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MSF in India, 2011
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Quality healthcare remains out of reach for millions of people living in India. Doctors Without Borders/Médecins Sans Frontières (MSF) provides free health services to people living in the states of Bihar and Chhattisgarh, the disputed region of Kashmir, remote villages on the border with Myanmar, as well as the enormous city of Mumbai.
Chhattisgarh: caught up in conflict
Villagers living in the forests of Chhattisgarh state are caught up in the long-running conflict between government forces and the Naxalites (a Maoist group). Medical facilities are scarce. MSF runs mobile clinics in 16 locations, providing healthcare and hospital referrals to rural communities in southern Chhattisgarh and to displaced people in camps in the neighbouring state of Andhra Pradesh.
In 2011, MSF expanded its activities in the area, conducting almost 68,000 consultations, covering antenatal care, nutritional support to children and pregnant women, treatment for malaria and tuberculosis (TB) and health promotion activities.
MSF carried out nearly 20,000 consultations in the mother and child center it runs in the town of Bijapur. The team administered more than 11,000 vaccinations and treated approximately 5,000 people for malaria. In the district hospital, staff screened for TB and performed emergency obstetric surgery. MSF also supports a community health center in Konta with TB counselling and health promotion activities.
Health needs in the disputed region of Kashmir
In Kashmir, more than 20 years of instability and violence have taken a toll on people’s health and on the availability of medical services, particularly in the areas along the militarized Line of Control. At clinics near the Line of Control, MSF delivers ante- and postnatal care, vaccinations and TB screening services. Female doctors are available for reproductive health consultations.
Mental health needs are great in Kashmir, due to the history of conflict, and MSF provides psychosocial services and counselling to traumatized people. In 2011, mental health staff saw almost 4,000 patients.
Countering neglect in the northeast
Nagaland, in northeastern India, near the border with Myanmar, is an isolated and neglected state, partly due to its geographical location, but also as a result of cultural differences and a long-running, low-level conflict between separatists and state security forces. The health infrastructure and supply system are poor, and there are few specialist medical staff.
During 2011, MSF rehabilitated the buildings of Mon district hospital, constructed a zone for waste management, improved basic healthcare services and trained hospital staff. The team held more than 30,000 outpatient consultations, and 3,044 people were admitted as inpatients.
The neighboring state of Manipur has also suffered from years of internal conflict. MSF continues to offer medical assistance at its clinics in rural areas, including reproductive health services and measles vaccinations. The team runs an HIV program, providing both first-line antiretroviral (ARV) treatment and second-line, for patients who develop resistance to first-line drugs. In addition, staff test, treat and counsel people with TB and multidrug-resistant TB (MDR-TB), and have introduced an innovative home-based model of care. Approximately 30,000 consultations were carried out in 2011.
Mumbai: HIV care for marginalized groups
HIV care in India is improving, but some people remain unable to access treatment in the public health system. These include individuals co-infected with HIV-2, a less common strain of HIV, hepatitis B, hepatitis C and MDR-TB, as well as those requiring alternative first-line drug regimes, and those whose second-line treatment fails.
Since 2006, MSF’s ARV treatment center in the Khar area of Mumbai has been providing medical and psychosocial care to these marginalized groups. The team also conducts outreach activities in the community and carries out operational research in an effort to improve HIV care countrywide.
India has the second-highest number of MDR-TB patients in the world, and in 2011 MSF increased the number of patients it treated for the disease at its Mumbai clinic. At the end of the year, 295 patients were on ARV treatment, 29 of whom were co-infected with MDR-TB. In addition, MSF initiated third-line HIV treatment for seven patients.
Kala azar and malnutrition in Bihar
Kala azar (visceral leishmaniasis) is endemic in Bihar state in eastern India. People living in poor conditions are most susceptible to the disease, which frequently goes undiagnosed and is fatal if left untreated. MSF has been diagnosing and treating kala azar in five local health centers in Vaishali district since 2007. Most people are treated as outpatients; only those suffering complications are admitted to Sadar hospital. More than 1,900 people received treatment with liposomal amphotericin B in 2011. MSF is investigating potential alternative treatments, including single-dose and combined therapies.
Bihar is one of the poorest states in India and there are high levels of malnutrition in children aged between six months and five years. In Darbhanga district, MSF operates a 20-bed inpatient therapeutic feeding center for children in a critical condition, and five outpatient centers, where those with severe malnutrition come for weekly medical check-ups and receive therapeutic food. More than 2,900 children were admitted to the program in 2011.
Local communities were also educated about the causes, symptoms and treatment of malnutrition, while an art exhibition helped raise public awareness of this neglected issue.
At the end of 2011, MSF had 736 staff in India. MSF has been working in the country since 1999.