Essential Drugs

Doctors who work for MSF are pretty much guaranteed they will face pathologies they would not have had to deal with in their home countries, even if their home countries are developing nations with significant health care problems. MSF's mandate is (for the most part) emergency response, and doctors respond to outbreaks of cholera, malaria and meningitis, treat victims of armed conflict, and set up treatment programs for HIV/AIDS sufferers.

Even doctors who served their residencies in Detroit, and have therefore seen more than their share of gunshot victims, have probably not treated too many patients who had stepped on land mines. The same is true of African trypanosomiasis, also known as sleeping sickness. Not too many cases of that at Karolinska University Hospital in Stockholm, for example.

MSF frequently operates in countries and regions where the health care infrastructure has completely fallen apart – the Democratic Republic of the Congo is an excellent example – and in order to maximize the speed and efficiency with which newly arrived medical teams can start delivering care to patients, the organization has developed a number of specialized kits, each containing a wide range of supplies needed to treat a certain number of patients in a particular pathology. MSF has also published a number of guidelines and protocols that share information from doctors who may have been in similar circumstances.

The book pictured above is a manual intended for use in the field by physicians, pharmacists, nurses and other health care workers involved in the prescription, dispensation and management of medicines. This particular volume looked as though it had been well used.

Other volumes published by MSF boast intriguing titles such as "Obstetrics in Remote Situations", "Management of Epidemic Meningoccocal Meningitis", "Blood Transfusions in Remote Areas", "Refugee Health in Emergency Situations" and "Rapid Health Assessment of Refugee or Displaced Populations".

Those titles are far more straightforward, I think, than "Essential Drugs", which has possibly been purchased by mistake by more than a few substance-impaired undergraduate university students.

Campaign for Access to Essential Medicines

Anyone's who has ever paid for their own medicines knows how crazy the pricing can be. Before I left for the Congo I had a yellow fever jab, which I think cost $100. And I had to get it in Yokohama because the (one) clinic in Tokyo that offers it had no more stock.

Setting aside the question of punitive pricing by pharmaceutical companies (a subject that has been thoroughly covered in many places ... The Economist is a good place to start, and a few years ago The New Yorker published a superb profile of Bill Gates and his foundation's work), the main issue is the provision of drugs at any price. [Even if a drug company reduces the price of treatment from $18 a day to $1 a day, if you don't have $1 a day, you're still out of luck.]

In addition to pricing is the problem of (lack of) focus by pharmaceutical researchers on diseases that primarily affect the developing world. [Soft penises and hard arteries pay drug company shareholders a lot more than, say, treatments for leishmaniasis or human African trypanosomiasis, not to mention tuberculosis, meningitis and malaria.]

The Campaign for Access to Essential Medicines is an international campaign started by Médecins Sans Frontières to increase the availability of essential medicines in developing countries. It aims to to lower the prices of existing drugs, vaccines and diagnostic tests, to stimulate research and development into new treatments for diseases that primarily affect the poor, and to overcome other barriers that prevent patients getting the treatment they need.

From the MSF campaign website, a summary of the barriers blocking access to medical tools in developing countries:

* Many medicines, in particular those that are still relatively new such as HIV medicines are too expensive for use in poor countries. Patent protection has increased in developing countries and this pushes prices up because patents provide a monopoly for the originator company for up to 20 years, blocking competition.

* When new and better treatments exist it can take a long time until they are registered, treatment policies are changed and they become truly available to patients. This has been the case, for example, with the more effective malaria treatment, artesiminin- based combination therapies that are replacing old, ineffective drugs.

* Research and development is not geared towards the needs of people in poor countries. Drugs and diagnostic tools are being developed on the basis of their future market potential rather than on patients’ needs. Only 1% of the drugs that have come to the market in the last 30 years were developed for tropical diseases or tuberculosis while the existing drugs for these diseases are often toxic and are becoming less and less effective due to resistance.

* Once medical tools are made available other barriers to access to care can become more apparent. One key problem delaying the further roll-out of HIV treatment is the chronic shortage of health staff, particular in Southern Africa, often due to inadequate salaries and poor working conditions.

My photos above show the (tiny) pharmacy stocks in several of the clinics/hospitals I visited, and a nurse distributing drugs to patients.