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MSF in Ethiopia, 2004
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The past year has brought about important developments in treating people with malaria and AIDS in Ethiopia. One positive change has been the country's move toward a new, more effective protocol for treating malaria, which is endemic in the country. This policy shift came about after many months of advocacy work done by MSF and numerous national and international organizations in the midst of a severe malaria epidemic that started near the end of 2003.
In most of Africa, conventional malaria treatments such as chloroquine and sulfadoxine- pyrimethamine (SP) are no longer effective in many patients due to the increased resistance of parasites to these drugs. To counter this problem, MSF has been promoting the use of artemisininbased combination therapy (ACT) which is derived from a centuries-old Chinese herbal medicine.
The malaria epidemic of late 2003 affected the southern Ethiopian state of Oromiya and other parts of the country. When the World Health Organization (WHO) announced that an estimated 15 million Ethiopians were at risk of contracting the disease, MSF asked the government for permission to use ACT. MSF believed that this combination therapy was vital to stopping the further spread of the epidemic. However, the government refused. It said it wanted more scientific evidence before determining whether the national treatment protocol should be changed. As a consequence, health staff from some organizations were forced to treat thousands of sick patients in the epidemic area with largely ineffective medicines, and MSF was obliged to adapt to the situation by using quinine as first-line treatment. The death toll from this outbreak was substantially higher than it was from malaria in 2001 and 2002. According to government figures, approximately 3,500 people died of malaria during the outbreak.
In response to intensive advocacy conducted by MSF and others, the ministry of health announced in May 2004 that it would change the protocol by July. The government planned to introduce ACT in August as the country's standard malaria treatment. The episode also pushed major institutions, such as the WHO and the Global Fund to Fight AIDS, Tuberculosis and Malaria to strengthen their support for ACT. While implementation was still pending in September, the change in policy enabled MSF to bring ACT drugs into the country. MSF teams are now starting to implement the new treatment in MSF projects.
A resettlement nightmare
Tension also erupted between the Ethiopian government and MSF around the government's three-year program to resettle approximately 2.2 million farmers from overcrowded, low-yield agricultural areas to underpopulated, more fertile land. The scheme is part of the government's plan to solve recurring hunger problems and increase agricultural production.
However, in 2003, during the pilot phase of the program in which more than 150,000 people were moved, MSF discerned poor planning and insufficient monitoring in some settlements, leading to high levels of malnutrition and disease. In various locations there was also insufficient water to support the increased population. MSF made a decision to intervene in a number of emergency situations by providing urgently needed health care and food programs for thousands of sick and malnourished settlers in the Amhara region. It opened a therapeutic feeding center for children and adults, a supplementary feeding program and mobile "fever clinics" to detect and treat malaria as well as the disease kala azar (visceral leishmaniasis). Kala azar is a sandfly-borne disease that affects the immune system and, if left untreated, kills almost all who contract it.
In 2004, MSF urged Ethiopian authorities to evaluate the program's pilot phase to help avoid future problems. With the resettlement program continuing and thousands of new settlers arriving, MSF fears that new health emergencies will erupt again in the most vulnerable new settlements.
Treatment for AIDS
Early 2004 also saw the start of Ethiopia's first free AIDS-treatment program using life-extending antiretroviral (ARV) medicines. In close cooperation with district health authorities and HIV/AIDS patient groups in the northern Tigray region, MSF began treating patients with ARVs in the district hospital in Humera. By mid-2004, 67 patients were receiving ARVs, and the program aims to admit 15 new patients per month. As part of the project, the MSF team provides voluntary HIV counseling and testing to the wider Humera community.
It also provides medical care to approximately 500 HIV-positive people and food for patients with HIV/AIDS, kala azar or tuberculosis who require it. Other MSF activities in Ethiopia MSF has helped control multiple meningitis outbreaks in the Gurage and Haydia zones in the southern Oromia region and most recently in the Wag Hamra zone in the Amhara region. In Wag Hamra, MSF also provides community therapeutic feeding in an area where people experience frequent food shortages and cannot get quality health care. In June 2004, MSF opened a primary health care clinic in the Somali region of southeastern Ethiopia. Based in Cherati, the clinic covers about 75,000 people living in an area in which health facilities are scarce or not working. Finally, at the border with Sudan and Eritrea, MSF treats people with kala azar in three locations.
MSF has worked in Ethiopia since 1984.