The global humanitarian physician’s group (Doctors Without Borders/Medicine Sans Frontieres, or MSF) zeroes in on ten horrifying examples of suffering so extreme that it is difficult imagine. At this time of year, it seems appropriate to try to take in at least two examples.
The first story below focuses on the tuberculosis epidemic that, as the New York Times explained last year, “is outrunning us. In the last few months, 53 patients in the South African province of KwaZulu-Natal were found to have a form of the disease resistant to enough existing drugs that it is virtually incurable. All but one of those patients has died. Airborne and deadly, extensively drug-resistant TB is a nightmare disease. It has been found worldwide, including in the United States. . .
“The development of antibiotics had allowed wealthy nations to dismiss TB as a disease of the past. But H.I.V and AIDS have changed that calculus. In Africa, active TB cases are rising by 4 percent a year, largely because H.I.V. activates latent TB infection. TB is the leading cause of AIDS-related deaths. Every patient tested in the KwaZulu-Natal study was H.I.V.-positive and more than a quarter of those who died were taking antiretroviral therapy.
“African health officials gathered in South Africa last week to discuss extreme tuberculosis, but they are hobbled by the world’s indifference . . .
“Money for clinical trials would speed things. But donors have always slighted tuberculosis. According to a new report by Results International, an advocacy group, the World Bank spent only $3.5 million directly on TB in Africa in 2005. The Global Fund to Fight AIDS Tuberculosis and Malaria and the Bill and Melinda Gates Foundation are big donors, but much more is needed. Stinginess created this problem. Generosity is needed to fix it.”
The second piece focuses on something we’ve talked about on this
blog: the shortage of doctors in the developing world. French doctors
founded Doctors Without Borders. Some Americans have joined them. But
one wonders, why don’t we start a similar organization of U.S. doctors
willing to care for patients in the neediest nations for a few years?
This is another case where we might give free medical school tuition to
students who agreed to join after graduating.
Drug-Resistant Tuberculosis Spreads As New Drugs Go Untested
A MSF physician examines a tuberculosis patient in the Maela refugee camp near Maesot.
year, tuberculosis (TB) kills an estimated two million people and
another nine million develop the disease. In spite of the rising human
toll, there have been no advances in treatment since the 1960s and the
most commonly used diagnostic test—sputum smear microscopy—was
developed in 1882 and only detects TB in half of the cases. An
estimated $900 million is needed annually for research and development
for TB, but only $206 million is invested worldwide.
Existing treatments and diagnostics are even less adapted for people
living with HIV/AIDS, the easiest prey for the TB bacilli. And for
those who become infected with multidrug-resistant TB (MDR-TB)—more
than 450,000 people every year—or develop it as a result of incomplete
treatment, the prospects for survival are even bleaker. The only
guarantee for the few who are able to access treatment for MDR-TB is up
to 24 months of ingesting a daily cocktail of highly toxic and
expensive drugs that often trigger violent side effects.
In MSF programs in Armenia, Abkhazia, Georgia, Cambodia, Kenya,
Thailand, Uganda, and Uzbekistan, even under the best conditions, only
55 percent of MDR-TB patients completed the 18 to 24 month treatment.
The remaining proportion died, did not improve, or stopped treatment
altogether because of side effects.
Adding to the frustration for medical staff on the TB pandemic’s
front line is the fact that not all new drugs are being tested in the
neediest patients—those with MDR-TB. A recent article authored by
international experts and published in the open-source medical journal
PLoS Medicine, called for the testing of new drugs in patients whose TB
is resistant to standard treatment. This approach could make it easier
to detect anti-TB activity of new drugs and ultimately accelerate drug
Political and Economic Turmoil Sparks Health-Care Crisis in Zimbabwe
Women queue to collect water from a spring outside the capital city
of Harare. Zimbabweans, especially those in high-density areas, are
facing massive water shortages.
Rampant unemployment, skyrocketing inflation, food shortages, and
political instability continued to wrack Zimbabwe in 2007. Up to 3
million people are believed to have fled to neighboring countries in
recent years among a population of 12 million.
The national health-care system, once viewed as one of the strongest
in southern Africa, now threatens to collapse under the weight of this
political and economic turmoil with the most acute consequences
potentially for the estimated 1.8 million Zimbabweans living with
HIV/AIDS. Currently, less than one-fourth of the people in urgent need
of life-extending antiretroviral (ARV) treatment receive it. This
translates into an average of 3,000 deaths every week. And the
prospects for a further scale up of the national AIDS program are dim.
Trained medical professionals are leaving the country, the
government program for HIV/AIDS treatment is oversubscribed, and the
lack of ARV supplies has stifled further expansion. Patients often face
obstacles to reach hospitals or clinics because of high fuel and
Through programs in Bulawayo, Tshlotsho, Gweru, Epworth, and various
locations in Manicaland province, MSF provides free medical care to
33,000 people living with HIV/AIDS, 12,000 of whom are receiving ARV
treatment—nearly one tenth of all people on treatment. However, MSF’s
ability to care for more people in need is hindered by the lack of
trained health workers, restrictions on which staff can prescribe ARV
drugs, and stricter administrative requirements for international staff
to work in the country.
At the same time, Zimbabweans are feeling the health impact of
degraded or nonexistent water-and-sanitation systems. During the year,
outbreaks of diarrhea affected people living in the capital, Harare,
and Bulawayo, the second largest city. Fleeing the country is also a
dangerous enterprise as evidenced by the reports of refugees being
beaten and raped along the South African border, and those who do make
it across may be destined to live in the shadows with little or no
access to health care.