How can we measure the impact of research? What is impact, and how can we show that research leads to measurable outcomes for patients? On 10 May, Médecins Sans Frontières (MSF) held their annual scientific day, and the focus of the day was to try and answer some of these questions. There was also a focus on the role that technology and social media can play in measuring the impact of research. more…

Does blogging help patients cope with the lengthy and toxic treatment for multidrug resistant tuberculosis? Do humanitarian responses to crises fail to take sufficient account of the plight of elderly people? Is giving money more effective than giving food supplements to tackle child malnutrition? And will global health expert and Ted Talks alumnus Hans Rosling repeat his sword swallowing routine? These are just a few of the questions that will be answered at the 2013 Médecins Sans Frontières (MSF) Scientific day, screened online live all day from the Royal Society of Medicine, London, UK, on Friday, May 10th. more…

In 2012, MSF projects in several countries saw an important increase in cases of malaria, and a prolonged peak in areas of seasonal transmission. More than six emergency interventions were launched to fight this increase.

While the past decade has seen drastic improvements in the response to malaria (rapid diagnostic tests, affordable artemisinin based combination therapies, and strategies relying on trained community healthcare workers) this 2012 experience showed that several challenges remain, including the scaled-up use of injectable artesunate for severe cases, outbreak response, and addressing malaria in areas of high seasonal transmission. more…

Global health leaders will gather in Abu Dhabi on 24 and 25 April for a vaccine summit to discuss recent accomplishments and seek ways to expand the impact of childhood vaccination under the decade of vaccines (DoV), an initiative for collective action announced by Bill Gates at the 2010 World Economic Forum. Promoting greater affordability and accessibility—key tenets for increasing immunisation coverage—should be at the top of the agenda. more…

My second day in South Sudan, the start of a nine month posting with MSF in this war torn, dustbowl of a town called Nasir, and I’m standing here in the medical ward, utterly lost. In every sense of the word.

How did previous doctors manage the workload out here? I’ve got no idea. In the past hour I’ve been called from the ward a handful of times. First was to the tuberculosis (TB) village, the group of mud huts behind the hospital, where forty TB patients live for the six month duration of their therapy, to talk with a man who is unhappy with the quantity of food he is being given and to try to persuade him not to leave. Next was to our living compound, where our logistician, Paul, is suffering from his second case of gastro this week (it won’t be long until I join the ranks, he assures me), followed by a visit to the re-feeding centre, where the health worker wanted me to please assist with the feeding of a malnourished, but surprisingly feisty young girl. The patch of high energy milk on the front of my T-shirt proves that I tried. And more recently there was the call to outpatients, where dozens of patients are waiting to be seen, crowding under the awning in a vain attempt to avoid this diabolical heat. Fifty degree afternoons are not unheard of here, I’m told. The local word for February, the month just passed, is simply “Fire.” more…

Amid the justified excitement surrounding the development of the first new drugs to treat tuberculosis (TB) in over 50 years it is worth remembering on World TB Day that in countries affected by conflict and instability the biggest challenges remain lack of access to diagnosis and treatment.

Working as a doctor treating TB and HIV for Medecins Sans Frontieres (MSF) has taken me to many areas with huge health system challenges. But these were nowhere more apparent than in the remote conflict affected areas of Shabunda and Kalonge in the South, and Mweso and Kitchanga in the North Kivu provinces of Democratic Republic of Congo (DRC).

In many conflict settings TB and HIV remain hugely neglected by international agencies, while conditions favour escalation of these diseases. Health services stop functioning; there is overcrowding and migration, lack of nutrition, and ongoing transmission due to few services and lack of access to treatment, and potentially increased HIV transmission. more…

My recent visit to the Buruli ulcer ward run by Médecins Sans Frontières in Akonolinga Hospital, Cameroon, was both inspiring and disturbing. The care provided was state of the art, but the visit led me to imagine an ideal world in which we could close these wards and change the face of this disease dramatically. So why would a doctor want to shut down hospital wards?

Buruli ulcer is an infection acquired mainly in rural, remote, and tropical parts of west and central Africa, most commonly in areas with limited access to healthcare. It affects mainly children and causes necrotising, progressive, lesions usually on the limbs, but occasionally affecting the face or trunk. Untreated they can progress to cause significant tissue destruction and may result in permanent deformity and disability, or even limb amputation. The frustrating thing to all involved is that the mode of transmission remains unclear—it is hard to prevent something when you don’t know how you get it in the first place. Although it is estimated to be the third most common mycobacterial infection worldwide it remains significantly under researched. more…

Pestilence, along with war, famine, and death, is sometimes portrayed as one of the four horsemen of the apocalypse of the Bible’s Book of Revelations, which describes, amongst other things, the coming of the end of times. It is a compelling image and indicative of the fear that plagues have engendered throughout history.

Plagues are great inducers of fear because though their causes are invisible their consequences are not, and their victims are arbitrarily plucked from life in a pattern we can’t discern and in ways for which traditionally there was no specific treatment. Like war and famine (and perhaps doctors) plagues are no respecters of borders and they often ride together. In refugee camps, the bringing together of large populations, often weakened by difficult migrations and deprivations, in relatively small areas that may be stressed from lack of water and sanitation, creates an environment where infections can thrive. more…

Ten years backwards—this was the journey through time that representatives from governments around the world took last week when they gathered at the World Health Organization (WHO) to discuss the recommendations of a 2012 WHO expert group report on how to address the medical research and development (R&D) system’s failures in meeting the needs of people in developing countries. But instead of tapping into the blueprint for action proposed by this group, the meeting’s delegates decided to simply continue monitoring the situation, by creating a global R&D “observatory”—a deeply disappointing outcome that will not help re-shape priorities, increase funding, or catalyse development of urgently needed new medical tools. At best it will only underscore further how badly these actions are needed. Practical discussions of new mechanisms to coordinate R&D efforts, secure sustainable financing for R&D, and establish a binding global R&D convention were postponed until 2016. So, after more than ten years of inter-governmental efforts to produce concrete proposals, these proposals will be shelved for almost four more years while countries hide behind excuses. A feeling of déjà vu… more…

At last, tackling tuberculosis (TB) in children is on the international agenda. This year, for the first time, an estimate of the extent of TB in children was included in the Global Tuberculosis Report. Although the report acknowledged that the figures were approximate and probably too low, their inclusion ends the paucity of global paediatric TB data. Also in the past year, there have been advances in paediatric TB care. The growing awareness and focus on the plight of children was reflected in the 2012 International Union of TB and Lung Health Conference held last week in Kuala Lumpur with workshops, symposiums, posters, and plenary sessions on paediatric TB. more…