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.


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. . 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.


 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!


Apr 272014


Today is Independence Day in Sierra Leone, officially the Republic of Sierra Leone, a nation in West Africa that is bordered by Guinea to the northeast, Liberia to the southeast, and the Atlantic Ocean to the southwest. Sierra Leone is a constitutional republic with a directly elected president and a unicameral legislature. The country has a tropical climate, with a diverse environment ranging from savannah to rainforests. The country covers a total area of 71,740 km2 (27,699 sq mi) and with an estimated population of 6 million (2011). Freetown is Sierra Leone’s capital, largest city as well as its economic, commercial and political center.


The population of Sierra Leone is made up of about sixteen ethnic groups, each with its own language and custom. The two largest and most influential are the Temne and the Mende. The Temne are predominantly found in the north of the country, while the Mende are predominant in the south-east. Sierra Leone is a predominantly Muslim country, with an influential Christian minority. Sierra Leone is regarded as one of the most religiously tolerant countries in the world, with Muslims and Christians collaborating and interacting with each other peacefully.


Although English is the language of instruction in schools and the official language in government administration, the Krio language (derived from English and several indigenous African languages) is the primary language of communication among Sierra Leone’s different ethnic groups, and is spoken by 90% of the country’s population. The Krio Language unites all the different ethnic groups, especially in their trade and interaction with each other.

Sierra Leone has relied on mining, especially diamonds, for its economic base since the 1930’s. It is also among the largest producers of titanium and bauxite, a major producer of gold, and has one of the world’s largest deposits of rutile (titanium dioxide crystal). Sierra Leone is home to the third-largest natural harbor in the world. Despite this natural wealth, 70% of its people live in poverty. The disparity between rich and poor, combined with rampant corruption led to a devastating civil war in 1991 that lasted 11 years and resulted in the deaths of 50,000 people. The diamond trade was at the heart of the corruption. Diamonds are sometimes referred to as Sierra Leone’s “resource curse.”


Sierra Leone’s history is fascinating and, unfortunately, I cannot go into detail here. I urge you to read more if you are interested. Archaeological finds show that Sierra Leone has been inhabited continuously for at least 2,500 years, populated by successive movements from other parts of Africa. The use of iron was introduced to Sierra Leone by the 9th century, and by 1000 CE coastal groups were based on agriculture. Sierra Leone’s dense tropical rainforest largely protected it from the influence of any pre-colonial African empires and from further Islamic influence of the Mali Empire. The Islamic faith, however, became common in the 18th century.

In 1462, Portuguese explorer Pedro de Sintra mapped the hills surrounding what is now Freetown Harbour, naming the formation Serra de Leão (Lion Mountains). The Italian rendering of this geographic formation is Sierra Leone, which became the country’s name. When Portuguese traders arrived at the harbor they built a fort which by 1495 acted as the European commercial hub. The Portuguese were joined by the Dutch and French, all of them using Sierra Leone as a trading point for slaves. In 1562, the English joined the slave trade when Sir John Hawkins shipped 300 enslaved people to the new colonies in North America.

In 1787 a settlement was founded in Sierra Leone in what was called the “Province of Freedom.” A number of so-called “Black Poor” arrived off the coast of Sierra Leone on 15 May 1787, accompanied by some English tradesmen. Many of these people were African Americans, who had been given their freedom after seeking refuge with the British Army during the American Revolution, but also included West Indians and Africans, along with Asians who had been living in London. After establishing Granville Town, disease and hostility from the indigenous people decimated the first group of colonists and destroyed their settlement. A second Granville Town was established by 64 remaining colonists.

In 1792 Thomas Peters and abolitionist John Clarkson founded the Sierra Leone Company, and resettled there 1196 freed slaves from the U.S. who had originally fled to Nova Scotia to seek protection from the British crown. Harsh winters and racism caused them to seek refuge elsewhere. These new settlers built Freetown and introduced North American architectural styles from the American South as well as Western fashion and culture. The initial process of society building in Freetown, however, was rife with difficulties, most notably the lack of basic supplies and provisions as well as the threat of illegal slave trading and re-enslavement.

In the early 19th century, Freetown served as the residence of the British governor who also governed the Gold Coast (now Ghana) and the Gambia settlements. At that time Sierra Leone served as the educational center of British West Africa. Fourah Bay College, established in 1827, rapidly became a magnet for English-speaking Africans on the West Coast. For more than a century, it was the only European-style university in western Sub-Saharan Africa.

Bai Bureh

Bai Bureh

During Sierra Leone’s colonial history, indigenous people mounted several unsuccessful revolts against British rule. The most notable was the Hut Tax war of 1898. The Hut Tax War consisted of a Northern front, led by Bai Bureh, and a Southern front, sparked at different times and for different reasons. Bureh’s fighters had the advantage over the vastly more powerful British for several months of the war. Hundreds of British troops and hundreds of Bureh’s fighters were killed. Bai Bureh was finally captured on 11 November 1898 and sent into exile in the Gold Coast, while 96 of his followers were hanged by the British.

The defeat in the Hut Tax war ended large-scale organized resistance to colonialism. However, resistance continued throughout the colonial period in the form of intermittent rioting and chaotic labor disturbances. Ongoing civil disturbances in the 1950’s, coupled with increased pressure on Britain to divest itself of African colonies, led to Sierra Leone gaining full national independence in 1961.

Rice is the staple food of Sierra Leone and is eaten at virtually every meal daily. The rice is prepared in numerous ways and topped with a variety of sauces made from favored ingredients such as potato leaves, cassava leaves, crain crain (leaves of the jute plant), okra, fried fish, and peanuts. Groundnut (peanut) stew is sometimes called the national dish of Sierra Leone. It can be made with either beef or chicken. As ever, the ingredients vary according to cook’s choice. Some cooks add vegetables such as carrots or corn, for example. The chief ingredients for the sauce are tomatoes, peanut butter, and hot peppers. It is customarily served over rice.


Sierra Leone Groundnut Stew


1 lb chicken or beef, diced
2 cups peanut butter
3 ozs tomato paste
2 (10 oz) cans diced tomatoes
4 cups chicken broth
2 tablespoons vegetable oil
1 onion, chopped
½ cup fresh mushrooms, sliced (or other vegetables)
1 scotch bonnet pepper (or other hot pepper) minced fine


Melt the peanut butter in a large saucepan over medium heat. Stir in the tomato paste, and blend with the peanut butter until smooth.

Add the diced tomatoes and chicken broth and simmer for 15 minutes, stirring occasionally to prevent burning.

Heat the oil over medium-high heat and sauté the onions until golden. Add them to the sauce.

Turn the heat to high, and the meat, and brown it thoroughly.

Add the browned meat, mushrooms, and hot pepper to the sauce. Cover and simmer until the meat is tender. Chicken will take no more than 30 minutes, but beef (depending on the cut) may take 2 hours or more.

Serve over boiled white rice.

Serves 6