Is anyone else puzzled by some of the bizarre language coming out of MSF in Myanmar these days?
[him] moderator
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MSF text: "Pushed to its limit by the lack of treatment provided by other actors, MSF has had to make the painful decision to drastically limit the number of new patients it can now treat."
[him] moderator comment: Did other actors push MSF to start providing ART? Do other actors push MSF to its limits? Does MSF not have its own agency? Is MSF not in charge of its own fate?
MSF text: "Unable to continue shouldering the primary responsibility for responding to one of Asia’s worst HIV crises, MSF insists that the government of Myanmar and international organizations urgently and rapidly scale-up the provision of antiretroviral therapy (ART)."
[him] moderator comment: It is uncommon for one nongovernmental organisation to insist that other nongovernmental organisations do something. Why is there no explanation of why MSF is "unable to continue"? Is there something we are not being told?
MSF text from http://doctorswithoutborders.org/publications/topten/article.cfm?id=3195
Perhaps more fundamentally, humanitarian organisations were not created to respond to chronic crises (and they never pretended they were.) Their reliance on expatriate implementers and parallel management systems and their need to remain independent from governments - all strategies designed for acute crises and interventions in armed conflicts in particular - seriously limit their potential as a catalyser for improved primary health care for all.
Gorik Ooms
From the Global AIDS Response towards Global Health
January 2009
(Anon) MSF is an elitist club which has difficulty to work with other organizations unless they have the lead. Their decision to withdraw from ARV treatment program around the world not only in Myanmar comes from their European centers but has never been discussed with grassroots level organization such as PHIV or others partners. MSF wanted to prove to the world that ARV treatment was possible in less developed settings. Now they have the proof, thanks to them, they can withdraw and let the others to sustain the ARV distribution. I suspect they will focus on others tasks where they will be alone and independent: they strive for their "splendid loneliness" and typically they prefer to lecture others more than collaborating. We will miss them in this endless fight for ARV treatment. (Anon)
Dear Him Moderator,
In reference to the Him 841 I don’t agree that the language used in the MSF report on HIV/AIDS in Myanmar is bizarre, rather that the sentences quoted are out of context with the rest of the report. In this respect I’m glad that you put the link to the ‘Preventable Fate’ report in your email. I would like to urge the Him readership to please take a look at the report, and related slideshow on the MSF website:
http://doctorswithoutborders.org/publications/topten/article.cfm?id=3195
I would appreciate your feedback or better, as you propose, to stimulate a discussion on Him relating to this important issue.
The main aim of the report is to raise awareness of the ongoing lack of HIV/AIDS treatment and care in Myanmar, especially where the Millennium Development Goal to ‘’ Achieve universal access to treatment for HIVAIDS for all those that need it, by 2010” is woefully nowhere near being achieved for the people of Myanmar.
In response to your point about being pushed to the limits. MSF has been providing ART since 2003 and very quickly became the main provider in the country. In 2003, as today, there are tragically few providers of ART in Myanmar. MSF has continued to expand the program having today almost 12,000 PHAs on ART across the country. As you know this number is a drop in the ocean compared to the need, however MSF has done all in its means to tackle these unmet needs. With so few other’s providing treatment, MSF have been pushed to the limit operationally and financially to respond to the needs of PHAs in Myanmar. With finite resources the Myanmar mission was forced to set strict criteria for admission to the ART program, whereas prior to late 2007 all PHAs were admitted. This has meant denying several thousand patients treatment and sending them away knowing most have no other alternatives means of getting treatment. This predicament, which we face daily, has impassioned the organization further to call on others actors to urgently scale-up services. For too long the HIV situation has been known about in Myanmar without a comprehensive response. This is why there is insistence of change; highlighting the need is now enough, far too many people are dying each year with no concrete solution being tabled.
On your last point, MSF has continued commitment to HIV/AIDS treatment and care to PHAs in Myanmar, and these commitments, as in the nature of the virus, are not short-term. In fact we have ambitious plans in 2009 to admit several more thousand people of ART in Myanmar. However, as the report says, a single NGO, cannot meet the huge unmet needs that exist in the country, its needs to be a collective effort, led by the state, which as it stands today is still a distant reality.
If anything is bizarre, it is the sad lack of investment in HIV in Myanmar.
Let us all hope that this situation can change in 2009.
Please do read the report.
Luke Arend
Deputy Head of Mission and author of the report
MSF Holland, Myanmar