Joe Starke is a South African doctor with a keen interest in emergency medicine. He is currently on his first mission with MSF and is working in an emergency room and inpatient department in Pakistan's North-West Frontier Province. So far he has encountered cholera, endured sweltering heat, monsoon rains and survived a bout of dysentery. He finds the entire experience exhilarating and this is his blog...

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 organization ? 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 have helped build the reputation of the organisation internationally.

But emergencies aren't the only time that MSF gets involved. 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 meet people each treasuring a bundle, bag, or folder filled with doctors letters, lab tests and x-ray reports, prescriptions, 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 as 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.