You don't need to be signed in to read BMJ Blogs, but you can register here to receive updates about other BMJ products and services via our site.


The price of joining the middle income country club: reduced access to medical innovation

10 Oct, 14 | by BMJ

When people think about medical humanitarian aid, the usual association is with war zones and natural disasters, and the assumption is that the most critical medical needs are concentrated in the world’s poorest countries. That’s mostly right, but not entirely.

While the needs of low income countries remain huge, there are large—and growing—populations excluded from access to healthcare who now live in countries classified as middle income countries (MIC). This shift presents enormous challenges, particularly in accessing new lifesaving drugs and vaccines for diseases that take a disproportionately high toll on poor, marginalized populations. more…

Grazia Caleo: Ebola—a blind outbreak

18 Sep, 14 | by BMJ

Grazia-Caleo-Ebola_2In José Saramago’s book Blindness, he describes an epidemic of an unknown infection that causes people to lose their sight. A single person remains uninfected to bear witness to the anger, chaos, violence, and death generated by the spread of disease.

In the novel, humanity’s descent into blindness represents the loss of reason and shows how fear can cause dramatic social breakdown. At the same time, the clear vision of one person represents the opportunity to restore light.

What I saw in Sierra Leone, as an epidemiologist working on Ebola, reminded me of Saramago’s book. more…

Sarah Woznick: A nurse’s account of working in Gaza

21 Jul, 14 | by BMJ

msf_gazaSarah Woznick is a specialist intensive care nurse working with Médecins Sans Frontières (MSF/ Doctors Without Borders). She arrived in Gaza six months ago from Denver, Colorado. She was due to leave the mission the day after operation “Protective Edge” began, but decided to stay on to help provide medical care.

Image: Sarah in the intensive care unit of Nasser hospital, Gaza. Credit: MSF. 

I was scheduled to leave Gaza the day after the military operation “Protective Edge” started. That first day there were lots of air strikes in our area. It’s a strange feeling when you realise that one is falling not far from you. Now I am a little more accustomed, but it still makes me jump from time to time. All of us think about our Palestinian colleagues. The MSF compound is a safe place, but their homes might not be, and we worry about them and their families. more…

MSF Scientific Day 2014: The role of evidence in humanitarian aid

22 May, 14 | by BMJ

SCIENTIFICDAY_FINAL_LOGOSThis year marks the 20th anniversary of the Rwandan genocide, in which between 500 000 and a million people were brutally killed. The international community failed to act and MSF concluded that “you can’t stop genocide with doctors.” The aftermath of the genocide included analysis of the failures of humanitarian aid, and led to moves to improve its quality and accountability. But how far has humanitarian aid moved since then?

In the past year, the bloody conflicts in the Central African Republic (CAR), South Sudan, and Syria have reached unspeakable levels of violence that have tested the limits of humanitarian assistance. Last month, three MSF colleagues were among 16 people killed during a meeting at the MSF hospital in Boguila, CAR. MSF activities have been scaled down in the area as a result. In 2013, unable to guarantee the safety of its staff, MSF took the difficult decision to leave Somalia after 22 years. And, last week, five MSF staff were finally released after being kidnapped in Syria in January; again resulting in MSF having to withdraw medical assistance from populations in dire need. more…

Estrella Lasry: Malaria control in emergencies—time for action

25 Apr, 14 | by BMJ

A lunar landscape, cracked earth, and scorching heat. 4,000 rudimentary tents made from wooden poles and plastic sheeting. And people everywhere, 95% of them women and children, according to camp authorities, and a few men, hoping at least to find safety and security, and perhaps even to make a first step towards a new life. It’s another day at one of the refugee camps where Médecins Sans Frontiéres (MSF) is working in Ethiopia, and “home” to thousands of South Sudanese people fleeing the latest wave of violence in their country. Any day now the rainy season will begin, bringing floods, and creating endless breeding sites for mosquitoes, and with them a new spike in malaria. more…

Goodman Makhanda and Jennifer Hughes: Drug resistant TB—dying for better treatment

20 Mar, 14 | by BMJ

msflogoTwo weeks ago there was a small celebration in a primary care clinic in Khayelitsha, South Africa. Siyabulela Qwaka* was officially declared cured after taking more than two years of treatment for pre-XDR TB (extensively drug resistant tuberculosis). This is hugely significant given that the chance of cure for someone with pre-XDR or XDR TB is less than 20%. more…

Tane Luna Ramirez: Humanitarian disasters leave women at higher risk

7 Mar, 14 | by BMJ

tane_luna_ramirezToday, as International Women’s Day approaches, up to 23,000 people will be forced to flee their homes, joining 45 million others around the world who are already displaced due to conflict, persecution, or natural disaster. Of course people of both sexes suffer and die from the direct consequences of these displacements, and from the crises that cause them. But women are especially vulnerable. For those who are pregnant, lack of care may be their biggest threat to survival. And especially in contexts of conflict, women and girls face a hugely increased risk of sexual assault. more…

Manica Balasegaram: Drugs for the poor, drugs for the rich—why the current research and development model doesn’t deliver

13 Feb, 14 | by BMJ

manica_balasegaram2The past month has seen the reputation of “Big Pharma” dented more than usual. The CEO of German pharmaceutical company Bayer, Marijn Dekkers, was reported as saying that the company didn’t develop a cancer drug for the Indian market, but rather “for Western patients who can afford it.” The comment summed up the attitude of the pharmaceutical companies towards the poor and succinctly described what is wrong with today’s research and development (R&D) system.

In a similar vein, last month British/Swedish pharma company AstraZeneca announced it was pulling out of all early stage R&D for malaria, tuberculosis (TB), and neglected tropical diseases—all diseases of the developing world. Instead, the company stated it will focus efforts on drugs for cancer, diabetes, and high blood pressure, all diseases that affect rich countries, with potentially plenty of people to pay the high prices on new drugs. more…

Helen Bygrave: HIV viral load in Africa—no longer why but how?

30 Jan, 14 | by BMJ

Access to HIV viral load monitoring in resource poor settings has long felt a bit like the search for the Holy Grail—a seemingly hopeless, but essential quest. But at the recent ICASA conference, the corridors were buzzing with the possibility that routine use of this technology in sub Saharan Africa could soon become a reality.

Viral load has been the gold standard for monitoring the response to antiretroviral therapy in western settings for many years. WHO recommended it as the strategy of choice in their 2013 guidelines, but, mainly because of the complexities of sample transport, the technicalities of the test, and the costs, most countries still rely on clinical staging and CD4 counts to identify treatment failure. In places where access to treatment for opportunistic infections is extremely limited, waiting for a life threatening stage 4 event is highly risky. And without virological confirmation, current immunological criteria for failure would result in around two thirds of patients being switched unnecessarily to second line treatment. If we believe in investing money in a monitoring strategy it seems logical to invest in one that clearly identifies patients with true virological failure and before they present with a life threatening complication. So what is needed to make routine viral load monitoring a reality in resource poor settings? more…

Tejshri Shah: Children and adolescents in conflict—survival alone is not enough

21 Nov, 13 | by BMJ

tejshri_shahWhen I was asked to write about the research gaps in paediatric mental health research in conflict settings my first reaction was to shout about the unmet need in mental health services for children and adolescents. I often hear my health peers in the UK saying, “this child needs help but, with services as they are, they won’t meet the criteria.” Now imagine yourself in a low or middle income country, where it is estimated that between 76% and 85% of people with severe mental disorders receive no treatment. This is staggering. Now, once again, transfer yourself in your imagination to the situation of children in a conflict zone, where there is fear, violence, displacement, and uncertainty, and think about the scale of their unmet mental health needs. more…

BMJ blogs homepage


Helping doctors make better decisions. Visit site

Creative Comms logo

Latest from The BMJ

Latest from The BMJ

Latest from BMJ podcasts

Latest from BMJ podcasts

Blogs linking here

Blogs linking here