H5N1

MSF in Haiti: Violence puts patients, staff, and medical activities at risk

A news release from MSF: Haiti: Violence puts patients, staff, and medical activities at risk.

Port-au-Prince, June 11, 2021—A spike in violence in Haiti's capital is putting medical activities in jeopardy, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) said today, warning that medical care cannot be sustained while armed clashes and robberies affect patients, staff, health facilities, and vehicles. 

In the first week of June, clashes in the neighborhood of Martissant and other districts of Port-au-Prince caused many injuries and displaced more than 1,000 people, including MSF patients and staff. From June 2 to 4, MSF's emergency center in Martissant received 42 patients with gunshot wounds, many of whom were transferred to MSF's trauma hospital in the Tabarre neighborhood, which increased its capacity for trauma patients from 50 to 68 beds. 

"We are witnessing an extremely worrying deterioration in the security situation," said Alessandra Giudiceandrea, MSF head of mission. "Some armed clashes took place near MSF's emergency center and offices in Martissant, where staff had to take cover from stray bullets. Armed individuals robbed two MSF ambulance drivers among other vehicles traveling from Martissant. To protect our staff, we had to reduce our community activities, but we are still treating emergencies based on our initial admission criteria." 

Clashes also took place in the city's Cité Soleil and Bel Air neighborhoods from May 15 to 31, and MSF's Tabarre hospital reached the limits of its capacity after receiving 41 patients, including 32 with wounds from violence. In another incident, a staff member of the Tabarre hospital was shot and killed on May 25 while returning home from work. 

The increased level of chronic violence is taking place amid a broader political and economic crisis in Haiti that affects people in many ways. Health systems are strained not only by insecurity but by a current increase in COVID-19 cases, economic challenges, and a high level of medical needs. 

"At a time when we should be scaling up because of COVID-19 and other needs, we are struggling to keep our existing facilities open due to insecurity," Giudiceandrea said. "We ask everyone to respect the need for medical activities to continue." 

In Martissant, insecurity and displacement may be hindering patients' ability to reach health care services. While MSF's emergency center reported an influx of trauma patients following the largest incidents of violence last week, patient numbers have now dropped below the center's normal average. 

MSF also provides care to survivors of sexual and gender-based violence through clinics in Port-au-Prince and Gonaïves, but staff are now seeing fewer patients, as people may fear leaving their homes to seek medical attention. MSF is concerned that the general increase in violence in the country is affecting the ability of sexual violence survivors to seek much-needed care. 

MSF has provided life-saving medical care to communities in Haiti for 30 years, but to continue providing such services in any community, MSF must be able to ensure the safety of patients and staff en route to and inside health care facilities. MSF demands that all groups and individuals involved in incidents of violence in Haiti respect the safety of health care workers, patients, medical supplies and facilities and that health care vehicles are granted safe passage without risk of attack.

Health facilities targeted in Tigray region, Ethiopia

A news release from MSF.org: Health facilities targeted in Tigray region, Ethiopia. Excerpt:

ADDIS ABABA – Health facilities across Ethiopia’s Tigray region have been looted, vandalised and destroyed in a deliberate and widespread attack on healthcare, according to teams from Médecins Sans Frontières (MSF). Of 106 health facilities visited by MSF teams between mid-December 2020 and early March 2021, nearly 70% had been looted, and more than 30% had been damaged; just 13% were functioning normally. 

In some health facilities across Tigray, the looting of health facilities continues, according to MSF teams. While some looting may have been opportunistic, health facilities in most areas appear to have been deliberately vandalised to make them non-functional.  In many health centres, such as in Debre Abay and May Kuhli in North-West Tigray, teams found destroyed equipment, smashed doors and windows, and medicine and patient files scattered across floors. 

In Adwa hospital in central Tigray, medical equipment, including ultrasound machines and monitors, had been deliberately smashed. In the same region, the health facility in Semema was reportedly looted twice by soldiers before being set on fire, while the health centre in Sebeya was hit by rockets, destroying the delivery room. 

MSF teams recently visited 106 medical facilities across Tigray region, Ethiopia. Of the facilities visited: 30% had been damaged, 73% had been looted, and 87% were no longer functioning or fully functioning. 

Hospitals occupied by soldiers 

Every fifth health facility visited by MSF teams was occupied by soldiers. In some instances, this was temporary; in others the armed occupation continues. In Mugulat in east Tigray, Eritrean soldiers are still using the health facility as their base. The hospital in Abiy Addi in central Tigray, which serves a population of half a million, was occupied by Ethiopian forces until early March. 

“The army used Abiy Addi hospital as a military base and to stabilise their injured soldiers,” says Kate Nolan, MSF emergency coordinator. “During that time, it was not accessible to the general population.” 

“They had to go to the town’s health centre, which was not equipped to provide secondary medical care – they can’t do blood transfusions, for example, or treat gunshot wounds,” says Nolan.  

"Health facilities and health staff need to be protected during a conflict, in accordance with international humanitarian law. This is clearly not happening in Tigray," said Oliver Behn, MSF General Director. 

Ambulances seized 

Few health facilities in Tigray now have ambulances, as most have been seized by armed groups. In and around the city of Adigrat in east Tigray, for example, some 20 ambulances were taken from the hospital and nearby health centres. 

Later, MSF teams saw some of these vehicles being used by soldiers near the Eritrean border, to transport goods. As a result, the referral system in Tigray for transporting sick patients is almost non-existent. Patients travel long distances, sometimes walking for days, to reach essential health services. 

Many health facilities have few – or no – remaining staff. Some have fled in fear; others no longer come to work because they have not been paid in months. 

Devastating impact on people 

The attacks on Tigray’s health facilities are having a devastating impact on people,” says Oliver Behn. “Health facilities and health staff need to be protected during a conflict, in accordance with international humanitarian law. This is clearly not happening in Tigray.”

Covid-19 ravages Navajo Nation as Trump makes election play for area

Via The Guardian: Covid ravages Navajo Nation as Trump makes election play for area. Excerpt:

Last spring, the Covid-19 pandemic struck the Navajo Nation worse than just about anywhere else in the United States or the rest of the world. Infections on the country’s largest American Indian reservation soared, reaching the highest per capita rate in the US in May. 

“Our people out here were hit very hard, and it spread like wildfire in our community,” said Jeff Begay, a business consultant living in the tiny community of Navajo Mountain, Utah. 

Begay, who is Navajo, said federal aid on the reservation has been slow and ineffective. More than 550 people on the reservation have died from Covid-19. Even in remote Navajo Mountain, Begay said there was an outbreak of four cases at a nearby church earlier in the pandemic.  

In mid-May, the Nation’s infection rate was 2,304 cases per 100,000 people – one in every 43 Navajos on the reservation had contracted Covid-19. As help from the federal government lagged, nonprofits like Doctors Without Borders stepped in to fill the void. 

Normally known for providing medical aid in war zones, the organization launched a rare US operation on the Navajo Nation, sending a team of medical professionals to help with infection prevention and offer technical support in health facilities. 

The conditions that are allowing the coronavirus to ravage the Navajo Nation – from poverty to poor healthcare to inadequate water infrastructure – are the result of decades of federal policies that have left the reservation’s living standards behind those of every US state. And under the Trump administration, they have remained the same or gotten worse.  

Unemployment and poverty are rampant. A third of families on the Nation don’t have running water, making hand-washing difficult. Many Navajo households are multigenerational and in hard-to-reach areas, giving the virus an easier path to vulnerable elders living far from health services.

MSF responds to new Ebola outbreak in Équateur province DR Congo

Via MSF.org: MSF responds to new Ebola outbreak in Équateur province DRC. Excerpt:

Following the declaration of this eleventh Ebola epidemic in DRC, MSF deployed teams to the health zones of Bolomba, Bikoro, Monieka, Ingende and Lotombe in order to curb the spread of the disease, support community surveillance and provide rapid treatment to patients living in hard-to-reach areas.  

“The epidemic is moving with people by land and river, to remote areas, in a province where infrastructure is scarce and villages far from each other,” said Dr Maria Mashako, MSF medical coordinator. “That’s why MSF is setting up a decentralised response and deploys our teams in the most remote, affected health areas, with small structures easily accessible to the communities.” 

As of 1 September, 2020, MSF teams are supporting nine treatment and isolation centres in five health zones to provide care as close as possible to the active hotspots of the disease.

In Bolomba health zone, in addition to the support provided to the Ebola treatment centre at the general hospital, we set up two small treatment and isolation centres in the remote health areas of Boso Mondomba and Yuli. 

The same decentralised approach has been adopted in the health zones of Monieka and Bikoro, where MSF is supporting four small care and isolation structures in difficult-to-access health areas. 

“We do not limit ourselves to supporting the response to the Ebola epidemic alone,” says Dr Mashako. “We are also supporting health centres in the hotspots and on the major axes of Bolomba and Bikoro, in order to guarantee the continuity of primary health services there, and allow early detection of suspected cases. This is done, for example, by donating drugs, training local medical personnel on Ebola or strengthening infection prevention and control measures.” 

Community engagement is key 

Little information is circulating on Ebola in the province, and the epidemic is affecting some health zones for the first time ever. That’s why our health promotion teams are supporting those of the Ministry of Health to strengthen awareness and community-based surveillance. In Bolomba, Bikoro and Monieka, this is one of the key activities done by MSF.

12,000 people per day could die from COVID-19 linked hunger by end of year, potentially more than the disease, warns Oxfam

Via ReliefWeb, a new release from Oxfam: 12,000 people per day could die from Covid-19 linked hunger by end of year, potentially more than the disease, warns Oxfam. Excerpt:

Eight of the biggest food and beverage companies pay out $18 billion to shareholders as new epicentres of hunger emerge across the globe 

As many as 12,000 people could die per day by the end of the year as a result of hunger linked to COVID-19, potentially more than could die from the disease, warned Oxfam in a new briefing published today. The global observed daily mortality rate for COVID-19 reached its highest recorded point in April 2020 at just over 10,000 deaths per day. 

‘The Hunger Virus’ reveals how 122 million more people could be pushed to the brink of starvation this year as a result of the social and economic fallout from the pandemic including through mass unemployment, disruption to food production and supplies, and declining aid. 

Oxfam’s Interim Executive Director Chema Vera said: “COVID-19 is the last straw for millions of people already struggling with the impacts of conflict, climate change, inequality and a broken food system that has impoverished millions of food producers and workers. Meanwhile, those at the top are continuing to make a profit: eight of the biggest food and drink companies paid out over $18 billion to shareholders since January even as the pandemic was spreading across the globe - ten times more than the UN says is needed to stop people going hungry.” 

The briefing reveals the world’s ten worst hunger hotspots, places such as Venezuela and South Sudan where the food crisis is most severe and getting worse as a result of the pandemic. It also highlights emerging epicentres of hunger – middle income countries such as India, South Africa, and Brazil – where millions of people who were barely managing have been tipped over the edge by the pandemic. For example: 

Brazil: Millions of poor workers, with little in the way of savings or benefits to fall back on, lost their incomes as a result of lockdown. Only 10 percent of the financial support promised by the federal government had been distributed by late June with big business favored over workers and smaller more vulnerable companies.  

India: Travel restrictions left farmers without vital migrant labour at the peak of the harvest season, forcing many to leave their crops in the field to rot. Traders have also been unable to reach tribal communities during the peak harvest season for forest products, depriving up to 100 million people of their main source of income for the year. 

Yemen: Remittances dropped by 80 percent – or $253 million - in the first four months of 2020 as a result of mass job losses across the Gulf. Borders and supply route closures have led to food shortages and food price spikes in the country which imports 90 percent of its food.  

Sahel: Restrictions on movement have prevented herders from driving their livestock to greener pastures for feeding, threatening the livelihoods of millions of people. Just 26 percent of the $2.8bn needed to respond to COVID-19 in the region has been pledged. 

Kadidia Diallo, a female milk producer in Burkina Faso, told Oxfam: “COVID-19 is causing us a lot of harm. Giving my children something to eat in the morning has become difficult. We are totally dependent on the sale of milk, and with the closure of the market we can’t sell the milk anymore. If we don’t sell milk, we don't eat.”

Dr. Joanne Liu: 100 days of solitude during COVID-19

An excerpt from today's Globe and Mail: Opinion: 100 Days of Solitude: 18 experiences of isolation during the pandemic.

Joanne Liu is a pediatric emergency specialist at Montreal’s Sainte-Justine Hospital and the former international director of Médecins sans frontières. 

In March, the invisible enemy was at everyone’s door – including mine, at the monastic lakeside writers’ retreat I was attending just outside of Geneva.

I had been fortunate enough to get a year-long sabbatical to write a book, but when I saw people were dying in the thousands from COVID-19, I knew had to help. I had already seen too many people die alone in places such as Yemen, Liberia and Sierra Leone, as we worked to staunch cholera and Ebola. 

From that version of isolation, I returned to Montreal and I self-isolated for 14 days. That was tough in its own way: While I was used to contributing concretely in health crises abroad, I was suddenly powerless in my own country, just waiting to get my hospital privileges reactivated. 

Eventually, I was lucky to find a way to contribute. I offered advice to governments in Ottawa, Quebec and New Brunswick, and did shifts in the ER and in our devastated senior-care homes. I always thought this was the best way to own a crisis – taking calls and going out into the field. 

 But one memory kept racing through my mind during this pandemic, just as it did during the Ebola crisis: seeing a child in Liberia, bawling in his bed as his nose bled, surrounded not by loved ones, but by medical staff rushing around in triage mode. Human beings are not meant to die alone. Full stop.  

The doctors who joined me then vowed to never feel so powerless again – to never be caught without diagnostic tests, treatments and vaccines. Yet here I was, in my own G7 country in 2020, where we were realizing too late that epidemics have no mercy – that if there are vulnerabilities in the chain, diseases will break them. 

Hopefully, no one will ever judge any country overwhelmed by an epidemic again. It’s been a hard 100 days, but in the days still to come, we need to understand that we are only as strong as our weakest link. We’re not over COVID-19 until all of us are over COVID-19.

DR Congo: Government to support Equateur in the fight against COVID-19 and Ebola

Via 7sur7.cd: DRC: Government to support Equateur in the fight against covid-19 and Ebola (Eteni Longondo). The Google translation:

The Minister of Health of the Democratic Republic of Congo, Doctor Eteni Longondo, arrived on Friday 05 June 2020 in Mbandaka, chief town of the province of Equateur.  

The latter used his stay in this part of the country to announce to the provincial authorities that the government will support them in the fight against the Ebola epidemic and the coronavirus pandemic. 

"We have thought about the eradication of these two diseases that are here. It is Ebola and covid-19 because we have a first case of covid-19 here in the province of Equateur. And I told the province that the government will support it technically and financially in the eradication of these two diseases,'' said the Minister of Health.  

He also presented to the provincial executive of Equateur the partners who made the trip with him as part of this mission. These include the delegation from OXFAM, UNICEF and the World Health Organization.  

It should be noted that the province of Ecuador has registered to date 11 cases of Ebola including 10 in Mbandaka and 1 in Bikoro, among which there are 6 deaths. However, 1 case of covid-19 is confirmed in Mbandaka, in the town of Wangata by the National Biomedical Research Institute. 

MSF opens coronavirus COVID-19 centre in Venezuela

Via MSF.org: MSF opens coronavirus COVID-19 centre in Venezuela.

More than 100 professionals from different disciplines have set up a specialist COVID-19 centre in a wing of the Ana Francisca Pérez de León II hospital in Petare, northeast Caracas, Venezuela. 

The plan to rehabilitate the hospital’s infrastructure and create an inpatient unit, including intensive care beds, where COVID-19 patients can receive medical and psychological care, is being carried out by Médecins Sans Frontières (MSF) in collaboration with Venezuelan authorities and the hospital's management team. Hospital staff have also received personal protective equipment (PPE) and training.    

MSF staff working with hospital staff across disciplines 

A team, made up of MSF and hospital staff and including doctors, nurses, epidemiologists, psychologists, technicians and transport and maintenance staff, has already begun caring for patients with COVID-19 symptoms. 

“It has been hard work and not without its challenges, due to the urgency of the situation and the need to adapt the hospital structure to the biosecurity measures, without compromising the rest of its emergency activities,” says Isaac Alcalde, coordinating MSF's emergency responses in Caracas and Miranda. “This has been possible thanks to the willingness of MSF staff and the hospital’s management team to find the best solutions for patients. It's a new situation for everyone.” 

Challenges in providing protective equipment 

So far, one of the biggest challenges for MSF in our global response to COVID-19 has been the shortage of PPE for our medical teams.

“We know that, in many countries, health workers have been exposed to risk, and there have been many infections due to the lack of PPE,” says Alcalde. “We will do our best to ensure that this does not happen here.”  

“But even with sufficient protection, the medical teams will face very difficult situations, both personally and professionally,” continues Alcalde. “We will make sure to provide them with all the support they need, including psychological support, to minimise the impact of this extraordinary situation.”   

MSF providing contact tracing, psychological care 

People arriving at the Ana Francisca Pérez de León II hospital with suspected COVID-19 are received by a medical team and questioned about their symptoms before being tested, either with a rapid test or with a polymerase chain reaction (PCR) test. Those who test positive are taken to the isolation area to be stabilised and to receive medical and psychological care. 

An MSF team visits patients’ families to provide health information and psychological support, while actively tracing the patient’s contacts and searching for other people with symptoms within their community. 

The COVID-19 centre has 22 beds, including 16 inpatient beds and 6 intensive care beds. We are also operating three ambulances, and have rehabilitated a further five public ambulances, for transporting patients between hospitals and between local diagnosis centres and hospitals. These are available not only for coronavirus patients but for patients suffering from other medical emergencies.

MSF opens a COVID-19 treatment centre in Haiti

Via MSF.org, a May 18 report: MSF opens a coronavirus COVID-19 treatment centre in Haiti. Excerpt and then a comment:

Médecins Sans Frontières (MSF) continues to respond to the global COVID-19 pandemic by opening a treatment centre in Port-Au-Prince, Haiti’s capital city, to help provide a coordinated response to the new coronavirus outbreak and strengthen the capacity of the Haitian healthcare system. 

MSF has re-purposed the Grands Brûlés hospital in Drouillard, a neighbourhood of the capital, to support patients who have tested positive for COVID-19 and have been referred by the Ministry of Public Health and Population, with hospitalisation and oxygen. The COVID-19 Centre is launching its activities with a 20-bed capacity, but can accommodate up to 45 beds, as the outbreak evolves.  

Our COVID-19 global response is focused on three main priorities: supporting health authorities to provide care for patients with COVID-19; protecting people who are vulnerable and at risk; and keeping essential medical services running.  

Protective equipment is scarce 

However, the COVID-19 pandemic is posing numerous challenges for health systems worldwide. In Haiti, there is a scarcity of personal protective equipment (PPE), including crucial items such as masks and aprons, and medical tools such as COVID-19 tests. 

“These challenges, including a shortage of medical staff due to travel restrictions, have forced us to reorient our activities at the Grands Brûlés hospital, and rely on our existing staff, who are working tirelessly to respond to this emergency,” said Hassan Issa, MSF Head of Mission in Haiti. 

"We have made preparations to prevent the spread of COVID-19 at our medical facilities by strengthening infection prevention and control, and working to ensure proper PPE is in stock. Triage and isolation spaces have been set up in the health structures we manage, and in those we support across the country.  Currently, we are supporting health institutions in Martissant, Port-à-Piment, Port Salut, Les Cayes, Croix-des-Bouquets, and Gonaïves."

The Haitian Ministry of Public Health and Population reports 812 confirmed COVID-19 cases and 25 deaths as of May 21.

MSF: New Ebola cases confirmed in DR Congo

Thanks to Mary Marshall for sending the link to this MSF report: New Ebola cases confirmed in DRC. Excerpt:

On 10 April 2020, a new case of Ebola was confirmed in the city of Beni, North-Kivu, northeastern Democratic Republic of Congo. The news came after a long interval without new confirmed cases: 52 days had passed since the notification of the previous confirmed case and 40 days had elapsed since the last patient was declared free of Ebola.  

Only two days remained before the expected declaration of the end of the outbreak (i.e. 42 days after the clearance of the last confirmed case) and the new confirmed diagnosis erased any expectation of such declaration.  

Unclear transmission of new case 

It is still unclear how the patient confirmed positive on 10 April contracted the virus:  he was diagnosed after his death, had no known contacts with previous Ebola patients and was not a former survivor of the virus who might have relapsed. Since the notification of this new case, five more Ebola cases have been confirmed in Beni, reaching a total of six new confirmed cases since 10 April. 

These new cases generated frustration and a certain level of suspicion within the community, and protests were held in the city of Beni, highlighting the need for strong communication efforts and community engagement.  

Flare-ups of disease still possible 

Although the end of the outbreak was in sight, flare-ups are likely according to World Health Organization, which highlights four main reasons why cases could resurge in DRC: Ebola transmission might have gone undetected due to gaps in the surveillance system or in areas where access for humanitarian organisations is limited due to the complex security environment.  

• The Ebola virus can persist in used needles, syringes or vials for several weeks. 

• The Ebola virus can persist in the body fluids of survivors for many months, and can be transmitted for a long time after a patient’s recovery (for example via sexual transmission or breastmilk), or in rare cases, a convalescent patient can relapse - as observed already during this outbreak. 

• The Ebola virus may be present in an animal reservoir in the region, and there is always a risk of a new introduction to humans.