MSF nutritional intervention started in June 2008 and was expected to run only until September. But as of September, with almost 24,000 children screened and 2,300 of them severely malnourished, the program will continue well into 2009.

Every newly admitted child is tested for malaria and screened for other medical conditions such as infections and diarrhea. In some areas, 60 to 90 per cent of the kids were found to have malaria. Two nurses do consultations, examine the children from head to toe and rule out any complications. They look for infections and depressed immunity. The children receive vitamin A, as well as folic acid to prevent anemia. They receive antibiotics and other drugs to treat complications.

George Mbaluto, a Kenyan nurse in charge of the program, describes how the mobile clinics for the feeding program are set up: “The mothers come with their children and sit together in the waiting area. Here they are given education on nutrition and personal hygiene.” Children between six months and five years are then screened with a mid-upper

Children who are severely malnourished without other medical complications will be treated on site, while a child who is very sick or has poor appetite is referred to St. Kizito Hospital in Matany, one of


two district referral hospitals. At St. Kizito, MSF supports the only inpatient therapeutic feeding centre in the region. Once children are stabilized at the centre, they are discharged and followed by the mobile clinics closer to their homes. In Karamoja many families cannot afford food, let alone the right food, and must survive on cereal porridges that lack essential nutrients. Therefore MSF treats malnourished children with therapeutic ready-touse food designed to match their needs. “Here we use Plumpy’nut, two sachets for children of less than eight kilograms and for children over eight kilograms, three sachets,” explains Mbaluto. “Soap and mosquito nets are provided to help with hygiene and to prevent malaria. A supply of Plumpy’nut is given to the mothers and they are asked to come back 10 days later. We have not seen many problems; rather, some good progress. Most of the children like the taste of the therapeutic food and are gaining weight. It depends on the location, but we usually see about 60 to 70 patients a day.” The team is encouraging community health workers to seek out malnourished children by visiting families and explaining the services MSF is offering. “So far, the mothers are coming steadily and in most clinics 80 to 90 per cent of them bring their children for followup visits,” Mbaluto says. “But still, in one or two clinics, we are only seeing around 50 per cent, so we have some work to do there.” MSF believes the challenge in areas most devastated by malnutrition is not only to treat those most affected but also to prevent them from falling into the terminal stages of malnutrition in the first place, and to do so by ensuring all children have access to nutrient-rich foods.

Susanne Doettling Communications officer

Photos © Julie Rémy

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© Ton Koene / MSF

Pakistan

MEETING HEALTHCARE NEEDS amid mountains and desert

or several years Médecins Sans Frontières (MSF) teams in Pakistan have been running clinics and health centres in the regions bordering Afghanistan, where insecurity has had a serious impact on healthcare. But it has become clear that in other rural areas in Pakistan many people are finding it hard or impossible to get medical treatment they can afford. This is particularly true of eastern Balochistan province, where people’s healthcare needs are some of the most neglected in the country.

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Life here is harsh, with cold winters and dry, blistering hot summers. There are steep barren mountains in the north of the province and desert plains in the south that slope down to the Indus valley. “We have been trying to work in east Balochistan on a permanent basis for several years now,” says Chris Lockyear, MSF’s head of mission in Pakistan. “Our new program in Jaffarabad district hopes to address some of the very great needs.”

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In June 2007, cyclone Yemyin brought widespread flooding to Balochistan. MSF physician Ahmed Bilal describes the emergency response: “We started working in an area that was very hard to reach, and when we got there we saw how terrible the conditions were. Whole villages were destroyed. We started up treatment centres under the open sky. We treated about 3,000 people in two weeks. When we heard that in one area children were dying of diarrhea, we very quickly did some rapid tests, which confirmed it was cholera. The MSF base in Islamabad immediately sent down cholera kits and logistical materials and we set up six cholera treatment centres. We treated more than 300 children. Before our arrival four children had died of cholera, but after we set up the treatment centres there were no deaths.” “I remember the conditions being very, very bad – nothing to drink, nothing to eat. We covered the whole of that difficult area and the regional officials really appreciated the

work of MSF – they said that MSF was right on the frontline, the first to get there in these terrible conditions.” Working in the floods, Bilal and his team saw how bad the general health situation is here. He has been working with MSF for more than three years, in many places, and he believes east Balochistan is an area in great need. The land is some of the richest in Balochistan, but most of it is owned by landlords and the majority of people work as daily labourers. “They often cannot pay for good food for themselves or their children,” explains Bilal. “The mothers are often very malnourished and when they are breastfeeding, they have no proper food to give their babies,” he adds. “And sewage gets into the drinking water channels, which people are using for drinking, for cooking, for everything. The number of cases of diarrhea, typhoid and hepatitis is very high and when they get diarrhea, the children quickly become malnourished.”


In July of 2008 MSF did a rapid nutritional survey and found high rates of malnutrition in the district. It was agreed with the authorities that MSF should start a nutrition program. “We are working in the main regional hospital, an old 40-bed hospital built in 1944,” says Bilal. “It is in very bad condition, and we have been offered a separate ward we are repairing. It is always busy and people come from far away, from all over the region. They know there are new doctors in the hospital, ‘doctors for weak children’ they call us.” The MSF team is seeing increasing numbers of patients. One of the biggest challenges is making sure patients continue their treatment after the first visit to the hospital. Outreach workers visit patients at home because some people find it hard to come back for check-ups and to collect their next ration of therapeutic food.

Gaining acceptance is also a challenge when working in a new area. Shah recalls a mother who brought in her two-year-old boy from a long way away by donkey cart. Her toddler had vitamin A deficiency, probably since birth, and was blind. He was severely malnourished so MSF gave him special therapeutic food rich in vitamins and minerals. The mother had brought her child alone on the first visit, but when she brought him back for a check up, her mother and mother-in-law came along. The boy was doing much better, and they all had tears in their eyes. They explained he used to just lie there limply, but now he was more active, showing signs of liveliness.

“I saw tears of joy and happiness running down the mother’s face,” says Shah. “This is the best thing, better than words, and it makes me feel what we are doing is really worthwhile.” After this family went back to their village, MSF had 30 more patients from the same area, a sign that MSF’s medical services are becoming better known. Now that the therapeutic feeding centre is fully up and running, MSF hopes to expand its medical programs in the region. Tuberculosis is common, as is hepatitis. People’s general health status is poor. There is little public health education. Maternal mortality is high, in part because life-saving caesarean sections are not available to women with delivery complications. The nearest referral hospital is 200 kilometres away, but people are too poor to get there. “Healthcare in this area is completely neglected,” says Bilal. “For the people here, I think there is a great need for MSF to do more.”

Robin Meldrum Communications officer

© MSF

People are so poor they cannot pay for transportation to the health clinic. Ninety per cent of mothers in the area

work as day labourers, mostly in the brick kilns or in the rice fields. They have to work up to 10 hours, in temperatures up to 50 C in July, and if they do not work a full day they do not get paid. “So it is very hard for them to find the time to come to the hospital,” explains MSF staff Aleem Shah. “They want to come, and they do come when they can, but often it is simply impossible so we need to go out to their homes.”

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MSF in Canada

15,000 COME TO REFUGEE CA Imagine, you have 3 minutes to gather your family and flee. his is what people in Winnipeg, Edmonton, Calgary and Vancouver were asked to do in September and October of 2008 when Médecins Sans Frontières (MSF) brought to their city a travelling exhibit called A Refugee Camp in the Heart of the City. The exhibit was a reconstruction of a refugee camp, where MSF field workers shared firsthand knowledge of the living conditions of the 42 million people around the world displaced by conflict. As they toured the different areas of the camp 15,000 visitors had to ask themselves: Where will I find shelter? How will I feed my family? How will I get medical care for my children?

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As a tour guide, it was an honour for me to represent the voices of people I worked with in Sudan and Bangladesh. They would have been so pleased to know their stories were being heard on the other side of the world here in Canada. Our Canadian image is difficult to define, but the people I have worked with in other countries see us as diverse, humble, fair and respectful of people regardless of their situation. After returning from Darfur, Sudan in the spring of 2008, I was numb to the suffering I had witnessed. It is difficult to talk about because the context is so hard to describe. Issues such as humanitarian crises are strange to slip into a dinner table conversation or daily interactions with people. Although I think about the people in Sudan every day, I rarely discuss them.

Many Canadians already have a difficult time understanding what it is like to live without secure access to water, sanitation, or basic healthcare. My weak verbal descriptions seem to cheapen the powerful representation the 42 million refugees and internally displaced people deserve. The Refugee Camp in the Heart of the City was a perfect tool for explaining the situation step by step, discussing the issues, then speaking with the tour group about the challenges and how they’re met, by MSF as well as the refugees themselves. It was amazing to see school groups – kids as young as eight years old – show interest, ask questions, and be motivated to learn more. Visitors to the exhibit were able to see how their awareness and desire for action – average Canadians wanting to make a difference – can support


MP IN THE HEART OF THE CITY refugees and displaced people struggling to survive. Activities like A Refugee Camp in the Heart of the City encourage the public to become aware and hold international powers accountable to their responsibilities.

the patients because these children appear so hopeless and close to death. Family members may be tempted to give the therapeutic food to their other children who do not appear to have such a seemingly grim fate.

During the four weeks I travelled with the exhibit, I guided about 80 tours. I expected I would get bored with the redundancy, but the participants on the tour asked many thoughtful questions and often shared with the group their knowledge, including sometimes their own experiences as refugees.

However, severely malnourished children have an excellent recovery rate. One nineyear-old student on the tour asked what I did to keep the mothers motivated. I answered it was not me who kept the mothers motivated but one of the local Sudanese MSF employees named Abdul. I was describing the games he played with the toddlers – having them deliver the therapeutic food to the beds of the younger kids. While mentioning his other inspirational interventions my eyes filled with tears and my lips started to quiver. I sent the students to the cholera station, the next area of the tour, to avoid my emotional

While at the nutrition station with a Grade 4 class on one tour, we were discussing how challenging it is to treat severely malnourished children. Mothers and care-givers have a difficult time staying motivated to re-feed

scene. Perhaps I am not as numb to the situation as I thought I was. Some westerners think poverty in the developing world is the reality of the people there and they do not suffer as much as we would in the same situation. Of course, nothing could be further from the truth. Abdul’s story is one that needs the context of a Refugee Camp exhibit for people to understand how the fundamental human act of caring makes a difference.

Kevin Barlow Registered nurse

Photos Š linda o. nagy / MSF

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© James Maskalyk

MSF reads

Suddenly… a book n the tenuous border area between the north and south of Sudan sits Abyei, a town of 60,000. Oil and the sharing of wealth in Sudan played a huge role in a 21-year conflict that only ended in 2005. It is anyone’s guess whether a planned referendum to determine separation of the south will ever come to pass. Abyei, always at risk for renewed hostility, was virtually destroyed in May 2008 during attacks. At that time Médecins Sans Frontières (MSF), which has been there since 2006, was treating 700 children for malnutrition.

Maskalyk’s quest seemed to be to create time and place travel so that no matter where they were, anyone reading would be present in the moments he was recounting – “That boy, the one whose bone we drilled into with a hypodermic cannula, the one who I used as an example of our small therapeutic successes, the one who came to life after lying dry, drooping in his mother’s arms, he died. I was told the next day. The cannula had stopped working, but he was drinking. An hour later, when the nurse next went to check, he was dead. A husk.

The suddenness and devastation of that attack underscores the work of MSF and the vital need for that work to continue. While the place of Abyei can be erased, the truth of it – that it existed, that the people there truly lived and breathed – is more deeply etched in the fabric of human consciousness by the penetrating and incisive depictions in Toronto physician James Maskalyk’s highly acclaimed blog, “Suddenly...Sudan.” Maskalyk wrote the blog from February to July of 2007, while working in Abyei on his first mission with MSF. Through his blog and his forthcoming book, Six Months in Sudan, due out in April 2009, Abyei and all of its heartbeats will continue to persist inside of us.

“Diarrhea is a killer. I see it nearly every day. It kills children, turns them to husks. The work it takes to keep their machinery turning with the desert outside and one inside, is simply too much. They cave in, exhausted, and creak to a stop.”

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Throughout the months of writing, Maskalyk’s blog embodied the meaning of témoignage, or bearing witness. He forces us to breathe the faint breaths of the helpless, brushes their skin up against our own, and draws our gaze into the soft eyes of those who smile as we smile, cry as we cry. Victories are one heartbeat at a time. Deaths, the same. Maskalyk’s témoignage teaches us to

give in, to let go and simply be – with the two-year-old abandoned near a tree by his family, with the young woman suffering from TB who walked for days to get to the clinic to deliver a premature baby “no bigger than a bird,” with the waiting, the laughing, the silent. Many read his blog – professionals, students, thinkers, family. They all got it. They understood. As one person put it, “I am grateful for your images and words but sometimes they twist inside my heart.” The original blog: www.msf.ca/blogs/JamesM.php The forthcoming book: www.randomhouse.ca

Calvin White Mental health counsellor

Calvin White is a mental health counsellor and writer who lives in Salmon Arm, British Columbia. In 2009 he plans to leave on his first mission with MSF, as a mental health officer.


Canadians on mission BANGLADESH Grant Assenheimer Oakville, ON

Logistician

BURUNDI Joel Montanez Moncton, NB

Mental health specialist

CAMEROON Serge Kaboré Québec, QC Robert Parker Québec, QC

Medical coordinator Project coordinator

CENTRAL AFRICAN REPUBLIC Patrick Boucher Montréal, QC Duncan Coady Pinawa, MB Edith Fortier Montréal, QC Mélanie Lachance Poisson Québec, QC Mireille Roy Montréal, QC Rachel Seguin Montréal, QC

Logistician Financial coordinator Project coordinator Nurse Laboratory technician Nurse

CHAD Nicolas Berubé Montréal, QC Ivan Gayton Vancouver, BC Guylaine Houle Montréal, QC Jean-Marc Kuyper Montréal, QC Audra Renyi Toronto, ON Sonya Sagan Binbrook, ON Matthew Schrader Massey, ON Luke Shankland Montréal, QC

Logistician Project coordinator Logistician Logistician Logistician Logistician Logistician Project coordinator

Judy Adams Miramichi, NB

Mental health specialist

KENYA Indu Gambhir Ottawa, ON Maguil Gouja Montréal, QC

Peter Saranchuk St. Catharines, ON

Doctor

COLOMBIA Project coordinator

DEMOCRATIC REPUBLIC OF CONGO Mélanie Bergeron Sherbrooke, QC Liaison officer Training officer Marie-Ève Bilodeau Ottawa, ON Logistician Owen Campbell Montréal, QC Emergency coordinator Annie Désilets Ottawa, ON Logistician Elias Frédéric Montréal, QC Nurse Elizabeth Kavouris Vancouver, BC Pierre Langlois Sainte-Catherine-de-Hatley, QC Administrator Project coordinator Tara Newell London, ON Logistician Jean-François Nouveaux Montréal, QC Nurse Nadia Perreault Mascouches, QC Mental health specialist Denis Roy Montréal, QC Laboratory technician Joannie Roy Verdun QC Sylvie Savard Hull, QC Financial coordinator

ETHIOPIA Justin Armstrong Haileybury, ON Project coordinator Nurse Vanessa Bailey Victoria, BC Nurse Stephanie Gee Vancouver, BC Doctor Doris Gonzalez-Fernandez Montréal, QC Logistician Ralph Heeschen Ajax, ON Doctor AnneMarie Pegg Yellowknife, NT Project coordinator Dominique Proteau Québec, QC Logistician Jonathon Rasenberg Flinton, ON Logistician Christophe Rouy Québec, QC

Project coordinator Financial coordinator

MOZAMBIQUE Isabelle Casavant Montréal, QC

CHINA

Martin Girard Montréal, QC

INDIA

Nurse

Daniel Arnold Vancouver, BC Logistician Logistician Leanna Hutchins Canmore, AB Nurse Victoria Kennedy Toronto, ON Logistician Sarah Lamb Toronto, ON Rink De Lange Sainte-Cécile-de-Masham, QC Water and sanitation specialist Nurse Leanne Olsen Sainte-Cécile-de-Masham, QC Nurse Jennie Partridge Canmore, AB Nurse Kerri Ramstead Brandon, MB Project coordinator Grace Tang Toronto, ON

MYANMAR Leah Battersby Whitehorse, YT Matthew Calvert Ottawa, ON Frédéric Dubé Québec, QC Mathieu Léonard Sherbrooke, QC Lori Wanlin Winnipeg, MB

Logistician Logistician Logistician Logistician Logistician

TURKMENISTAN Sharla Bonneville Toronto, ON

Logistician

UZBEKISTAN Ada Yee Calgary, AB

Financial coordinator

NIGER Maude Bernard Montréal, QC José Godbout Blainville, QC Audrey St-Arnaud Blainville, QC

Nurse Project coordinator Nurse

NIGERIA Sharon Janzen Vancouver, BC

Nurse

PAKISTAN Frank Boyce Belleville, ON Gabriele Pahl Kingsville, ON

Doctor Medical coordinator

Dispatches

Médecins Sans Frontières/Doctors Without Borders 720 Spadina Ave., 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

PAPUA NEW GUINEA Violet Baron Cochrane, AB Financial coordinator Nurse Maryse Bonnel Morin Heights, QC Project coordinator Shannon Lee Fredericton, NB Project coordinator Julia Payson Vernon, BC Nurse Alanna Shwetz Smiths Falls, ON

Lori Beaulieu Prince George, BC Administrator Nurse Nancy Dale Toronto, ON Medical coordinator Luis Neira Montréal, QC Logistician James Squier Saltspring Island, BC

SOUTH AFRICA

Charmaine Brett Ottawa, ON Human resources officer Financial coordinator Annie Dallaire Montréal, QC Doctor Wendy Lai Toronto, ON Patrick Laurent Montréal, QC Water and sanitation specialist Administrator Monic Lessard Montréal, QC Nurse Elaine Sansoucy Saint-Hyacinthe, QC Logistician Kevin Tokar Ottawa, ON

Cheryl McDermid Vancouver, BC

Editorial director: Avril Benoît Translation coordinator: Julie Rémy

SOMALIA

HAITI

Editor: linda o. nagy

Contributors: Kevin Barlow Susanne Doettling Robin Meldrum Tara Newell Gregory Vandendaelen Calvin White

Circulation: 83,000 Layout: Tenzing Communications Printing: Warren’s Imaging and Dryography Winter 2009

Doctor

SRI LANKA John Crosbie Toronto, ON

Logistician

SUDAN Reshma Adatia Vancouver, BC Laura Archer Westmount, QC

Coordinator Nurse

ISSN 1484-9372

page 15


Š Bruno De Cock / MSF

CHOOSE TO MAKE A DIFFERENCE

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

www.msf.ca


Dispatches (Winter 2009)