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Doctors Without Borders Frustrated by Shortage of Medicines - 2002-07-12


The aid organization Doctors Without Borders says its work in developing countries is being frustrated by a shortage of medicines. A traveling exhibition, now in Los Angeles, is highlighting the problem.

On the campus of UCLA, a trailer houses an exhibit that takes visitors into another world.

People are asked to spin a wheel and then are assigned an identity, a country and a set of symptoms. For example, the make-believe patient may be told that he or she lives in Thailand and suffers from headaches, shivering, vomiting and exhaustion.

The visitor consults a doctor or nurse in a simulated clinic, learning that the cause of the symptoms is malaria. Patients with different symptoms are diagnosed with other diseases.

The exhibit focuses on five illnesses that afflict the developing world, and visitors learn some chilling statistics. The ticking of a clock helps dramatize the problem.

Every minute, five people die of AIDS and two children die of malaria. Someone dies of sleeping sickness every eight minutes. Every 10 minutes, a person dies of kala azar, which like sleeping sickness is a parasitic illness. Every minute, four people die of tuberculosis.

In each case, doctors in the developing world face a dilemma. Dr. Jaco Homsy, who has spent 11 years in Uganda, said "we realize increasingly in the field as doctors and nurses and health workers that we become increasingly unable to treat the people who need it because the treatments are not available, they are not effective or they are just too expensive."

Doctor Homsy said that in the case of malaria, the traditional treatment of chloroquine does little to fight drug-resistant strains of malaria. "We are facing huge problems because in Africa, in many countries, even sometimes in Asia where the resistance is 100 percent, I am talking about Myanmar, chloroquine is still listed as the first-line treatment because governments do not have the money to list the effective drugs on their national protocols."

Resistance is also developing to other malaria medicines, including one sold under the brand name Fansidar. Dr. Homsy says the most effective treatment today is based on an herbal extract called artemisinin, first isolated in China, which is used in combination with other drugs. Pharmaceutical companies have agreed to reduce the price for a full course of the treatment from $20 to $2. But the cost is still 10 times the cost of chloroquine and is far too high for the average consumer in many countries.

The situation is similar with other infectious diseases, which altogether claim 14 million lives each year, according to the World Health Organization.

Some volunteers at the exhibit have just returned from the field. Michelle Kelly, a nurse, has served seven missions with Doctors Without Borders, the last ending three weeks ago in Huambo province, Angola. She worked at a camp where UNITA rebels and others from rebel-held areas had gathered after the April cease-fire that ended hostilities in the Angolan civil war. "The people arrived in bleak shape there," she said. "Certainly there was not enough food for them in Huambo province, so the rates of severe malnutrition were off the charts as far as the severity that we saw."

Christine Nadori, the medical program officer for the U.S. branch of Doctors Without Borders, said the everyday work of the organization, which is daunting enough to begin with, is frustrated by the lack of effective treatments. "We are known for our fast logistics and the fact that we are in war zones. But the fact is that we can build as many latrines as we want and make sure that they have got clean water and do all the things that we normally do like vaccinate the children against measles and do primary health care, but more and more we were confronted with the fact that a lot of our patients were dying from AIDS."

In the case of AIDS, cheaper generic drugs are becoming available, over the objections of the pharmaceutical giants that hold the original patents. But even at a reduced cost of several hundred dollars a year, the anti-viral drugs are too expensive for many people.

Dr. Homsy notes that some pharmaceutical firms make discounted drugs available on their own accord, and others respond given enough publicity and pressure. Private initiatives are helping. Microsoft's Bill Gates and his wife give $600 million a year to combat illnesses in poor countries through their Bill and Melinda Gates Foundation.

But Doctors Without Borders says more has to be done to meet the needs of the sick in Africa and Asia. The group says there is little financial incentive for drug companies to develop new treatments for sleeping sickness, tuberculosis and other ailments that afflict developing countries.

Visitors to the exhibit are asked to sign petitions urging the U.S. government and the pharmaceutical industry to respond to the need for medicines for diseases the organization calls "neglected."

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