Sunday, May 24, 2009

Medicins Sans Frontieres / Doctors Without Borders

Yesterday, I was fortunate to be at a pre-conference session of the Quality of End of Life Care Coalition that featured a former president of Medicins Sans Frontieres é Doctors without Borders; Dr. James Orbinski. He was President of the International Council of Médecins Sans Frontières at the time the organization received the 1999 Nobel Peace Prize. James Orbinski also is the co-founder and Chair of the Board of Directors of Dignitas International, a medical humanitarian organization working with communities to dramatically increase access to life-saving treatment and prevention in areas overwhelmed by HIV/AIDS. He is an Associate Professor of Medicine at the University of Toronto.

He had many interesting stories from his work over the years in Africa, specifically Rwanda during the genocide of 1994 and Malawi over many years working in the area of HIV.

He talked about a world of 6.8 billion people where 3.8 billion people live on $US2 per day or less. And it is now being upset even more as we experience crises of finance, fuel, food, and climate. He talked about the hallmark of equality being that people in similar situations are being treated similarly and how much we need to do to achieve that

He talked about Malawi, a country where the life expectancy is 36 compared with ours approaching 80 – more than two times as high. As we experience in Canada, HIV is moving to being a chronic but treatable disease but Anti Retroviral Therapy (ART) is required to achieve that. But drugs are not made available to 95% 0f those who need them in the world – mostly very poor and in the developing world. Pharmaceutical companies and governments blatantly pursue patent rights over lives! In 2000, ART for a year for one person in Africa cost $US15,000. Remember people are living on about $US2 per day or $US730 per year.

Doctors Without Borders set out to manufacture generics because in their evidence based policy analysis, it was the only thing they could do. They were warned by the best that it could not be done, but with help form the world's best scientists and technicians they did it and brought down the price of ART in some of Africa to $US100 per year – still a big chunk out of $US730, but not 21 times more than $US 730. In 1999, 20,000 people in Africa were on ART and now there are 5,000,000 on i t.

Malawi, with a population of about 12,000,000, has 100 doctors or one doctor for 120,000 people – quite typical for much of Africa. Ontario, on the other hand has 12,945,000 people and according to the website of the College of Physicians and Surgeons of Ontario, it has 23,266 doctors or one for every 557 people. Young people have to be sent to Europe and the West to be trained in medicine and 80% stay in the country where they studied. As Orbinski wryly noted, "You cannot take Ibo or Mpho to Paris to live and expect them to return to the poor farm in a scorched part of Africa." Now Doctors Without Borders is setting up teaching partnerships with western institutions like the University of Toronto and the BC Centre of Excellence in HIV with local Africans schools to do medical training there and hopefully keep more of the new doctors where they originally intended to be!

When I left Botswana, the organization where I worked had to cut almost a third of its staff due to the world financial crisis creating a big reduction in financial aid. A friend of mine had worked on building a school in Mali in 2008 and it now sits half completed for the past year for the same reasons. Equality is still a long way away – but some are working on it!

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