It's International Nurses Day on May 12th- 

Let a nurse in your life know how amazing they are! 

Whether they scrub-up as nurse anesthetists in an operating theater, inject a vaccine to thousands of children in one day, manage the functioning of a hospital ward, travel hundreds of miles to install a mobile clinic in isolated communities or provide first screening for people rescued from a sinking boat, they are usually the first and last face patients will see when in our care. 

If doctors have no borders; nurses definitely have no limits.

We advocate for our patients and do everything that we can within our hospital to provide the best standard of care, but it can be quite overwhelming at times when what happens outside of our fences is completely beyond your control.

One of the things I do in these moments to help keep things in perspective, is to take a few moments to walk around the health facilities we have here. I remind myself to focus on all the things that we CAN actually do, and that do make a huge difference.  

It is amazing how much is still able to be done right here in our hospital, even with all the constraints on time, resources and people power. At these short stitches in time I just marvel at all the activities that are happening simultaneously at any one moment: you can walk past the ER where people are resuscitated and brought back to life with emergency treatments, then past the out-patient clinics and see patients receiving life-changing mental health counseling and support for the terrible traumas they have endured. 

You can stop in at the training tent and see a new generation of dedicated nurses and clinical officers participating so attentively in learning sessions to improve their clinical skills and knowledge, wanting to provide the best standard of care to their patients. 

Dr. Saschveen blogs from Tanzania: http://blogs.msf.org/en/staff/blogs/msf-in-tanzania/treating-refugees-in-tanzania-perspective

Caring for patients whose lives have been shattered by bullets, shrapnel, or severe burns is often a long and complex process.

Off-the-shelf prosthetics can be prohibitively expensive and are generally one size fits all. But no two patients are alike—from lifestyle to skin tone to aspirations, each has different needs when it comes to the prosthetic design that will benefit them most.

This is where 3-D printing comes in.

Check out our spring Alert feature on Medical Innovations

 https://medium.com/msf-alert/testing-custom-3-d-printed-prosthetics-for-refugees-6e36207abb0f

Because I’m A Woman…

Women & girls forced to flee face health risks & further danger on their journey, simply because they are women. Hear their stories in our special International Women’s Day feature: http://becauseimawoman.msf.org

Conditions in Domiz refugee camp were dire when it first opened. 

Women gave birth in their tents. 

We set up a maternity unit with a 24-hour delivery room. 

4 years. 

1 maternity clinic. 

3,400 babies delivered. 

27,400 gynecological consultations.

Illustrating One of the World’s Busiest Maternity Hospitals

Aurélie Neyret, Illustrator with The Ink Link collective, recently visited #Afghanistan to help give a voice to the staff and patients of a Doctors Without Borders Maternity Hospital in Khost who, for cultural reasons, cannot be portrayed in photo or video. 

Khost maternity, situated in the south east of Afghanistan about 30km from the Pakistani border, is thought to be one of the busiest maternities in the world. Over 400 (almost all female) Afghan staff work alongside 12 international staff to assist in the delivery of around 2,000 babies each month. 

Dr Guilia is a gynecologist from Italy spending two months in Khost. Alongside Afghan colleagues, she is called in to manage women with high risk pregnancies or those experiencing complications. 

On this occasion she performed a c-section due to placenta previa. This is a condition where the placenta grows over the cervix blocking the baby’s way out and meaning that a vaginal delivery is just not possible. Placenta previa can cause massive hemorrhaging and death if a c-section is not performed in good time.

Men are not allowed into the #MSF Maternity Hospital in #Khost but are accommodated in a special caretakers' room so they can be nearby whilst their family members give birth. This way, they are onsite to consent to life saving procedures like c-sections when they are needed. 

During this time health promoters like Barakat Shah give them information about the danger signs to watch out for during pregnancy, the importance of breast feeding as well as the contraceptive options available for free at the hospital. 

http://www.doctorswithoutborders.org/

Two Little Girls

Ian Cross is a doctor from the UK who is currently working at the MSF project in Kutupalong, Bangladesh. The project serves Rohingya refugees who have fled violence in neighbouring Myanmar. Here he tells the stories of two little girls who came for treatment at the clinic...

She didn't see the soldier who fired the shot. Her father was running from the village carrying her in his arms. Her arms were around his neck. The bullet smashed through her right forearm and entered her father's head, killing him instantly.

She didn't talk much about what happened next. She crossed the border in to Bangladesh with her mother and little brother. Her arm was too badly damaged for us to treat in our facility at Kutupalong, so we referred her to the Memorial Christian Hospital, a couple of hours away to the north. The surgeons began by fixing the forearm bones. I reviewed her when she returned to the clinic with her arm in a cast. She couldn't stretch out her fingers because the extensor tendons in her forearm had been destroyed by the bullet. 

After a month or so, she was ready for further surgery to reconstruct the tendons. She came to the clinic this morning, proud to show me the result. She could waggle her fingers. She was delighted. Her mother was so grateful for the treatment she received that she asked us to tell the world what had happened to her daughter. How can you be shot through the eye and remain alive? This little girl didn't see who shot her either.

The bullet entered her skull obliquely, in front of her right ear. The bullet traversed her eyeball and exited through the side of her nose. The eye was completely destroyed of course. The surgeons repaired a hole an inch across between her eye socket and the brain. The sight in her left eye is normal. Although she was unfortunate to have been shot, she was incredibly lucky to survive. 

These two little girls managed to reach Bangladesh and received excellent care. But how many more died before they were able to leave Myanmar?

Read more from Ian: http://blogs.msf.org/en/staff/authors/ian-cross

Warning: this song will be stuck in your head all day! 

Here’s how artists and young HIV activists are tackling stigma in DRCongo

#WorldAIDSDay

We Need Your Help

World health leaders meet next week in Moscow to TALK about the world’s deadliest infectious disease. Now is the time to tell them we need real ACTION to save more lives like Sinethemba’s with newer drugs and better treatment programs. Sign our petition today: https://stepupfortb.org/

An absolutely inhumane policy that endangers people #forcedfromhome

 U.S. plans to cap number of refugees at 45,000. It’s the lowest cap in decades

We walk you through a Doctors Without Borders/Médecins Sans Frontières (MSF) maternity hospital in Jordan’s Irbid governorate. In the last four years, 10,000 babies have been born here, most of them to Syrian refugees. 

Here’s what’s happening in Bangladesh:

More than 422,000 people have fled to Bangladesh from Rakhine state in Myanmar within the last three weeks- this is after a wave of targeted violence against members of the Rohingya ethnic minority. 

Medical facilities, including our own clinics, are completely overwhelmed. 

Massive humanitarian aid is needed in Bangladesh following the arrival of hundreds of thousands of refugees- most have moved into makeshift settlements without adequate access to shelter, food, clean water, or latrines.

When you walk through the settlement, you have to wade through streams of dirty water and human feces.

Learn more

I suddenly found myself treating my own premature triplets.

Whenever I see a newborn baby fighting for their life, it reminds me of my own three children. 

It feels like I am treating my own children every single day. I want to save them all.

There is a largely ignored reality in Homa Bay, Kenya: 30 percent of the population is HIV positive. While advancements in HIV treatment have changed the prognosis of living with the disease…

AIDS

Continues

To

Kill.

Not only in Kenya, but around the world. One million people died from AIDS last year.

Antiretroviral drugs, known as ARVs, have been found to be effective in keeping the virus at bay since the late 1980s. For many years, these drugs were not available in Africa due to their prohibitive cost. Now, in Kenya, “ARV drugs are available. Diagnostics are available,” explains Dr. Berna Gurer, a physician with MSF in Homa Bay.

“So the question is: why are HIV patients still dying?”

The answer is a complex mix of stigma and access to care. Many patients do not know they are living with the disease since they have never been tested. When they start their treatment at a late stage, the virus is much harder to manage. Others interrupt their treatment at some point and become resistant to standard drugs. These people will need a different type—called second-line—for care. As nations decrease their funding for HIV treatment around the world, it will only become more difficult to get reliable access to care. It does not have to be this way.

Watch the full video.

 They come from Sudan, Somalia and Ethiopia. They are young adults and unaccompanied minors, pregnant women and entire families. They gather here in Ventimiglia, Italy, a small town on the Mediterranean coast, major transit point for refugees, and final frontier of the dangerous journey to Europe.

As many migrate north to nations like France and Germany, they pass through Ventimiglia, but recent increased policing along the borders here has prevented people from crossing successfully. As a result, the population of refugees and migrants is growing. With camps full, people look to the urban landscape for shelter, sleeping under bridges and overpasses. Some even sleep along the banks of the Roia river.

Citizens engaged: citizens on both sides of the border have stepped up to help the growing population. In Ventimiglia, Sant Antonio church has transformed into a temporary shelter and food kitchen; local bars offer refugees meal discounts and free electricity to charge their phones, since makeshift shelters lack power. MSF began collaborating with these local efforts in fall of last year to provide care for migrants in transit, especially for expectant mothers and to address the effects of mental trauma. Often, the trauma from the migration route leaves individuals with feelings of depression, abandonment and anxiety.

While people wait for the next step in Ventimiglia, not every asylum claim is approved by the government. When these applications are denied, the options are limited, though a last effort remains: to walk the five miles from Ventimiglia into France, a journey along the highway known as the “Pass of Death.” Since September, 10 have died on this route attempting to cross the border, and some, avoiding the highway altogether, travel along the equally dangerous railroad or mountain path instead. It is along this route that Roya Citoyenne, a local community group across the French border, has created a temporary shelter where, if only for a moment, refugees can safely rest as they seek their final destination.

When Zahra brought her children, Kholah and Saher, to our Abs hospital in Yemen, they were suffering from dehydration and malnutrition. 

Life in her village is hard, Zahra explains, with many supplies lacking: “It’s even hard to get them the milk they need. I spend many days looking for milk, worried and anxious.” 

The ongoing civil war in Yemen has left the health system in shambles, and now many in rural areas are without access to medical care. With services disrupted, in recent months the country now faces a severe cholera outbreak that is affecting thousands. While successful treatment does exist—serious cases can improve within four days with rehydration therapy—without a reliable health infrastructure, many are in danger of falling ill beyond the reach of clean water and proper care.

Without clean water, deadly diseases spread rapidly, especially in refugee camps.

Team Leader Craig and Nurse Jacob break down how MSF's huge water treatment plant in Palorinya works and why it’s vital to the health of thousands of refugees who have fled South Sudan to live in Uganda.