Controversies Involving Doctors Without Borders
Doctors Without Borders, the French humanitarian group, that goes also by its French name Medecins Sans Frontieres (MSF), is no stranger to controversy. The organization relishes in the controversy as a vehicle to create change in the areas in which they operate. (Le Pape, 2011) Doctors Without Borders has faced many controversial issues in the areas that they have been stationed to help in. Many of these issues involve the treatments and methods that they wish to employ. The following will focus on the controversy that Doctors Without Borders Created in Burundi, Haiti, and the use of painkillers during surgery.
Malaria in Burundi (2000-2002)
The Republic of Burundi, a country in the Great Lakes region of Eastern Africa had been suffering from a malaria epidemic in 2000. On December 12 of that same year, MSF published a press release in which they addressed the recent surge in patients and the demand to the World Health Organization (WHO) for treatments that would prove more effective. MSF was able to identify the recent increase of patients through data based on sixteen healths centers at which MSF was working and a mortality survey that took place from October 13 through December 9, 2000. Swamp farming, the discontinued use of anti-vectors, and resistance to chloroquine, a medicine created to treat malaria were identified as the cause of the surge of malaria patients. The press release ended in a request to several private and public partners working to fight malaria for support to use artemisinin-based teatments (ACT). ACT are a group of drugs that are the fastest acting of all current drugs in treating malaria. The controversy began when the desk officer responsible for programs in Burundi stated "Sadly it is currently impossible for us to use artemisinin derivatives because the government has asked us ‘not to introduce any new drugs.’ All efforts to secure support from the WHO have proven fruitless because the organization will not recommend the use of medicines that are not registered in the country. This is a sad example of the ongoing struggle to use the best available treatments." (Le Pape, 2011) To treat the malaria, MSF recommended using artemisinin derivatives combined with sulfadoxine-pyrimethamine, an antimalarial for uncomplicated malaria. For complicated malaria, MSF recommended artemether combined with sulfadoxine-pyrimethamine. These recommendations were made because of their effectiveness, lower transmission rate, and a reduction in resistance. (Le Pape, 2011)
In 2001, the Frech section of MSF begant o use the ACTs even though the Burundian Ministry of Health did not recommend this treatment for uncomplicated malaria. This practice was tolerated until "MSF-France decided publicly to denounce the treatment protocol for uncomplicated malaria, unfavorably comparing the poor results of the national protocol with artemisinin-based treatment data obtained from one of their programs in Kayanza Province."(Le Pape, 2011) The Health Ministry then demanded the the use of ACTs to be discontinued in all MSF active health centers. Shortly after all MSF activities were suspended in the Kayanza Province on November 8. In December, the MSF-France head of mission was expelled by the Burudian authorities from the country. MSF felt that "national protocol could no longer be respected, and decided to start using an artemisinin-based combination “immediately” without waiting for the results of assessments by the Ministry of Health and the WHO." (Le Pape, 2011) The general director of MSF-France wrote a letter to Burundi's health authorities and the WHO justifying the use of ACTs. This letter " brought ethical obligations to the forefront, stressing that a doctor is obliged to administer effective treatment, and affirming that MSF respected this obligation in Burundi".(Le Pape, 2011) To resolve the issue, the Burundian president, MSF international movement presidents, and the MSF-France president met. This meeting resulted in the Burundian president asking for the MSF to continue its work in Burundi.
In 2001, the Frech section of MSF begant o use the ACTs even though the Burundian Ministry of Health did not recommend this treatment for uncomplicated malaria. This practice was tolerated until "MSF-France decided publicly to denounce the treatment protocol for uncomplicated malaria, unfavorably comparing the poor results of the national protocol with artemisinin-based treatment data obtained from one of their programs in Kayanza Province."(Le Pape, 2011) The Health Ministry then demanded the the use of ACTs to be discontinued in all MSF active health centers. Shortly after all MSF activities were suspended in the Kayanza Province on November 8. In December, the MSF-France head of mission was expelled by the Burudian authorities from the country. MSF felt that "national protocol could no longer be respected, and decided to start using an artemisinin-based combination “immediately” without waiting for the results of assessments by the Ministry of Health and the WHO." (Le Pape, 2011) The general director of MSF-France wrote a letter to Burundi's health authorities and the WHO justifying the use of ACTs. This letter " brought ethical obligations to the forefront, stressing that a doctor is obliged to administer effective treatment, and affirming that MSF respected this obligation in Burundi".(Le Pape, 2011) To resolve the issue, the Burundian president, MSF international movement presidents, and the MSF-France president met. This meeting resulted in the Burundian president asking for the MSF to continue its work in Burundi.
Map of Africa highlighting the Republic of Burundi
MSF doctors assisting malaria patients in Burundi
Haitian Earthquake Relief Efforts
In the midst of the earthquake that ravaged Haiti January 2010, MSF engaged in a very public disagreement with US air traffic controllers. MSF stated that one of their planes carrying medical supplies was turned away at the Port-au-Prince airport. According to MSF, this was the fifth instance of them being turned away. Medics working with the injured have accused US air traffic controllers of turning away essential medicine supplies that could have saved lives, with priority going to US military flights. (Khan, 2010)
Controversy Involving the Use of Painkillers
In 2007, The New York Times published an article in which it revealed the quantity of painkillers MSF used during surgery in the areas where the operate. The article begins with the amount uf morphonine MSF used. "Seven years ago, the international aid agency Doctors Without Borders performed 10,000 surgeries around the world. The total number of vials of morphine used in those operations: 10."(McNeil, 2007) The article then continued by adding that in France, the country of origin of MSF "a woman who gives birth by Ceasarean section may receive up to 12 vials of morphine by injection."(McNeil, 2007)
Xavier Lassalle, the pain specialist for MSF, says that part of the problem is that the doctors working for MSF "subconsciously harbored old prejudices, believing that Africans or Asians didn’t feel pain as intensely as Europeans or Americans did."(McNeil, 2007) In response to those prejudices, Lassale says “there is very little ethnic variation in pain. On the other hand, there are very strong individual variations.” The article describes an instance in where a surgery patient in Sierra Leone was speaking calmly and appeared relaxed, however, he rated his pain as 10.
However, early 2007, the use of painkillers had greatly improved. They have become readily available and patients routinely report their pain to doctors using the 1-10 scale recommended by the WHO.
Xavier Lassalle, the pain specialist for MSF, says that part of the problem is that the doctors working for MSF "subconsciously harbored old prejudices, believing that Africans or Asians didn’t feel pain as intensely as Europeans or Americans did."(McNeil, 2007) In response to those prejudices, Lassale says “there is very little ethnic variation in pain. On the other hand, there are very strong individual variations.” The article describes an instance in where a surgery patient in Sierra Leone was speaking calmly and appeared relaxed, however, he rated his pain as 10.
However, early 2007, the use of painkillers had greatly improved. They have become readily available and patients routinely report their pain to doctors using the 1-10 scale recommended by the WHO.
Bibliography
Le Pape and Defourny (2011). Chapter 4 of Medical Innovations in Humanitarian Situations. Retrieved 24 September, 2011 from http://www.doctorswithoutborders.org/publications/book/medicalinnovations/book.cfm?id=5240&cat=medical-innovations
Khan (2010). US Military Presence in Haiti Sparks Controversy. Retrieved 27 September, 2011 from http://www.opendemocracy.net/opensecurity/security_briefings/200110
McNeil (2007). Doctors Without Borders, Without Painkillers. Retrieved 27 September, 2011 from http://www.nytimes.com/2007/09/14/health/14painmsf.html?pagewanted=print
Khan (2010). US Military Presence in Haiti Sparks Controversy. Retrieved 27 September, 2011 from http://www.opendemocracy.net/opensecurity/security_briefings/200110
McNeil (2007). Doctors Without Borders, Without Painkillers. Retrieved 27 September, 2011 from http://www.nytimes.com/2007/09/14/health/14painmsf.html?pagewanted=print
