Dec 202017
 

Médecins Sans Frontières (MSF), known in English as Doctors Without Borders was founded on this date in 1971 by Bernard Kouchner and a group of doctors and journalists in Paris. In the aftermath of the Biafra secession, which created a medical crisis in the region, the founding members of MSF sought to expand accessibility to medical care across national boundaries and irrespective of race, religion, creed or political affiliation. To that end, the organization emphasizes “independence and impartiality”, and explicitly precludes political, economic, or religious factors in its decision making. For these reasons, it limits the amount of funding received from governments or intergovernmental organizations. These principles have allowed MSF to speak freely with respect to acts of war, corruption, or other hindrances to medical care or human well-being. Only once in its history, during the 1994 genocide in Rwanda, has the organization called for military intervention.

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MSF’s principles and operational guidelines are highlighted in its Charter, the Chantilly Principles, and the later La Mancha Agreement. Governance is addressed in Section 2 of the Rules portion of this final document. MSF has an associative structure, where operational decisions are made, largely independently, by the five operational centers (Amsterdam, Barcelona-Athens, Brussels, Geneva and Paris). Common policies on core issues are coordinated by the International Council, in which each of the 24 sections (national offices) is represented. The International Council meets in Geneva, Switzerland, where the International Office, which coordinates international activities common to the operational centers, is also based. MSF has general consultative status with the United Nations Economic and Social Council. It received the 1999 Nobel Peace Prize in recognition of its members’ continued efforts to provide medical care in acute crises, as well as raising international awareness of potential humanitarian disasters. MSF also received the 1996 Seoul Peace Prize.

During the Nigerian Civil War of 1967 to 1970, the Nigerian military formed a blockade around the nation’s newly independent south-eastern region, Biafra. At this time, France was the only major country supportive of the Biafrans (the United Kingdom, the Soviet Union and the United States sided with the Nigerian government), and the conditions within the blockade were unknown to the world. A number of French doctors, led by Bernard Kouchner, volunteered with the French Red Cross to work in hospitals and feeding centers in besieged Biafra. After entering the country, the volunteers, in addition to Biafran health workers and hospitals, were subjected to attacks by the Nigerian army, and witnessed civilians being murdered and starved by the blockading forces. The doctors publicly criticized the Nigerian government and the Red Cross for their seemingly complicit behavior. These doctors concluded that a new aid organization was needed that would ignore political/religious boundaries and give priority to the welfare of victims.

The Groupe d’Intervention Médicale et Chirurgicale en Urgence (“Emergency Medical and Surgical Intervention Group”) was formed in 1971 by French doctors who had worked in Biafra, to provide aid and to emphasize the importance of victims’ rights over neutrality. At the same time, Raymond Borel, the editor of the French medical journal TONUS, had started a group called Secours Médical Français (“French Medical Relief”) in response to the 1970 Bhola cyclone, which killed at least 625,000 in East Pakistan (now Bangladesh). Borel had intended to recruit doctors to provide aid to victims of natural disasters. The two groups of colleagues merged to form Médecins Sans Frontières.

MSF’s first mission was to the Nicaraguan capital, Managua, where a 1972 earthquake had destroyed most of the city and killed between 10,000 and 30,000 people. The organization, today known for its quick response in an emergency, arrived three days after the Red Cross had set up a relief mission. On 18th and 19th September 1974, Hurricane Fifi caused major flooding in Honduras and killed thousands of people (estimates vary), and MSF set up its first long-term medical relief mission.

Between 1975 and 1979, after South Vietnam had fallen to North Vietnam, millions of Cambodians emigrated to Thailand to avoid the Khmer Rouge. In response MSF set up its first refugee camp missions in Thailand. When Vietnam withdrew from Cambodia in 1989, MSF started long-term relief missions to help survivors of the mass killings and reconstruct the country’s health care system. Although its missions to Thailand to help victims of war in Southeast Asia could arguably be seen as its first war-time mission, MSF saw its first mission to a true war zone, including exposure to hostile fire, in 1976. MSF spent nine years (1976–1984) assisting surgeries in the hospitals of various cities in Lebanon, during the Lebanese Civil War, and established a reputation for its neutrality and willingness to work under fire. Throughout the war, MSF helped both Christian and Muslim soldiers alike, helping whichever group required the most medical aid at the time. In 1984, as the situation in Lebanon deteriorated further and security for aid groups was severely reduced, MSF withdrew its volunteers.

MSF has been continually hard at work in Cambodia, where I now live. In 1999, Cambodia was hit with a malaria epidemic. The situation of the epidemic was aggravated by a lack of qualified practitioners and poor quality control which led to a market of fake antimalarial drugs. Counterfeit antimalarial drugs were responsible for the deaths of at least 30 people during the epidemic. This has prompted efforts by MSF to set up and fund a malaria outreach project and use Village Malaria Workers. MSF also introduced a switching of first-line treatment to a combination therapy (Artesunate and Mefloquine) to combat resistance and fatality of old drugs that were used to treat the disease traditionally.

Cambodia is one of the hardest hit HIV/AIDS countries in Southeast Asia. In 2001, MSF started introducing antiretroviral therapy to AIDS patients for free. This therapy prolongs the patients’ lives and is a long-term treatment. In 2002, MSF established chronic diseases clinics with the Cambodian Ministry of Health in various provinces to integrate HIV/AIDS treatment, alongside hypertension, diabetes, and arthritis which also have a high prevalence rate. The aim is to reduce facility-related stigma as patients are able to seek treatment in a multi-purpose clinic as opposed to an HIV/AIDS specialized treatment center.

MSF also provided humanitarian aid in times of natural disaster such as a major flood in 2002 which affected up to 1.47 million people MSF introduced a community-based tuberculosis program in 2004 in remote villages, where village volunteers are delegated to facilitate the medication of patients. In partnership with local health authorities and other NGOs, MSF encouraged decentralized clinics and has provided localized treatments to more rural areas since 2006. Since 2007, MSF has extended general health care, counselling, HIV/AIDS and TB treatment to prisons in Phnom Penh via mobile clinics. However, poor sanitation and lack of health care still prevails in most Cambodian prisons as they remain some of the world’s most crowded.

In 2007, MSF worked with the Cambodian Ministry of Health to provide psychosocial and technical support in offering pediatric HIV/AIDS treatment to affected children. MSF also provided medical supplies and staff to help in one of the worst dengue outbreaks in 2007, which had more than 40,000 people hospitalized, killing 407 people, primarily children. In 2010, Southern and Eastern provinces of Cambodia were hit with a cholera epidemic and MSF responded by providing medical support that was adapted for usage in the country.

Cambodia is one of 22 countries listed by WHO as having a high burden of tuberculosis. WHO estimates that 64% of all Cambodians carry the tuberculosis mycobacterium. Hence, MSF has since shifted its focus away from HIV/AIDS to tuberculosis, handing over most HIV-related programs to local health authorities.

MSF runs a blog with all manner of information. Go here and you’ll find this recipe for Sierra Leone cheesecake which I’ll reproduce for amusement. http://blogs.msf.org/en/staff/blogs/msf-in-sierra-leone/cooking-with-msf-sierra-leone-cheesecake . It is an actual recipe despite the amusing interjections:

Photo: Chris Sweeney/MSF

Chris Sweeney is a nurse on his second assignment with MSF. He’s currently in Sierra Leone working with children under five as part of a mother and child health programme run by the Ministry of Health. Here he teaches us how to make a tasty cheesecake, using limited ingredients and a little ingenuity…

To make a cheesecake MSF-style, you will need the following ingredients:

 One skinny Scotsman, preferably named Chris.

      • An MSF t-shirt to use as apron. You don’t want to dirty one of the two shirts you brought with you on assignment, after all.
      • Two metal tins: one smaller that can fit in the other. The larger tin shall act as a water bath, or, for those who heeded MSF’s advice that learning French would be a good idea, a bain-marie.
      • 45 cheese triangles – and a supermarket that sells them.
      • White chocolate. Or dark chocolate. Or whatever chocolate someone is kind enough to bring to the assignment.
      • Somewhere to hide the chocolate so it doesn’t get eaten.
      • Half a pack of digestive biscuits. (If you don’t have digestives, use a flour, butter, and sugar base – just remember to sieve the flour to remove all the beetles and larvae).
      • Butter or margarine.
      • Sugar, best placed in the sun to get rid of the ants.
      • Three eggs. These can be laid by the hen you named after the last midwife, or you can buy these at the market.
      • Vanilla extract.
      • Condensed milk.

  Method

 1. Mix the ingredients for your biscuit base and press into the foil-wrapped love–heart-shaped tin.

 2. Turn on the gas oven. It has two settings; “is the oven working?” and “I can’t enter the kitchen because the stove is propelling heat across the room like a jet engine”. I recommend the second option.

 3. Place a thick tray on the bottom shelf so that the flames don’t touch the cheesecake, but instead lick around the tray.

 4. Unwrap cheese triangles. At triangle 30, start to think this was a bad idea.

 5. Beat the cheese. After 30 minutes of profuse sweating in the 40 degree kitchen, a colleague will see you and share that there is a blender in the cupboard.

 6. Place beaten cheese into the blender with everything else (minus the chocolate).

 7. Apologise to your colleague who cannot hear her Nigerian soap operas because the blender sounds like a motorbike.

 8. Melt chocolate by taking it out of the fridge. Squeeze into the mix.

 9. Scoop the mix onto your biscuity base. Place on the middle shelf of the oven. Switch oven off after one hour and leave it in there for one hour without heat. Don’t ask why this second hour is important – it is Google’s advice.

 10. Leave in fridge overnight.

 11. Present the cheesecake and tell everyone there is afternoon tea.

 12. Listen to colleagues remind you that you’re British.

 And there you have it! Your very own cheesecake, MSF-style!

 

Aug 202015
 

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Today is World Mosquito Day, created on 20 August 1897, marking a world changing discovery made by Sir Ronald Ross, a British doctor working in India who first made the link that female mosquitoes transmit malaria between humans. On making this breakthrough on this date, Ross declared that it should be known as World Mosquito Day henceforth. Ross went on to become the first British person to be awarded the Nobel Prize for medicine in 1902.

Ross’s discovery laid the foundations for scientists to better understand the deadly role of mosquitoes which currently infect 250 million people with malaria every year, causing 850,000 deaths. World Mosquito Day is still a little known celebration, but given the global importance of eradication of malaria it should be better known.

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Females of most mosquito species are ectoparasites, whose tube-like mouthparts. or proboscis, pierce the hosts’ skin to consume blood. Thousands of species feed on the blood of various kinds of hosts, mainly vertebrates, including mammals, birds, reptiles, amphibians, and even some kinds of fish. Some mosquitoes also attack invertebrates, mainly arthropods. Though the loss of blood is seldom of any importance to the victim, the saliva of the mosquito often causes an irritating rash that is a serious nuisance. Much more serious though, are the roles of many species of mosquitoes as vectors of diseases. In passing from host to host, some transmit extremely harmful infections such as malaria, yellow fever, west nile virus, dengue fever, filariasis, and other arboviruses, making it the deadliest animal in the world.

Various species of mosquitoes are estimated to transmit various types of disease to more than 700 million people annually in Africa, South America, Central America, Mexico, Russia, and much of Asia, with millions of resultant deaths. At least two million people annually die of these diseases, and the morbidity rates are many times higher still. Effective control is a major health concern. There are various methods:

Personal protection

Fortunately mosquitoes don’t like me apparently because I don’t have any of the usual attractors. The feeding preferences of mosquitoes include those with type O blood, heavy breathers, those with a lot of skin bacteria, people with a lot of body heat, and pregnant women. Individuals’ attractiveness to mosquitoes also has a heritable, genetically-controlled component. If you do suffer, repellants and mosquito nets work.

Source reduction

Since many mosquitoes breed in standing water, source reduction can be as simple as emptying water from containers around the home. This is something that homeowners can accomplish. For example, homeowners can eliminate mosquito breeding grounds by removing unused plastic pools, old tires, or buckets; by clearing clogged gutters and repairing leaks around faucets; by regularly (at least every 4 days) changing water in bird baths; and by filling or draining puddles, swampy areas, and tree stumps. Eliminating such mosquito breeding areas can be an extremely effective and permanent way to reduce mosquito populations without resorting to insecticides. However, this may not be possible in parts of the developing world where water cannot be readily replaced due to irregular water supply.

Biocontrol

Biological control or “biocontrol” is the use of natural enemies to manage mosquito populations. There are several types of biological control including the direct introduction of parasites, pathogens and predators to target mosquitoes. Effective biocontrol agents include predatory fish that feed on mosquito larvae such as mosquitofish (Gambusia affinis) and some cyprinids (carps and minnows) and killifish. Tilapia also consume mosquito larvae. Direct introduction of tilapia and mosquitofish into ecosystems around the world have had disastrous consequences. However, utilizing a controlled system via aquaponics provides the mosquito control without the adverse effects to the ecosystem.

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Other predators include dragonfly naiads, which consume mosquito larvae in the breeding waters, adult dragonflies, which eat adult mosquitoes and some species of lizard and gecko.

Dead spores of the soil bacterium Bacillus thuringiensis, especially Bt israelensis (BTI) interfere with larval digestive systems. It can be dispersed by hand or dropped by helicopter in large areas. BTI loses effectiveness after the larvae turn into pupae, because they stop eating. Two species of fungi can kill adult mosquitoes: Metarhizium anisopliae and Beauveria bassiana.Oil drip

An oil drip can or oil drip barrel was a common and nontoxic antimosquito measure. The thin layer of oil on top of the water prevents mosquito breeding in two ways:[ mosquito larvae in the water cannot penetrate the oil film with their breathing tube, and so drown and die; also adult mosquitoes do not lay eggs on the oiled water.

Pesticide

Control of adult mosquitoes is the most familiar aspect of mosquito control to most of the public. It is accomplished by ground-based applications or via aerial application of residual chemical insecticides. Generally modern mosquito-control programs in developed countries use low-volume applications of insecticides, although some programs may still use thermal fogging.

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DDT was formerly used throughout the world for large area mosquito control, but it is now banned in most developed countries. DDT remains in common use in many developing countries (14 countries were reported to be using it in 2009), which claim that the public-health cost of switching to other control methods would exceed the harm caused by using DDT. It is sometimes approved for use only in specific, limited circumstances where it is most effective, such as application to walls.

The role of DDT in combating mosquitoes has been the subject of considerable controversy. Although DDT has been proven to affect biodiversity and cause eggshell thinning in birds such as the bald eagle, some say that DDT is the most effective weapon in combating mosquitoes, and hence malaria. While some of this disagreement is based on differences in the extent to which disease control is valued as opposed to the value of biodiversity, there is also genuine disagreement amongst experts about the costs and benefits of using DDT.

Notwithstanding, DDT-resistant mosquitoes have started to increase in numbers, especially in tropics due to mutations, reducing the effectiveness of this chemical; these mutations can rapidly spread over vast areas if pesticides are applied indiscriminately. In areas where DDT resistance is encountered, malathion, propoxur or lindane are used.

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There’s no question that blood should be the culinary ingredient of the day. In looking back I see that I have made reference to blood in recipes a few times; now it’s time for the full monty. Many cultures consume blood as food, often in combination with meat. The blood may be in the form of blood sausage (the most common), as a thickener for sauces, a cured salted form for times of food scarcity, or in a blood soup. Culinary blood comes from domesticated animals, obtained at a place and time where the blood can run into a container and be swiftly consumed or processed. In many cultures the animal is slaughtered, in others it is bled and remains alive. In some cultures, blood is a taboo food.

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Blood sausage, or black pudding, is any sausage made by cooking animal blood with a filler until it is thick enough to congeal when cooled. Pig or cattle blood is most often used. Typical fillers include meat, fat, suet, bread, rice, barley and oatmeal. Varieties include drisheen, moronga, black pudding, blutwurst, blood tongue, kishka (kaszanka), biroldo, morcilla, mustamakkara, verivorst, and many types of boudin. Blood sausage is found worldwide. Black pudding is a great favorite in the U.K. as part of the full English breakfast. In Argentina and China it is commonly found grilled.

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Blood pancakes are found in Galicia (filloas), Scandinavia, and the Baltic; for example, Swedish blodplättar, Finnish veriohukainen, and Estonian veripannkoogid. There’s a video here on Swedish blood pancakes in English (with a fair amount of swearing!).

https://www.youtube.com/watch?v=bQcGprXpjk0

You’ll see that blood pancakes are like regular pancakes – a mix of egg flour and mix – only some of the fluid is blood which darkens and thickens the batter when cooked. Could be good with blood sausage.

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Blood soups and stews, which use blood as part of the broth, include czernina, dinuguan, haejangguk, mykyrokka, pig’s organ soup, tiet canh and svartsoppa. Spartan warriors going into battle reputedly ate blood soup for strength and courage. Such soups are most often found in eastern Europe and SE Asia.

Blood is also used as a thickener in sauces, such as in traditional coq au vin or pressed duck, and puddings, such as tiết canh. It can provide flavor or color for meat, as in cabidela.

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Blood can also be used as a solid ingredient, either by allowing it to congeal before use, or by cooking it to accelerate the process. In Hungary when a pig is slaughtered in the morning, the blood is fried with onions and served for breakfast. In China, “blood tofu” is most often made with pig’s or duck’s blood, although chicken’s or cow’s blood may also be used. The blood is allowed to congeal and simply cut into rectangular pieces and cooked. This dish is also known in Java as saren, made with chicken’s or pig’s blood. Blood tofu is found in curry mee as well as the Sichuan dish, maoxuewang. In Tibet, congealed yak’s blood is a traditional food.

In some cases, blood is used as an ingredient without any additional preparation. Raw blood is not commonly consumed by itself, but may be used as an addition to drinks or other dishes. One example is the drinking of seal blood which is traditionally believed by the Inuit to bring health benefits.

Consumption of blood as a nutrient is forbidden in Islam and Judaism, and in many cultures meat that is considered “bloody” (such as rare or raw beef) is thought unfit for consumption. In the Greek Bible, blood was forbidden by Apostolic Decree (Acts 15:19-21).