• Between War and Peace: Humanitarian Assistance in Violent Urban Settings

      Lucchi, E; Médecins Sans Frontières, Spain (2010-06-07)
      Cities are fast becoming new territories of violence. The humanitarian consequences of many criminally violent urban settings are comparable to those of more traditional wars, yet despite the intensity of the needs, humanitarian aid to such settings is limited. The way in which humanitarian needs are typically defined, fails to address the problems of these contexts, the suffering they produce and the populations affected. Distinctions between formal armed conflicts, regulated by international humanitarian law, and other violent settings, as well as those between emergency and developmental assistance, can lead to the neglect of populations in distress. It can take a lot of time and effort to access vulnerable communities and implement programmes in urban settings, but experience shows that it is possible to provide humanitarian assistance with a significant focus on the direct and indirect health consequences of violence outside a traditional conflict setting. This paper considers the situation of Port-au-Prince (Haiti), Rio de Janeiro (Brazil) and Guatemala City (Guatemala).
    • Cholera in Haiti: please do not forget zinc.

      Rossi, G; Zachariah, R; Draguez, B; Van Herp, M (2011-05-21)
    • Hope for Haiti?

      Veeken, H; Médecins Sans Frontières, Amsterdam, Netherlands. (Published by: BMJ Publishing Group Ltd, 1993-07-31)
      Haiti, one of the world's five poorest nations, gets international attention because of the number of refugees who leave by boat in search of a better future. The 80,000 inhabitants of Ile de la Gonave are neglected, even in Haiti--there is no government medical post, and facilities in the health posts run by missions are minimal. Typhoid and cholera epidemics threaten the island. Médecins Sans Frontières plans to send staff and supplies and train local health workers.
    • Mosquitoborne infections after Hurricane Jeanne, Haiti, 2004

      Beatty, Mark E; Hunsperger, Elizabeth; Long, Earl; Schürch, Julia; Jain, Seema; Colindres, Rom; Lerebours, Gerald; Bernard, Yves-Marie; Dobbins, James Goodman; Brown, Mathew; et al. (2007-02-01)
      After Hurricane Jeanne in September 2004, surveillance for mosquitoborne diseases in Gonaïves, Haiti, identified 3 patients with malaria, 2 with acute dengue infections, and 2 with acute West Nile virus infections among 116 febrile patients. These are the first reported human West Nile virus infections on the island of Hispaniola.
    • Moving from the 'Why' to the 'How': Reflections on Humanitarian Response in urban settings

      Lucchi, E; Médecins Sans Frontières, Operational Centre Barcelona-Athens, Barcelona, Spain. Elena.LUCCHI@barcelona.msf.org (2012-07-01)
      Given the rising numbers of crises in urban settings, Médecins Sans Frontières (MSF) is currently shifting its focus from 'why' it should intervene to 'how' it should intervene effectively in these contexts. Beyond communities affected by natural disasters and epidemics, MSF has chosen to target populations in urban settings that are affected by violence or by marginalisation and neglect: these groups appear to suffer the greatest number of severe threats to their health and well-being. Recent reflection within MSF has identified a number of key operational challenges to confront in order to respond efficiently to the needs of these populations. These include: appropriate assessments; measurable indicators of vulnerability and impact; pertinent operational approaches and medical strategies; adapted security management; and responsible closure of activities. This paper summarises the main lessons learned from working in urban settings with the principal aim of mutual sharing and understanding.
    • Rectal screening displays high negative predictive value for bloodstream infection with (ESBL-producing) Gram-negative bacteria in neonates with suspected sepsis in a low-resource setting neonatal care unit.

      Lenglet, A; Schuurmans, J; Ariti, C; Borgundvaag, E; Charles, K; Badjo, C; Clezy, K; Evens, E; Senat-Delva, R; Berthet, M; et al. (Elsevier, 2020-09-02)
      Objectives: We analysed the concordance of rectal swab isolates and blood culture for Gram-negative bacteria (GNB) isolates in neonates with a suspicion of neonatal sepsis admitted to a neonatal care unit in Haiti. Methods: We matched pairs of blood and rectal samples taken on the date of suspected sepsis onset in the same neonate. We calculated the proportion of rectal isolates in concordance with the blood isolates by species and genus. We calculated the negative predictive value (NPV) for GNB and extended-spectrum β-lactamase (ESBL)-producing GNB for all rectal and blood isolate pairs in neonates with suspected sepsis. Results: We identified 238 blood and rectal samples pairs, with 238 blood isolate results and 309 rectal isolate results. The overall concordance in genus and species between blood and rectal isolates was 22.3% [95% confidence interval (CI) 17.4-28.0%] and 20.6% (95% CI 16.0-26.2%), respectively. The highest concordance between blood and rectal isolates was observed for samples with no bacterial growth (65%), followed byKlebsiella pneumoniae (18%) and Klebsiella oxytoca (12%). The NPV of detecting GNB bacterial isolates in rectal samples compared with those in blood samples was 81.6% and the NPV for ESBL-positive GNB was 92.6%. Conclusions: The NPV of rectal swab GNB isolates was high in all patient groups and was even higher for ESBL-positive GNB. Clinicians can use the results from rectal swabs when taken simultaneously with blood samples during outbreaks to inform the (de-)escalation of antibiotic therapy in those neonates that have an ongoing sepsis profile.