Episode: "The Conflict"
CONGO | SIBERIA | AFGANISTAN
In this episode, Peter and Maria are on an “exploratory mission,”
in which their primary purpose is not to provide medical care. What
is an exploratory mission?
An exploratory mission is a short-term project meant
to assess the medical needs in a given area or among a given population
and to gauge the feasibility of a medical intervention, if one is
warranted. If access to the population in need of health care is
a concern, an exploratory mission may go further, securing permission
from local authorities to work safely and autonomously.
In order to assess medical needs, volunteers on an
exploratory mission may conduct a survey of the population they’re
visiting. Other times, they will collect lab samples. In this case,
Peter and Maria’s job was to roughly assess the prevalence
or cachexia in the communities they visited and identify a number
of representative people with the condition for testing, which they
did. (See the project profile for more information on the results.)
After an exploratory mission, MSF will reach a decision
on whether an intervention is justified, and just as important,
whether one can be conducted safely and effectively.
In this episode, Peter and Maria find a woman
with leprosy in a rural village in the Democratic Republic of Congo.
If leprosy has been so successfully contained in developed nations,
why does it still exist in countries like the DRC and India?
Leprosy is a mycobacterial infection, and is most
often spread through prolonged, close contact. Interestingly, however,
not much more is known about how leprosy is transmitted. The containment
of leprosy in developed countries has been achieved not through
vaccines or other preventative measures, but through treatment of
the disease once it has been caught.
Currently, the World Health Organization (WHO) recommends
a multidrug therapy regimen composed of antibacterials. If treated
early and effectively, the disease does not reach a stage where
it becomes contagious, which explains the much lower rates of leprosy
in developed countries. In developing nations, however, access to
the necessary drugs is often limited – even more so in rural
areas like the Yahuma region of the Democratic Republic of Congo.
In this episode, Laura Lobera and Wibke Haas
go to great lengths to find and treat one patient with tuberculosis
(TB) in Siberia. Why is this necessary?
The area where Laura and Wibke are working is a hotspot
for multi-drug resistant tuberculosis (MDR-TB), a strain of the
disease which is more difficult and more expensive to treat ($5000
per year per patient) because it does not respond to more than one
of the commonly used TB treatments. MDR-TB results from the improper
treatment of drug susceptible, or conventional tuberculosis. So
every time a patient abandons the eight-month tuberculosis treatment
part way through, he or she runs a risk of contracting and spreading
In Siberia’s prisons, MSF has been successful
in pioneering Directly Observed Treatment, Short-Course (DOTS) for
MDR-TB. The program Laura and Wibke are working on is an expansion
of this program to the civil sector, in which they train Russian
health workers to make house visits to ensure that patients are
sticking with their therapy. In this context, every patient’s
treatment must be carefully tracked.