The Medecins Sans Frontieres Intervention in the Marburg Hemorrhagic Fever Epidemic, Uige, Angola, 2005. I. Lessons Learned in the Hospital.

When the epidemic of Marburg hemorrhagic fever occurred in Uige, Angola, during 2005, the international response included systems of case detection and isolation, community education, the burial of the dead, and disinfection. However, despite large investments of staff and money by the organizations involved, only a fraction of the reported number of cases were isolated, and many cases were detected only after death. This article describes the response of Medecins Sans Frontieres Spain within the provincial hospital in Uige, as well as the lessons they learned during the epidemic. Diagnosis, management of patients, and infection control activities in the hospital are discussed. To improve the acceptability of the response to the host community, psychological and cultural factors need to be considered at all stages of planning and implementation in the isolation ward. More interventional medical care may not only improve survival but also improve acceptability

Prefiguring a feminist academia: a multi-vocal autoethnography on the creation of a feminist space in a neoliberal university

Purpose: This paper is a reflective piece on a PhD workshop on “feminist organising” organised in November 2017 by the three authors of this paper. Calls to resist the neoliberalisation of academia through academic activism are gaining momentum. The authors’ take on academic activism builds on feminist thought and practice, a tradition that remains overlooked in contributions on resisting neoliberalisation in academia. Feminism has been long committed to highlighting the epistemic inequalities endured by women and marginalised people in academia. This study aims to draw on radical feminist perspectives and on the notion of prefigurative organising to rethink the topic of academic activism. How can feminist academic activism resist the neoliberal academia? Design/methodology/approach: This study explores this question through a multi-vocal autoethnographic account of the event-organising process. Findings: The production of feminist space within academia was shaped through material and epistemic tensions. The study critically reflects on the extent to which the event can be read as prefigurative feminist self-organising and as neoliberal academic career-focused self-organising. The study concludes that by creating a space for sisterhood and learning, the empowering potential of feminist organising is experienced. Originality/value: The study shows both the difficulties and potentials for feminist organising within the university. The concept of “prefiguration” provides a theoretical framework enabling us to grasp the ongoing efforts on which feminist organising relies. It escapes a dichotomy between success and failure that fosters radical pessimism or optimism potentially hindering political action.</div

Does village water supply affect children’s length of stay in a therapeutic feeding program in Niger? Lessons from a Médecins Sans Frontières program

Objective: With an increasing move towards outpatient therapeutic feeding for moderately and severely malnourished children, the home environment has become an increasingly important factor in achieving good program outcomes. Infections, including those water-borne, may significantly delay weight gain in a therapeutic feeding program. This study examined the relationship between adequacy of water supply and children’s length of stay in a therapeutic feeding program in Niger. Methods: The length of stay in a therapeutic feeding program of Médecins Sans Frontières in Niger was registered for 1518 children from 20 villages in the region. In parallel, the quality and quantity of the water source in each village were documented, and the association between adequacy of the water supply and length of stay in the program was assessed through Generalized Estimating Equation analysis. Results: 36% of the children presented with a secondary infection, 69% of which were water-related. When stratified by the adequacy of the quantity and/or quality of the water supply in their village of origin, non-adequacy of the water supply was clearly associated with a higher prevalence of secondary water-related infections and with much longer lengths of stay of malnourished children in the therapeutic feeding program. Conclusion: This study suggests that therapeutic feeding programs using an outpatient model should routinely evaluate the water supply in their target children’s villages if they are to provide optimal care

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

Abstract Introduction The 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 description Military 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). Conclusions The 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

Odds ratio’s for a shorter length of stay, as assessed by ordinal logistic regression (odds of an individual with a shorter length of stay falling in a category with less adequacy of water supply).

<p>Odds ratio’s for a shorter length of stay, as assessed by ordinal logistic regression (odds of an individual with a shorter length of stay falling in a category with less adequacy of water supply).</p

Proportion of secondary infections among children from the 20 selected study villages presenting for primary care.

<p>Proportion of secondary infections among children from the 20 selected study villages presenting for primary care.</p

Comparison of the length of stay in an MSF feeding program versus adequacy of the village water supply.

<p>Comparison of the length of stay in an MSF feeding program versus adequacy of the village water supply.</p