• Doctoring beyond frontiers.

      Hakewill, P A; Médecins Sans Frontières Australia, Sydney, NSW. 100243.3671@compuserve.com (Medical Society of Australia, 2008-02-21)
    • Malaria, malnutrition and MSF. Médecins Sans Frontières.

      Evans, D; Médecins Sans Frontières, Glebe, NSW. office@sydney.msf.org (Medical Society of Australia, 2008-02-21)
      This is a personal account of my brief time in Burundi as a volunteer doctor with Médecins Sans Frontières (MSF) at the beginning of 2001. Burundi is a small nation in central Africa (bounded by the Democratic Republic of Congo, Rwanda and Tanzania) which has suffered from problems between the Hutu and Tutsi "ethnic groups", similar to those for which Rwanda is better known. Unlike Rwanda, the war between government troops and rebel forces continues in Burundi. MSF has been in Burundi since 1992, providing basic healthcare, nutrition programs, surgical services and epidemiological intervention. In late 2000, a malaria epidemic began in Burundi's highland regions where transmission is normally low, and thus the population largely not immune. Malnutrition rates also increased and MSF rapidly expanded its usual program in an attempt to control these new health problems.
    • Outcomes for Mycobacterium ulcerans infection with combined surgery and antibiotic therapy: findings from a south-eastern Australian case series.

      O'Brien, D P; Hughes, A; Cheng, A C; Henry, M J; Callan, P; McDonald, A; Holten, I; Birrell, M; Sowerby, J M; Johnson, P D; et al. (Medical Society of Australia, 2007-01-15)
      OBJECTIVE: To describe the effect of antibiotics on outcomes of treatment for Buruli or Bairnsdale ulcer (BU) in patients on the Bellarine Peninsula in south-eastern Australia. DESIGN: Observational, non-randomised study with data collected prospectively or through medical record review. PATIENTS AND SETTING: All 40 patients with BU managed by staff of Barwon Health's Geelong Hospital (a public, secondary-level hospital) between 1 January 1998 and 31 December 2004. MAIN OUTCOME MEASURES: Epidemiology, clinical presentation, diagnosis, treatment and clinical outcomes. RESULTS: There were 59 treatment episodes; 29 involved surgery alone, 26 surgery plus antibiotics, and four antibiotics alone. Of 55 episodes where surgery was performed, minor surgery was required in 22, and major surgery in 33. Failure rates were 28% for surgery alone, and 19% for surgery plus antibiotics. Adjunctive antibiotic therapy was associated with increased treatment success for lesions with positive histological margins (P < 0.01), and lesions requiring major surgery for treatment of a first episode (P < 0.01). The combination of rifampicin and ciprofloxacin resulted in treatment success in eight of eight episodes, and no patients ceased therapy because of side effects with this regimen. CONCLUSIONS: Adjunctive antibiotic therapy may increase the effectiveness of BU surgical treatment, and this should be further assessed by larger randomised controlled trials. The combination of rifampicin and ciprofloxacin appears the most promising.