Fieldset
The grinding burden of chronic disease

Many MSF projects are set up in response to emergencies: earthquakes, outbreaks of epidemic disease or the fallout from violent conflict for example. It is perhaps the classic image or perception of the organisation  – rushing “into the breach” to save the day.

Many MSF projects are set up in response to emergencies: earthquakes, outbreaks of epidemic disease or the fallout from violent conflict for example. It is perhaps the classic image or perception of the organisation  – rushing “into the breach” to save the day.

This is of course a vital role and the speed and effectiveness of the response that MSF is consistently able to mount in these sorts of situations is one of the things which has helped build the reputation of the organisation internationally.

But emergencies aren’t the only time that MSF gets involved however. There are also many projects running worldwide that have a more long-term or stable character and deal with more persistent problems.

My work here in the Northwest Frontier Province falls into this category. While there always remains the threat of violent conflict in our region, or the possibility of a natural disaster (such as the earthquake which devastated areas of Kashmir in 2005, to which MSF responded with a high degree of success), the work I am doing here now is not addressing any acute emergency. Rather, the team I work with is attempting to prop up or fill the gaps in a national health system that is struggling to meet the needs of the population.

In this sort of “quietly” urgent situation, it is often those with chronic disease who suffer the most.

Everyday in the ER and MSF inpatient department, I am meeting people each treasuring a bundle, bag or folder filled with doctors letters, lab tests and x-ray reports, prescriptions and sick notes and referrals: cacophonies of paperwork which, due to a fundamental lack of integration, add up to little tattered piles of confusion. Misdiagnosis (sometimes radically), inappropriate treatment or no treatment at all, missed or absent follow-up and review, and often numerous and unnecessary over-investigation without benefit, is the norm.

Without doubt, there are centres of medical excellence in Pakistan where the highest standards are upheld but like in so many other places in the world, these are beyond the budget of the majority of people. As a result, a significant proportion of people suffer the burden of inadequate care.

We hear all this in the usually long and complicated stories our patients tell us about their ailments, and it is difficult to suppress the rising frustration and sadness at things being this way.

At the moment under our care is a woman essentially crippled by Rheumatoid Arthritis. Though this is a disease that is difficult to manage even under the best of circumstances, due to delays in her diagnosis and long and tragic gaps in her treatment, she is far more severely affected than she could have been had she received a consistent and appropriate level of care. Though she is only in her 40’s, even the most simple movement is an agony. Her hands are twisted and virtually useless and she requires full-time care from her family.

Talking with her, I am reminded how many others here are carrying similar burdens and that we are reaching such a small proportion of those who could use our help.

Accepting this limitation is a daily challenge but at least with time and care we will help this one person; and then perhaps tomorrow another, and another after that. One day at a time until we can do more.