Journal Article > EditorialFull Text
BMJ. 2021 December 20; Volume 375; n3126.; DOI:10.1136/bmj.n3126
Caluwaerts S
BMJ. 2021 December 20; Volume 375; n3126.; DOI:10.1136/bmj.n3126
Conference Material > Abstract
Haider A, Finger F
Epicentre Scientific Day Paris 2021. 2021 June 10
In this presentation, we provide an overview of the evolution of the COVID-19 pandemic in Yemen and Afghanistan and describe the characteristics of patients seen selected MSF health facilities.
YEMEN
The true burden of the COVID-19 pandemic in Yemen is largely underestimated. The official surveillance data is limited to the southern governorates only. The country has experienced two waves so far and until May 31 2021, the total number of confirmed cases reported was 6 746 with 1 322 associated deaths. With limited testing capacity, PCR tests are spared for suspect cases presenting with severe symptoms only. MSF has been operating several COVID-19 projects in the southern and northern parts since the beginning of the pandemic. To date, MSF France has treated 2 138 COVID-19 patients. The in-hospital mortality was 30%. This presentation provides an overview of the evolution of the pandemic in Yemen and a description of patients seen at MSF health facilities.
AFGHANISTAN
Afghanistan is currently experiencing a third wave of COVID-19. To date (31 May 2021) a total of nearly 73 000 confirmed cases and 3 000 deaths have been reported. The PCR testing capacity remains limited, particularly outside the national capital, and the characteristics of suspected patients are poorly described. MSF has bee supporting the pandemic response in Herat, the regional capital of Western Afghanistan, by running a COVID-19 triage at the Herat Regional Hospital and through case management. To date, over 31 000 patients have been received at the triage, and, if required, oriented towards appropriate care. In addition, patient data collected at the triage facility are a valuable surveillance tool since they allow to follow epidemic trends and to describe patient characteristics. Here we give an update about the current situation in Afghanistan and Herat and describe the characteristics of patients through the three epidemic waves.
YEMEN
The true burden of the COVID-19 pandemic in Yemen is largely underestimated. The official surveillance data is limited to the southern governorates only. The country has experienced two waves so far and until May 31 2021, the total number of confirmed cases reported was 6 746 with 1 322 associated deaths. With limited testing capacity, PCR tests are spared for suspect cases presenting with severe symptoms only. MSF has been operating several COVID-19 projects in the southern and northern parts since the beginning of the pandemic. To date, MSF France has treated 2 138 COVID-19 patients. The in-hospital mortality was 30%. This presentation provides an overview of the evolution of the pandemic in Yemen and a description of patients seen at MSF health facilities.
AFGHANISTAN
Afghanistan is currently experiencing a third wave of COVID-19. To date (31 May 2021) a total of nearly 73 000 confirmed cases and 3 000 deaths have been reported. The PCR testing capacity remains limited, particularly outside the national capital, and the characteristics of suspected patients are poorly described. MSF has bee supporting the pandemic response in Herat, the regional capital of Western Afghanistan, by running a COVID-19 triage at the Herat Regional Hospital and through case management. To date, over 31 000 patients have been received at the triage, and, if required, oriented towards appropriate care. In addition, patient data collected at the triage facility are a valuable surveillance tool since they allow to follow epidemic trends and to describe patient characteristics. Here we give an update about the current situation in Afghanistan and Herat and describe the characteristics of patients through the three epidemic waves.
Journal Article > ResearchFull Text
Int Health. 2016 November 3; Volume 8 (Issue 6); 390-397.; DOI:10.1093/inthealth/ihw035
Valles P, Van den Bergh R, van den Boogaard W, Tayler-Smith K, Gayraud O, et al.
Int Health. 2016 November 3; Volume 8 (Issue 6); 390-397.; DOI:10.1093/inthealth/ihw035
BACKGROUND
Trauma is a leading cause of death and represents a major problem in developing countries where access to good quality emergency care is limited. Médecins Sans Frontières delivered a standard package of care in two trauma emergency departments (EDs) in different violence settings: Kunduz, Afghanistan, and Tabarre, Haiti. This study aims to assess whether this standard package resulted in similar performance in these very different contexts.
METHODS
A cross-sectional study using routine programme data, comparing patient characteristics and outcomes in two EDs over the course of 2014.
RESULTS
31 158 patients presented to the EDs: 22 076 in Kunduz and 9082 in Tabarre. Patient characteristics, such as delay in presentation (29.6% over 24 h in Kunduz, compared to 8.4% in Tabarre), triage score, and morbidity pattern differed significantly between settings. Nevertheless, both EDs showed an excellent performance, demonstrating low proportions of mortality (0.1% for both settings) and left without being seen (1.3% for both settings), and acceptable triage performance. Physicians' maximum working capacity was exceeded in both centres, and mainly during rush hours.
CONCLUSIONS
This study supports for the first time the plausibility of using the same ED package in different settings. Mapping of patient attendance is essential for planning of human resources needs.
Trauma is a leading cause of death and represents a major problem in developing countries where access to good quality emergency care is limited. Médecins Sans Frontières delivered a standard package of care in two trauma emergency departments (EDs) in different violence settings: Kunduz, Afghanistan, and Tabarre, Haiti. This study aims to assess whether this standard package resulted in similar performance in these very different contexts.
METHODS
A cross-sectional study using routine programme data, comparing patient characteristics and outcomes in two EDs over the course of 2014.
RESULTS
31 158 patients presented to the EDs: 22 076 in Kunduz and 9082 in Tabarre. Patient characteristics, such as delay in presentation (29.6% over 24 h in Kunduz, compared to 8.4% in Tabarre), triage score, and morbidity pattern differed significantly between settings. Nevertheless, both EDs showed an excellent performance, demonstrating low proportions of mortality (0.1% for both settings) and left without being seen (1.3% for both settings), and acceptable triage performance. Physicians' maximum working capacity was exceeded in both centres, and mainly during rush hours.
CONCLUSIONS
This study supports for the first time the plausibility of using the same ED package in different settings. Mapping of patient attendance is essential for planning of human resources needs.
Journal Article > Short ReportFull Text
Colomb. J. Anesthesiol. 2015 December 23; Volume 44 (Issue 1); 13-16.
Izquierdo G, Trelles M, Khan N
Colomb. J. Anesthesiol. 2015 December 23; Volume 44 (Issue 1); 13-16.
INTRODUCTION
Helmand province, whose capital is Lashkar-Gah, is one of the most volatile provinces affected by the conflict in Afghanistan. Doctors without Borders began to work in Boost Hospital in 2009.
METHOD
Retrospective review of surgical procedures at the Doctors without Borders Operational Center in Brussels, February 11, 2010 to September 30, 2012.
RESULTS
5719 surgeries were performed on 4334 patients. 47% were emergency interventions and 75% were first interventions. 39.7% (n = 1721) of patients were female. In the Gyneco-obstetric (G) area, the average age was 31.3 years. 848 Cesarean operations (76%) were performed and 95% of these were urgent. Of these patients (n = 598) 64% were at ASA II. Spinal anesthesia (SA) was administered in 44.4% (n = 415) of patients, followed by general anesthesia without intubation (GA-) in 39.3% (n = 367). In 16% (n = 151), general anesthesia was administered with endotracheal intubation (GA+). Transoperatory mortality was 0.8% (n=7).
CONCLUSIONS
The Boost Hospital offers a surgical service of relevance in the south of Afghanistan. This hospital is supported by Doctors without Borders (MSF) and has helped to reduce the maternal mortality in that region through the provision of quality care in obstetric emergencies. By applying health standards, and medical teams and material, MSF has helped the Afghan population, particularly gestating mothers, to improve its health while achieving a transoperatory mortality in Cesareans of <1%.
Helmand province, whose capital is Lashkar-Gah, is one of the most volatile provinces affected by the conflict in Afghanistan. Doctors without Borders began to work in Boost Hospital in 2009.
METHOD
Retrospective review of surgical procedures at the Doctors without Borders Operational Center in Brussels, February 11, 2010 to September 30, 2012.
RESULTS
5719 surgeries were performed on 4334 patients. 47% were emergency interventions and 75% were first interventions. 39.7% (n = 1721) of patients were female. In the Gyneco-obstetric (G) area, the average age was 31.3 years. 848 Cesarean operations (76%) were performed and 95% of these were urgent. Of these patients (n = 598) 64% were at ASA II. Spinal anesthesia (SA) was administered in 44.4% (n = 415) of patients, followed by general anesthesia without intubation (GA-) in 39.3% (n = 367). In 16% (n = 151), general anesthesia was administered with endotracheal intubation (GA+). Transoperatory mortality was 0.8% (n=7).
CONCLUSIONS
The Boost Hospital offers a surgical service of relevance in the south of Afghanistan. This hospital is supported by Doctors without Borders (MSF) and has helped to reduce the maternal mortality in that region through the provision of quality care in obstetric emergencies. By applying health standards, and medical teams and material, MSF has helped the Afghan population, particularly gestating mothers, to improve its health while achieving a transoperatory mortality in Cesareans of <1%.
Journal Article > ResearchFull Text
Public Health Action. 2019 September 1; Volume 9 (Issue 3); 107-112.; DOI:10.5588/pha.18.0045
Gil Cuesta J, Trelles M, Naseer A, Momin A, Ngabo Mulamira L, et al.
Public Health Action. 2019 September 1; Volume 9 (Issue 3); 107-112.; DOI:10.5588/pha.18.0045
English
Français
Español
INTRODUCTION
Conflicts frequently occur in countries with high maternal and neonatal mortality and can aggravate difficulties accessing emergency care. No literature is available on whether the presence of conflict influences the outcomes of mothers and neonates during Caesarean sections (C-sections) in high-mortality settings.
OBJECTIVE
To determine whether the presence of conflict was associated with changes in maternal and neonatal mortality during C-sections.
METHODS
We analysed routinely collected data on C-sections from 17 Médecins Sans Frontières (MSF) health facilities in 12 countries. Exposure variables included presence and intensity of conflict, type of health facility and other types of access to emergency care.
RESULTS
During 2008–2015, 30,921 C-sections were performed in MSF facilities; of which 55.4% were in areas of conflict. No differences were observed in maternal mortality in conflict settings (0.1%) vs. non-conflict settings (0.1%) (P = 0.08), nor in neonatal mortality between conflict (12.2%) and non-conflict settings (11.5%) (P = 0.1). Among the C-sections carried out in conflict settings, neonatal mortality was slightly higher in war zones compared to areas of minor conflict (P = 0.02); there was no difference in maternal mortality (P = 0.38).
CONCLUSIONS
Maternal and neonatal mortality did not appear to be affected by the presence of conflict in a large number of MSF facilities. This finding should encourage humanitarian organisations to support C-sections in conflict settings to ensure access to quality maternity care.
Conflicts frequently occur in countries with high maternal and neonatal mortality and can aggravate difficulties accessing emergency care. No literature is available on whether the presence of conflict influences the outcomes of mothers and neonates during Caesarean sections (C-sections) in high-mortality settings.
OBJECTIVE
To determine whether the presence of conflict was associated with changes in maternal and neonatal mortality during C-sections.
METHODS
We analysed routinely collected data on C-sections from 17 Médecins Sans Frontières (MSF) health facilities in 12 countries. Exposure variables included presence and intensity of conflict, type of health facility and other types of access to emergency care.
RESULTS
During 2008–2015, 30,921 C-sections were performed in MSF facilities; of which 55.4% were in areas of conflict. No differences were observed in maternal mortality in conflict settings (0.1%) vs. non-conflict settings (0.1%) (P = 0.08), nor in neonatal mortality between conflict (12.2%) and non-conflict settings (11.5%) (P = 0.1). Among the C-sections carried out in conflict settings, neonatal mortality was slightly higher in war zones compared to areas of minor conflict (P = 0.02); there was no difference in maternal mortality (P = 0.38).
CONCLUSIONS
Maternal and neonatal mortality did not appear to be affected by the presence of conflict in a large number of MSF facilities. This finding should encourage humanitarian organisations to support C-sections in conflict settings to ensure access to quality maternity care.
Journal Article > ResearchFull Text
Int Orthop. 2014 July 20; Volume 38 (Issue 8); 1555-1561.; DOI:10.1007/s00264-014-2451-6
Bertol MJ, Van der Bergh R, Trelles M, Kenslor H, Basimuoneye JP, et al.
Int Orthop. 2014 July 20; Volume 38 (Issue 8); 1555-1561.; DOI:10.1007/s00264-014-2451-6
PURPOSE
While the orthopaedic management of open fractures has been well-documented in developed settings, limited evidence exists on the surgical outcomes of open fractures in terms of limb salvage in low- and middle-income countries. We therefore reviewed the Médecins Sans Frontières-Operational Centre Brussels (MSF-OCB) orthopaedic surgical activities in the aftermath of the 2010 Haiti earthquake and in three non-emergency projects to assess the limb salvage rates in humanitarian contexts in relation to surgical staff skills.
METHODS
This was a descriptive retrospective cohort study conducted in the MSF-OCB surgical programmes in the Democratic Republic of Congo (DRC), Afghanistan, and Haiti. Routine programme data on surgical procedures were aggregated and analysed through summary statistics.
RESULTS
In the emergency post-earthquake response in Haiti, 81% of open fracture cases were treated by amputation. In a non-emergency project in a conflict setting in DRC, relying on non-specialist surgeons receiving on-site supervision and training by experienced orthopaedic surgeons, amputation rates among open fractures decreased by 100 to 21% over seven years of operations. In two trauma centres in Afghanistan (national surgical staff supported from the outset by expatriate orthopaedic surgeons) and Haiti (national musculoskeletal surgeons trained in external fixation), amputation rates among long bone open fracture cases were stable at 20% and <10%, respectively.
CONCLUSIONS
Introduction of and training on the proper use of external fixators reduced the amputation rate for open fractures and consequently increased the limb salvage rates in humanitarian contexts where surgical care was provided.
While the orthopaedic management of open fractures has been well-documented in developed settings, limited evidence exists on the surgical outcomes of open fractures in terms of limb salvage in low- and middle-income countries. We therefore reviewed the Médecins Sans Frontières-Operational Centre Brussels (MSF-OCB) orthopaedic surgical activities in the aftermath of the 2010 Haiti earthquake and in three non-emergency projects to assess the limb salvage rates in humanitarian contexts in relation to surgical staff skills.
METHODS
This was a descriptive retrospective cohort study conducted in the MSF-OCB surgical programmes in the Democratic Republic of Congo (DRC), Afghanistan, and Haiti. Routine programme data on surgical procedures were aggregated and analysed through summary statistics.
RESULTS
In the emergency post-earthquake response in Haiti, 81% of open fracture cases were treated by amputation. In a non-emergency project in a conflict setting in DRC, relying on non-specialist surgeons receiving on-site supervision and training by experienced orthopaedic surgeons, amputation rates among open fractures decreased by 100 to 21% over seven years of operations. In two trauma centres in Afghanistan (national surgical staff supported from the outset by expatriate orthopaedic surgeons) and Haiti (national musculoskeletal surgeons trained in external fixation), amputation rates among long bone open fracture cases were stable at 20% and <10%, respectively.
CONCLUSIONS
Introduction of and training on the proper use of external fixators reduced the amputation rate for open fractures and consequently increased the limb salvage rates in humanitarian contexts where surgical care was provided.
Journal Article > EditorialFull Text
BMJ. 2022 January 10; Volume 376; o46.; DOI:10.1136/bmj.o46
Mesic A
BMJ. 2022 January 10; Volume 376; o46.; DOI:10.1136/bmj.o46
Conference Material > Abstract
Omar MF, Kashifa Z, Ghalib MK, Deslandes D, Morton N
MSF Scientific Days UK 2019: Innovation. 2019 May 10
INTRODUCTION
Palliative care improves the quality of life of patients, and their families, facing problems associated with life-threatening illness, through the prevention and relief of suffering. Most children needing palliative care at the end of life are neonates residing in low- and middle-income countries; around 68% have perinatal conditions, and nearly 10% have congenital anomalies. MSF operates maternity services within Dasht-e-Barchi hospital, Kabul, Afghanistan, where over one thousand deliveries take place each month. The intermediate-level neonatal unit receives babies with extremely low birth weight, extreme prematurity, congenital anomalies and other conditions such as severe birth asphyxia. For many of these babies, intensive curative therapy is deemed not in the baby's best interests and providing appropriate comfort care is required. We describe our efforts to implement palliative care in this setting.
METHODS
Steps taken towards implementation of palliative care within the neonatal unit initially involved discussions with key stakeholders, including the project clinical staff, the Ministry of Health and community leaders, to identify needs and local barriers. Following this, sensitization and training of staff was carried out to improve understanding of palliative care. Finally, we developed a palliative care framework, involving tools for clinical management, as well as guidance for decision-making and communication, and the implementation of a palliative care committee.
ETHICS
This innovation project did not involve human participants or their data; the MSF Ethics Framework for Innovation was used to help identify and mitigate potential harms.
RESULTS
Discussions with key stakeholders, including individuals based within the Ministry of Health, community leaders, and clinical staff, helped identify contextual barriers to implementing palliative care, including religious beliefs and the lack of an existing medical and legal framework. Some staff initially described resistance, partly due to their lack of experience or training in palliative care, and the absence of formal policies around palliative care in Afghanistan. We carried out training for nursing and medical staff, focusing on core concepts and technical skills. We developed a communication framework, to help deliver clear and consistent information to caregivers, addressing the need for understanding improvements in quantity and quality of the baby’s life. To further enhance communication and collaboration, a palliative care committee was established, including nursing, medical and managerial staff. This committee meets regularly to discuss palliative care issues, as well as also holding ad-hoc meetings to support clinical decision-making and caregiver counselling.
CONCLUSIONS
The implementation of neonatal palliative care requires involvement of key stakeholders to overcome potential barriers and to develop a clear framework. The palliative care committee we developed provides a support system to help facilitate consistent decision-making, and a collaborative multi-disciplinary approach for clinical care. While there are ongoing challenges in such a context, our experience shows that it is possible to implement context-specific and family-centered palliative care.
CONFLICTS OF INTEREST
None declared.
Palliative care improves the quality of life of patients, and their families, facing problems associated with life-threatening illness, through the prevention and relief of suffering. Most children needing palliative care at the end of life are neonates residing in low- and middle-income countries; around 68% have perinatal conditions, and nearly 10% have congenital anomalies. MSF operates maternity services within Dasht-e-Barchi hospital, Kabul, Afghanistan, where over one thousand deliveries take place each month. The intermediate-level neonatal unit receives babies with extremely low birth weight, extreme prematurity, congenital anomalies and other conditions such as severe birth asphyxia. For many of these babies, intensive curative therapy is deemed not in the baby's best interests and providing appropriate comfort care is required. We describe our efforts to implement palliative care in this setting.
METHODS
Steps taken towards implementation of palliative care within the neonatal unit initially involved discussions with key stakeholders, including the project clinical staff, the Ministry of Health and community leaders, to identify needs and local barriers. Following this, sensitization and training of staff was carried out to improve understanding of palliative care. Finally, we developed a palliative care framework, involving tools for clinical management, as well as guidance for decision-making and communication, and the implementation of a palliative care committee.
ETHICS
This innovation project did not involve human participants or their data; the MSF Ethics Framework for Innovation was used to help identify and mitigate potential harms.
RESULTS
Discussions with key stakeholders, including individuals based within the Ministry of Health, community leaders, and clinical staff, helped identify contextual barriers to implementing palliative care, including religious beliefs and the lack of an existing medical and legal framework. Some staff initially described resistance, partly due to their lack of experience or training in palliative care, and the absence of formal policies around palliative care in Afghanistan. We carried out training for nursing and medical staff, focusing on core concepts and technical skills. We developed a communication framework, to help deliver clear and consistent information to caregivers, addressing the need for understanding improvements in quantity and quality of the baby’s life. To further enhance communication and collaboration, a palliative care committee was established, including nursing, medical and managerial staff. This committee meets regularly to discuss palliative care issues, as well as also holding ad-hoc meetings to support clinical decision-making and caregiver counselling.
CONCLUSIONS
The implementation of neonatal palliative care requires involvement of key stakeholders to overcome potential barriers and to develop a clear framework. The palliative care committee we developed provides a support system to help facilitate consistent decision-making, and a collaborative multi-disciplinary approach for clinical care. While there are ongoing challenges in such a context, our experience shows that it is possible to implement context-specific and family-centered palliative care.
CONFLICTS OF INTEREST
None declared.
Journal Article > CommentaryFull Text
Disasters. 2009 July 27; Volume 33 (Issue 4); DOI:10.1111/j.1467-7717.2008.01088.x
Pinera JF, Reed RA
Disasters. 2009 July 27; Volume 33 (Issue 4); DOI:10.1111/j.1467-7717.2008.01088.x
Kabul and Monrovia, the respective capitals of Afghanistan and Liberia, have recently emerged from long-lasting armed conflicts. In both cities, a large number of organisations took part in emergency water supply provision and later in the rehabilitation of water systems. Based on field research, this paper establishes a parallel between the operations carried out in the two settings, highlighting similarities and analysing the two most common strategies. The first strategy involves international financial institutions, which fund large-scale projects focusing on infrastructural rehabilitation and on the institutional development of the water utility, sometimes envisaging private-sector participation. The second strategy involves humanitarian agencies, which run community-based projects, in most cases independently of the water utilities, and targeting low-income areas. Neither of these approaches manages to combine sustainability and universal service. The paper assesses their respective strengths and weaknesses and suggests ways of improving the quality of assistance provided.
Conference Material > Slide Presentation
Rapoud D, Cramer E, Al Asmar M, Sagara F, Ndiaye B, et al.
MSF Scientific Day International 2024. 2024 May 16; DOI:10.57740/2acXDPpuix