In recognition of World Humanitarian Day 2018, PLOS ONE Senior Editor Adya Misra reflects on the Médecins Sans Frontières Scientific Research Day held earlier this year.
Médecins Sans Frontières (MSF) are perhaps best known for the medical work they do in the most challenging conditions around the world. The association, made up mainly of healthcare professionals strives to provide healthcare where it’s needed the most and to provide a voice to the atrocities they witness. While they remain politically neutral in providing humanitarian assistance to those in need, MSF are also seen as an advocate of those populations in danger. MSF also carry out research to improve its operations to inform future projects and to benefit the population they aim to help.
This year PLOS ONE had the opportunity to attend the scientific research day hosted by MSF at the Royal Society of Medicine, London on 24th May 2018. A recurring theme during the day was the focus on neglected populations and putting people at the heart of the research. The Executive Director of MSF, Vickie Hawkins started off the Scientific Day by highlighting the importance of listening to people and putting people at the centre of their work. This sentiment was echoed by Claire Mills who is the Medical Director at MSF who highlighted that the organisation needs to think about real change, within MSF and outside it.
The research showcased during the day highlighted the work being done by MSF in the most challenging conditions in the world. This year, the research focussed on the most vulnerable and the most neglected populations; from those displaced due to climate change to those that have fled their homes due to political conflict with attention on the biggest risk factors of mortality in the world: contracting an infectious disease, being displaced from your home and being a woman.
The high risk due to infectious disease, especially HIV in Africa, is still attributed to lack of timely diagnosis and appropriate healthcare available to patients. The stigma of being diagnosed with HIV is high, especially in East African countries like Swaziland, Mozambique where HIV prevalence rates are among the highest. Self-testing for HIV in high risk populations is aimed to reduce the stigma associated with acceptance of HIV testing services. We heard from Robin Nesbitt from MSF Swaziland, about the implementation of oral self-testing in Swaziland, to improve diagnosis in high risk populations. This could allow individuals to self-test in a private and confidential way which could reduce stigma associated with seeking healthcare for HIV. The promising results of this study have led to the adoption of this self-testing kit as an additional testing strategy in Swaziland.
Another highly infectious disease with high prevalence rates in Asia and Africa, Tuberculosis (TB) remains affects the most vulnerable populations. MSF have been working with the Malawian Prison Health Service since 2014 to support healthcare in challenging conditions in two prisons. Alarming results showed that the incidence of TB had increased in these prisons between 2014 and 2017. 60 prisoners living in a space meant for 20 in Malawian prisons has caused overcrowding and the lack of ventilation has proved a challenge for controlling the transmission of TB. We heard from Reinaldo Ortuno about the comprehensive package of medical services that includes screening, diagnosis and treatment of HIV/TB to prisoners upon entry, stay and exit. MSF has developed an operational toolkit that outlines the three phase model of care which can be used in other prisons.
Maternal Health is often overlooked in times of civil unrest, public health or humanitarian crises. While the data are scarce, high rates of maternal and neonatal mortality have been demonstrated during the Ebola outbreak in West Africa. 100% neonatal mortality has been reported, but whether this is attributable to Ebola is currently not known. Séverine Caluwaerts from MSF Belgium reported on the management and survival of pregnant patients admitted to the MSF Ebola Treatment Centres in West Africa and she showed that a high proportion of pregnant women did not survive. While the data remain scarce, Séverine recommended that all women of reproductive age admitted to an Ebola Treatment Centre should be routinely tested for pregnancy. She also stressed that hospital delivery of babies was crucial, so both mother and child may receive appropriate healthcare.
One of main the main priorities in improving maternal health is to reduce maternal/neonatal mortality and to achieve this, health efforts are usually focused on antenatal care. Mpumi Mantangana, from MSF Cape Town, talked about Post-natal clubs in South Africa whose aim is to improve the uptake of HIV services for mother-infant pairs. Integrating maternal, child health and HIV services in post-natal clubs provided integrated healthcare opportunities for HIV infected mothers and their infants. This innovative intervention showed high retention for the mother-infant pairs as well as high rates of viral suppression. Mpumi told us that women felt postnatal clubs provided them with peer support, advice and a reduction in stigma which may explain the high retention rate.
Displaced and migrant populations
Continuing the theme of vulnerable populations, we heard from Mitchell Sangma from MSF Netherlands who has been working with factory slum workers in Bangladesh, illustrating the poor working conditions they face daily. A hazard assessment in the factories showed that only a third of the factories provided an ergonomically acceptable working environment and overall this population faced high rates of morbidity due to limited access to healthcare. Mitchell noted that occupational health was a new and challenging area for MSF with important implications for this marginalised population.
Unfortunately, the most marginalised and vulnerable populations today include Syrian and Rohingya refugees. MSF conducted a survey among the displaced in Syria to collect valuable information on the demographics, violence experienced, mental health issues and mortality. Larissa Vernier also from MSF Amsterdam provided a snapshot of devastating mortality rates in this population, with 65% of deaths caused by conflict related violence. In addition, the survey found that children in the Ein-Issa camp were found to be highly exposed to violence which has lead to an increased mental health burden.
MSF personnel working with the Rohingya people also provided a unique insight into the current crisis in Bangladesh. The results of mortality surveys carried out in this population showed that 9000 people died within 31 days of fleeing Myanmar. Sidney Wong from MSF Amsterdam noted that the Myanmar authorities claim the number of refugees is 500 whereas the estimates according to MSF are nearly 626,000 at the time of the meeting. This study was an excellent example of medical data that can be used to influence political change. Sidney reminded us of the words by Dr James Orbinski, Former President of the MSF International Council “We are not sure that words can always save lives, but we know that silence can certainly kill”. Sidney also told us about the conditions in which MSF staff are providing healthcare to the Rohingya people, something often overlooked by the press. MSF camps are prone to bad weather in Bangladesh, due to geographical reasons and there have been many cases of Diptheria and Measles.
Kate White from MSF London went on to tell us about how the first case of Diptheria at the MSF camps was misdiagnosed since a lot of physicians have little experience with this deadly infectious disease. In collaboration with LSHTM, a predictive real time model was generated to understand the extent of the Diptheria outbreak and to inform decisions on operations and resourcing. Combined with the operational challenges, the clinical challenges of this work were highlighted with clear implications for advocacy.
The research showcased on this day highlighted the variety of work done by MSF staff in improving healthcare for vulnerable populations living in very tough conditions. MSF’s experience within HIV/TB research has highlighted the importance of understanding the political landscape, working with ministries and stakeholders to progress policy development to have a greater impact on human health. The knowledge gained from this area of research should be used to inform other operational projects undertaken by MSF and the Scientific Days help in sharing this knowledge to a broader audience.
Featured Image: Felton Davis, Flickr CC BY