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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…

Grania Brigden: TB patients take the stage—now for an R+D model that meets their needs

8 Nov, 13 | by BMJ

Grania BrigdenAt last week’s Union World Conference on Lung Health, TB patients finally took centre stage, with patients invited to describe the realities of the two year treatment regimen for multidrug resistant TB (MDR-TB) and advocacy groups storming events to call for greater vision in TB treatment and research. Their stories and concerns mirrored those shared with Médecins Sans Frontières (MSF) in a manifesto for better treatment for drug-resistant TB and in blogs by MDR-TB patients.

Patients are right to be concerned. In the past year, there has been no improvement in WHO estimates for MDR-TB: fewer than a third of patients were detected; 170 000 people died; 17 000 patients were diagnosed, but not started on treatment; and only 48% of those started on treatment were cured.

Zeros Action at Stop TB Symposium from Treatment Action Group.


Unni Karunakara and Jean-Christophe Dollé: The limits of humanitarian aid—MSF and TB in Somalia

23 Oct, 13 | by BMJ

unniJXTFOn 14 August 2013, Médecins Sans Frontières (MSF) took one of the most difficult decisions in our history and closed all of our medical humanitarian aid operations in Somalia after more than 22 years of assisting people who have suffered decades of war, epidemics, man-made and natural disasters. more…

Sophie Reshamwalla: The bomb blast injury boys of Pakistan

17 Oct, 13 | by BMJ

sophie_reshamwalla2My mobile rings. It is a nurse from the Emergency Room (ER):

“Dr Sophie, we have a boy whose legs have come off. Please could you come to help?”

I shout “I’m coming!” before hanging up and starting the laborious task of correctly putting on my hijab, along with pulling on my shalwar kameez, making sure that I don’t need an umbrella for an erratic hail storm, and run over to the ER in my flip flops. more…

Unni Karunakara: Médecins Sans Frontières’s decision to pull out of Somalia

24 Sep, 13 | by BMJ

Mobile clinics in IDPs camp downtown Mogadishu close to former frontline. The team is screening for malnutrition. Dr Unni Karunakara examining a child.  MSF OCG started its emergency response to the Somali crisis of summer 2011 beginning of August. In addition to basic health care and nutritional care, the team launch a measles vaccination.Médecins Sans Frontières’s announcement on 14 August that we were closing all our medical programmes in Somalia sent shockwaves through political and humanitarian communities.

It came at a time when world leaders, for the first time in decades, were beginning to make positive noises about a country on the road to recovery and with a stable government. For them, the timing of our decision could not have been worse. In media interviews, we were asked to explain the discrepancy between the upbeat tone of governments and our own harsh judgement that led to one of the most painful decisions in MSF history.


Julien Potet: How access to life saving antisera is dwindling fast, and what to do about it

29 Aug, 13 | by BMJ

What do snakebites, tetanus, and rabies have in common? Answer: Treating patients with these life threatening conditions relies on antisera, a class of immunoglobulin-rich products derived from the plasma of human volunteers or animals and used for passive immunization after suspected exposure (to tetanus or rabies), or for antivenom activity following snakebites. Each year about 55,000 people die of rabies and over 60,000 of tetanus, while snakebites kill between 20,000—94,000 people and lead to many more cases of permanent disability. more…

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