My name is Philipp du Cros and I am a doctor working as a tuberculosis (TB) programme implementer for Médecins sans Frontières (MSF) UK. What does that mean? My work involves visiting MSF programmes and helping them to start providing or improve existing TB services. When asked to write a blog for the BMJ Christmas appeal, I struggled with how to choose from the huge variety of MSF projects delivering emergency healthcare worldwide. In the past year I have worked in challenging settings in Burma, conflict-affected Manipur in northeast India and Swaziland. But my recent visit to Zimbabwe exemplified the problems faced by so many of our patients in accessing care and was a profoundly moving experience.

You don’t have to search too hard on the internet to find headlines about Zimbabwe, with stories detailing the recent hyperinflation, high unemployment, food shortages, and the large numbers of economic refugees who have fled to neighbouring countries. An estimated 1.3 million people are living with HIV in Zimbabwe and rates of TB are over three times higher in 2007 than they were in 1990. Despite the massive gains to roll out antiretroviral drugs in Africa, access to this life-saving treatment is still estimated at reaching fewer than 25% of those in urgent need in Zimbabwe.

MSF has supported the Ministry of Health in HIV care since 2002 working in rural and city clinics in Beitbridge, Buhera, Bulawayo, Epworth, Gweru, and Tsholotsho. Programmes also provide care for malnourished children and diagnosis and treatment of TB. Recently, decentralising treatment services has been a main focus, helping more patients access care through bringing services closer to where patients live.

My job was to visit 4 project sites to work with teams to help improve integration of HIV and TB services and look at how to reduce the risk of TB transmission within HIV and TB clinics. During my visit, two experiences in particular made a big impression on me. The first was chatting to the patients waiting in one of the rural HIV clinics for treatment. Faced with a chatty Australian doctor asking them about what they wanted from their care they were remarkably kind and open about the day to day obstacles that they face. Their most pressing needs were to be able to get life-saving antiretroviral drugs to treat their HIV. Aside from that the things they most wanted would be top on the list of most patient surveys in the NHS: to be treated with respect, to have short waiting times, and to have services close to where they live. But in their case the typical journey they had made was often a 4 hour walk, with the lucky few able to afford riding in a “scotch cart” – essentially a large 2 wheeled metal barrow pulled by a team of donkeys.

The second was a man who had returned to Zimbabwe from a neighbouring country, a journey of around 200 kilometres. He had stopped taking his HIV treatment and was in urgent need of hospital care. MSF covered costs of transport, but watching this frail man being helped by relatives to get into yet another slow and uncomfortable scotch cart to go to a hospital after he had already travelled for 2 days to reach help was very difficult.

While being struck by the vast medical needs, two aspects of the joint MSF/ministry of health projects inspired me with hope. The first was hearing the response of one patient to being asked how he was after taking only 1 month of the 6 months treatment for TB. In a loud voice, full of determination and pride, he stated “I was dead, but now you see I am alive.” The second, was seeing the enthusiasm with which some ladies who were patients of the HIV clinic rushed off to football training. While medical care for their HIV was an ongoing part of their lives, they had chosen to form a ladies football team to help fight the stigma against HIV that many people face in Zimbabwe (for a more detailed description of the story of some of these ladies and a trailer to a documentary recently featured on CNN see this link http://www.thepositiveladiessoccerclub.com/ )

This mix of frustration with the indignities and struggles faced by our patients , and rewards when patients get the treatment they need and barriers are overcome , typifies the life of an MSF doctor and reaffirmed for me the reasons why I joined MSF – to help bring effective healthcare to people in accordance to their needs , regardless of the obstacles or borders that may stand in the way.

Philip du Cros works as a TB implementer for MSF.