MSF Experience Research Articles

Introduction of a standardised protocol, including systematic use of tranexamic acid, for management of severe adult trauma patients in a low-resource setting: the MSF experience from Port-au-Prince, Haiti

BackgroundBleeding is an important cause of death in trauma victims. In 2010, the CRASH-2 study, a multicentre randomized control trial on the effect of tranexamic acid (TXA) administration to trauma patients with suspected significant bleeding, reported a decreased mortality in randomized patients compared to placebo. Currently, no evidence on the use of TXA in humanitarian, low-resource settings is available. We aimed to measure the hospital outcomes of adult patients with severe traumatic bleeding in the Médecins Sans Frontières Tabarre Trauma Centre in Port-au-Prince, Haiti, before and after the implementation of a Massive Haemorrhage protocol including systematic early administration of TXA.MethodsPatients admitted over comparable periods of four months (December2015- March2016 and December2016 - March2017) before and after the implementation of the Massive Haemorrhage protocol were investigated. Included patients had blunt or penetrating trauma, a South Africa Triage Score ≥ 7, were aged 18–65 years and were admitted within 3 h from the traumatic event. Measured outcomes were hospital mortality and early mortality rates, in-hospital time to discharge and time to discharge from intensive care unit.ResultsOne-hundred and sixteen patients met inclusion criteria. Patients treated after the introduction of the Massive Haemorrhage protocol had about 70% less chance of death during hospitalization compared to the group “before” (adjusted odds ratio 0.3, 95%confidence interval 0.1–0.8). They also had a significantly shorter hospital length of stay (p = 0.02).ConclusionsImplementing a Massive Haemorrhage protocol including early administration of TXA was associated with the reduced mortality and hospital stay of severe adult blunt and penetrating trauma patients in a context with poor resources and limited availability of blood products.

Treatment of thalassemia among paediatric Syrian refugees in Lebanon: MSF experience

Treatment of thalassemia among paediatric Syrian refugees in Lebanon: MSF experience

ART in times of war: the MSF experience in Yambio, South Sudan

ART in times of war: the MSF experience in Yambio, South Sudan

Integration of diabetes care and associated costs: MSF experience in Democratic Republic of Congo and Swaziland

Integration of diabetes care and associated costs: MSF experience in Democratic Republic of Congo and Swaziland

The new WHO decision-making framework on vaccine use in acute humanitarian emergencies: MSF experience in Minkaman, South Sudan

IntroductionThe main causes of death during population movements can be prevented by addressing the population’s basic needs. In 2013, the World Health Organization (WHO) issued a framework for decision making to help prioritize vaccinations in acute humanitarian emergencies. This article describes MSF’s experience of applying this framework in addition to addressing key population needs in a displacement setting in Minkaman, South Sudan.Case descriptionMilitary clashes broke out in South Sudan in December 2013. By May 2014, Minkaman, a village in the Lakes State, hosted some 85,000 displaced people. MSF arrived in Minkaman on 28 December 2013 and immediately provided interventions to address the key humanitarian needs (health care, access to drinking water, measles vaccination). The WHO framework was used to identify priority vaccines: those preventing outbreaks (measles, polio, oral cholera vaccine, and vaccine against meningococcal meningitis A (MenAfrivac®)) and those reducing childhood morbidity and mortality (pentavalent vaccine that combines diphtheria, tetanus, whooping cough, hepatitis B, and Haemophilus influenzae type B; pneumococcal vaccine; and rotavirus vaccine). By mid-March, access to primary and secondary health care was ensured, including community health activities and the provision of safe water. Mass vaccination campaigns against measles, polio, cholera, and meningitis had been organized. Vaccination campaigns against the main deadly childhood diseases, however, were not in place owing to lack of authorization by the Ministry of Health (MoH).ConclusionsThe first field use of the new WHO framework for prioritizing vaccines in acute emergencies is described. Although MSF was unable to implement the full package of priority vaccines because authorization could not be obtained from the MoH, a series of mass vaccination campaigns against key epidemic-prone diseases was successfully implemented within a complex emergency context. Together with covering the population’s basic needs, this might have contributed to reducing mortality levels below the emergency threshold and to the absence of epidemics. For the WHO framework to be used to its full potential it must not only be adapted for field use but, most importantly, national decision makers should be briefed on the framework and its practical implementation.

Risk for vaccine preventable diseases in Northern Syria after 5 years of civil war: the MSF experience

Risk for vaccine preventable diseases in Northern Syria after 5 years of civil war: the MSF experience

MSF Experience with Testing Hybrid Model of Telemedicine During Humanitarian Intervention - Providing Distant Clinical Support in Madaoua, Niger

MSF Experience with Testing Hybrid Model of Telemedicine During Humanitarian Intervention - Providing Distant Clinical Support in Madaoua, Niger

Humanitarian Negotiations Revealed: The MSF Experience ed. by Claire Magone, Michaël Neuman, and Fabrice Weissman

Humanitarian Negotiations Revealed: The MSF Experience ed. by Claire Magone, Michaël Neuman, and Fabrice Weissman

MSF experience from conflict & other humanitarian settings – burden of disease and key programmatic challenges

MSF experience from conflict & other humanitarian settings – burden of disease and key programmatic challenges

Mental health and trauma: MSF experience with asylum seekers in Sicily, 2014-2015

Mental health and trauma: MSF experience with asylum seekers in Sicily, 2014-2015

MSF obstetric fistula care programmes – taking stock of MSF experience in the prevention and management of obstetric fistula

MSF obstetric fistula care programmes – taking stock of MSF experience in the prevention and management of obstetric fistula

From remote control to remote management, and onwards to remote encouragement? The evolution of MSF's operational models in Somalia and Afghanistan

AbstractThis Opinion Note continues the discussion started in Antonio Donini and Daniel Maxwell's “From Face-to-Face to Face-to-Screen: Remote Management, Effectiveness and Accountability of Humanitarian Action in Insecure Environments”, published previously in the Review, by exposing the realities of Médecins Sans Frontières' (MSF) struggle with the issue of remote management. By reviewing MSF's experience with remote management in Somalia and Afghanistan, the authors explore how operational compromise evolves over time, based on specific contextual factors, and highlight the challenges that this form of compromised action poses to MSF's identity and principles.

From remote control to remote management, and onwards to remote encouragement? The evolution of MSF's operational models in Somalia and Afghanistan – CORRIGENDUM

This Opinion Note continues the discussion started in Antonio Donini and Daniel Maxwell's “From Face-to-Face to Face-to-Screen: Remote Management, Effectiveness and Accountability of Humanitarian Action in Insecure Environments”, published previously in the Review, by exposing the realities of Medecins Sans Frontieres' (MSF) struggle with the issue of remote management. By reviewing MSF's experience with remote management in Somalia and Afghanistan, the authors explore how operational compromise evolves over time, based on specific contextual factors, and highlight the challenges that this form of compromised action poses to MSF's identity and principles.

Mental health services for children exposed to armed conflict: MSF experience in DRC, Iraq and occupied Palestinian territory

Mental health services for children exposed to armed conflict: MSF experience in DRC, Iraq and occupied Palestinian territory

The sound of silence in humanitarian work

Humanitarian Negotiations Revealed: The MSF Experience. Clare Magone, Michael Neuman, Fabrice Weismann, editors. C. Hurst and Co. Publishers Ltd.; 2012 Witnessing” and speaking out (témoignage) are important aspects of the work of Médecins Sans Frontières. As MSF celebrates 40 years of “