Mitchell Sangma started out as a medical doctor with Doctors Without Borders/Médecins Sans Frontières (MSF) in 2010. On his fourth and most recent assignment, he led MSF’s medical team in Zimbabwe. He shares his experience of a particularly difficult case and the challenge of fighting against the odds.
The 22-year-old had limited chances of surviving from a rare type of skin cancer. His HIV-positive status had led on this cancer; an infection he developed when his immunity level plunged. He was emaciated and bedridden the first time I saw him. His family couldn’t afford his treatment; he himself barely had enough money to reach the MSF-supported district hospital.
This hospital was in a remote area known as Gokwe North. MSF has been working alongside the Ministry of Health (MoH) here so as to improve medical care. The youth was in need of chemotherapy, but my medical team feared that it was going to be an uphill battle due to his worsening condition and the inaccessibility of special services. Giving antiretrovirals (ARVs) without first giving treatment for skin cancer was also not advisable at that time as his immunity was very low and therefore he was in danger of developing a sudden immune response which could be life threatening.
A life saved
My team and the MoH doctor discussed the way forward for him. We knew that we needed to refer him to a specialised facility if he was to make it, but the type of treatment he needed was only available in the capital city of Harare. My MSF team decided not to give up. We contacted an expert on the subject. It was under her watch that he was sent to Harare and received chemotherapy. After three cycles of treatment, we could finally begin giving him ARVs.
In six months, his condition improved. He could walk again and his skin lesions started to fade. It was amazing to see how not giving in to the circumstances helped all of us to pull through. Overcoming this situation, we were also able to create a referral pathway for such cases the hospital may receive in the future.
Making medical care reach distant corners
Yet I don’t know how many others have been able to survive such conditions. In Gokwe North district there was only one ART centre earlier – the one in the district hospital. Many HIV-positive individuals had to travel sometimes for six hours to collect their medicines, something which they need to take throughout their life. I could imagine how difficult it would have been for these people to leave an entire day’s work – the district is not only large, it is also reliant on agriculture. The rainy season leaves the temporary road covered in slush while plumes of dust envelope it during the parched summers. Barriers like these can be overpowering enough to force people to prioritise other considerations over their health, which did happen in Gokwe North.
The attempt therefore was to make sure that ARV medicines were within reach. Besides the district hospital, MSF started supporting all the 18 rural health centres. Everyday MSF teams visited the clinics where they shared technical support as well as expertise with the MoH staff. HIV diagnostic and ARV centres opened in all the rural clinics with time. As an MSF medical team leader, I was proud to know that this ‘decentralised’ process would help many patients get medical attention at their nearest rural health centres.
Facing another reality: Abuse of women
Sexual and Gender-based Violence (SGBV) was another major part of the programme in Zimbabwe. Each story of abuse is disturbing and even more so when survivors can acquire diseases like HIV. In my experience, the society is still traditional and the fear of stigma can muffle the voices of survivors. The reality is only made bitter when families shy away from healthcare services for a fear of reporting their cases to the police. MSF has paid a lot of attention to SGBV; starting sensitisation activities on the relevance of timely treatment throughout the community among other things.
Through our active push, we were able to set up an SGBV committee in the district which now serves as a platform to discuss SGBV in the district. We also worked on special training to MoH clinical staff in the district hospital as well as in the rural health clinics. The survivors too receive psychosocial support and required medical services. But we all know that there is still a long way to go.
Why I joined MSF
In the end, I can’t say that I wanted to be a humanitarian. Early on I was a confused doctor who had just graduated from university and who wanted to travel to new places. However, I did want to be in the public domain. The first time I came across MSF was through an article published in the Readers Digest. I was fascinated by MSF’s work, and the dedication of its staff in the face of difficulties. Here was something I could do, I told myself, but I never applied. It was a presentation by an MSF doctor during my Masters course that captured my attention, and shortly after I decided to work towards my application to join. After having completed more than four years with MSF now, I can say I’ve made a personal gain- I’ve become a better doctor.
Sangma has been to South Sudan, Uzbekistan and Uganda apart from working as a national staff member in Chhattisgarh, India.