Sarah Venis is a Research Coordinator in the Manson Unit of Médecins Sans Frontières (MSF) UK, which aims to improve the quality of MSF’s medical programmes worldwide. Following the annual MSF Scientific Day, Venis distils the key areas of debate and advance in humanitarian scientific research.
What links delivery of HIV treatment in conflict settings, resistance to malaria drugs in Cambodia, the ongoing Ebola outbreak in Guinea, and technological innovations in mapping and telemedicine in medical humanitarian programmes? They were all topics presented at the annual Médecins Sans Frontières (MSF) Scientific Day in May 2014 at the Royal Society of Medicine, London, UK. The event was also live-streamed and watched by over 2200 viewers in 102 countries and is freely available to watch online until the end of August 2014.
Why was MSF Scientific Day created and what difference does it make?
The MSF Scientific Day was first held ten years ago to share research carried out in MSF’s programmes. MSF research focuses on some of the world’s most disadvantaged populations, often excluded from healthcare and who rarely make it onto research agendas. The aim was and remains two-fold – to advocate for the needs of MSF’s patients and to expose the research done by MSF to intense scrutiny and debate from within and outside the organisation. The overarching aim is to improve the delivery of lifesaving medical care to populations suffering conflict, natural disasters or exclusion from health systems. Our audience is typically made up of current and former MSF staff, global health professionals, academics, other non-governmental organisations, students and research journal editors and bloggers. When we went online three years ago we were able to take the research back to the countries where it was carried out – with our online viewers able to ask questions directly to the researchers in the auditorium.
Ebola outbreaks and research in conflict
MSF Scientific Day allows the major issues in the evidence base underlying medical humanitarian relief to be debated vigorously. A key debate this year was around Ebola response – why does MSF have a strong focus on Ebola rather than other equally lethal but less media-interesting diseases? Armand Sprecher, public health specialist at MSF who presented an analysis of the 2014 Guinea Ebola outbreak noted that MSF was the only organisation with the expertise and capacity to respond effectively: “Someone needed to step up to the plate, MSF did”. Sprecher highlighted the difficulty of training overstretched local health systems to respond to rare events, especially in the current outbreak that was the first ever to occur in Guinea.
The need to adapt new models to work in the most difficult settings is a major issue. In response to the challenges faced in the conflicts in Syria, Central African Republic (CAR) and South Sudan, Vickie Hawkins, Executive Director of MSF UK, called for “new and innovative ways to reach patients stuck in the heart of crisis when our tried and tested methods have failed”. A hard-hitting presentation by Jennifer Leaning from Harvard University, USA, outlined the need for increased rigour in strategic decision-making and new models of action, with ‘a lighter touch, focusing on training local physicians’. She challenged MSF to address the fact that in long-term conflicts, refugee populations could be in camps for generations – and that the challenge was not just to keep people alive but to help them to live. Conducting research in such emergency settings presents its own challenges. Sid Wong, Medical Director of MSF-OCA, noted that MSF needs “more rigour in looking at ourselves and self-evaluating”, while Francesco Checchi, public health specialist from Save the Children called for “vision and methodological courage…we don’t need a multitude of new studies, we need to identify priorities and do a few focused studies well”.
Observing change: from HIV monitoring to Buruli ulcer
Whilst it was clear from speakers at MSF Scientific Day that ‘when you need to do a trial, you need to do a trial’, the utility of solid observational studies using MSF programme data was also highlighted by MSF’s Helen Bygrave, who raised the question of whether it is now safe to stop CD4 monitoring in HIV care when there is viral load testing available. Presenting the first data set from a resource-poor setting, called for by the World Health Organization (WHO), she showed that ongoing CD4 testing was not needed after initial baseline measurement. The switch would be a substantial cost saving, critical for the success of rolling out wider HIV treatment as prevention programmes.
On a related note, MSF’s Marc Biot highlighted the power of simple survey data in his presentation of a telephone survey that exposed stockouts of HIV and tuberculosis drugs in pharmacies across South Africa. The report led to establishment of a stockout monitoring project and ongoing activism to ensure attention to adequate drug supplies.
Another example, presented by MSF’s Daniel O’Brien, revealed how analysis of MSF programme data on Buruli ulcer, an extremely neglected disease, was fed into development of commonsense WHO guidance on treating Buruli and HIV co-infection.
Key questions still calling out for answers
In a powerful summary Philipp du Cros, Head of MSF’s Manson Unit, UK, remarked: “The challenges are long-term, and it’s a double challenge in this abnormal condition; how can we be better, when we’re also in retreat? Which are the questions that are going to have the highest impact? Which are the methodologies? How can activism, the outrage at a problem, provoke us to do a study that provokes us to more activism? The difficult questions need answering, and the imperatives bear repeating. Jennifer [Leaning] reminded us that it starts with dignity, the empathy for the humanitarian act. That it’s not just about keeping people alive. It’s about helping them to live”.
For more on research in emergency settings and the importance of open data in the humanitarian sector, read what those engaged with the field had to say here, following the 2014 MSF Scientific Day. The 2015 MSF Scientific Day will be held on May 8th – updates can be found here and @MSFsci.