Developing Humanitarian Medicine (DHM)

With USAID's closure this summer, much of its institutional memory is at risk of disappearing. DHM's USAID Oral History Collection is capturing the voices of agency officials, workers & contractors.

Read more: www.dhm.manchester.ac.uk/blog/usaid-o...

#OralHistory #HumanitarianAid #Archives

Henry Sese (meteorologist) reminded us of the link between climate change and NCDs. With very dry and hot conditions increasing, respiratory issues are becoming more prevalent. Kisii is experiencing prolonged droughts and floods. Floods lead to cholera and other water-borne diseases.

Dr Charles Olang’o (Maseno university, medical anthropologist) spoke of the real social and medical impacts of the fragmentation evident in NGO-led patient groups. He also emphasised the lived experience of patients, and the need to walk long distances to centralised distribution centres.

Evans Obochwa (lecturer in Kisii university) reminds us that NCDs are the leading cause of global deaths (41 million worldwide, according to WHO in 2023). Advocacy is needed in demanding TRIPS flexibilities and for WHO to add NCD drugs to Emergency Medical Lists.

For example, mental health medications which increase appetite as a side-effect are not sustainable in this context.

Costanza Torre (medical anthropologist with Developing Humanitarian Medicine (DHM) speaks to us about her ethnographic work in Palabek refugee camp, northern Uganda, discussing the impact of food insecurity. Access is fundamental but not enough – we need wider structural changes.

There is a high demand for medications for NCDs and cancer particularly, which is evident in the phenomenon of people travelling to buy medicines abroad. Magani is facilitating access in a new way, and will demonstrate that there is a need in-country for medicines.

Jean-Baptiste Marion (MSF France) is speaking to us about Magani, a new MSF venture which is an online platform for drugs intended to disrupt the global market and increase access to medicines in low and middle-income countries.

However, one of the lead suppliers, Novo Nordisk, last year ceased supply without warning, resulting in stockouts, rationing, prioritisation of vulnerable groups. MSF Access continues to advocate and challenge the prioritisation of profit over lives by multinational pharmaceutical companies.

Candice Sehoma, Advisor with MSF Access, is now speaking to us about the increasing prevalence of diabetes on the African continent, which is expected to have 35 million people with diabetes by 2055. South Africa has been a pioneer in making insulin pens free in the public system since 2014.

Our first speaker is Rosemary Mburu (WACI Health Executive Director). She spoke of people power in disrupting global pharmaceutical markets, and the importance of ensuring both quality and affordability.

Starting off the second day with Roundtable 4: (How) Can humanitarians disrupt NCD drug and diagnostics markets? Drugs, Medical Marketplaces, and Patient Groups, chaired by Dr Janelle Winters and Dr Chimwemwe Phiri.

He also emphasised food insecurity in the context of ration cuts by the World Food Programme, which affects side-effects to certain medications. psychological distress and depression (risky coping mechanisms can expose people to NCDs).

Dr. Afema Erick (MD and public health practitioner) is discussing client factors in the management of NCDs, specifically the high expectations refugees have when they transition from a better-resourced system into another e.g. Sudan to Uganda.

Dr Jared Mbete reminded us of the reality in ‘weak systems’ for healthcare access where patients are forced to self-fund care. Lack of knowledge is the elephant in the room, which needs to be tackled with public awareness. NCDs can be managed if knowledge on diagnosis and care is spread.

Prof Isaac Nyamongo (anthropologist, specialist in embedding culture into chronic care) spoke of displacement to areas where no systems or access to NCD medications exist, and the need to address communication barriers on understandings of NCDs.

Garang Piol Buk Buk (practitioner with cross-border experience) spoke about the co-existence of more chronic crises with depleting resources for humanitarians. Humanitarians prioritise, and neglect underlying risk factors that affect the burden of disease, meaning NCDs are not prioritised.

Kicking off Roundtable 2: The Pragmatics of Chronicity: Practitioners’ Perspectives on the Challenges of Managing NCDs in Displacement Contexts (chaired by Dr. Peter Gutwa).

Key questions: How do NCDs manifest uniquely in displacement settings? How do interrupted systems affect chronic care?

Another question asked how MSF can combat creating dependency and weakening healthcare systems in its interventions. Dr. Endashaw Aderie suggested earlier handover to government authorities, and Dr. Jemaiyo Chabeda emphasised the centrality of anthropological research at the start of new projects.

The Q&A discussion for Roundtable 1 touched on the role of herbalists, often the first point of healthcare contact for Kenyans and others, and the acceptance of 'modern' medicine in the Rohingya camps in Bangladesh, where the facilitation of traditional practices in maternal care is central.

Dr. Pesh Muwanguzi ( @hcrinstitute.bsky.social ) : mental health and NCD care suffered because units and 'star' healthcare staff were redeployed for Covid treatment in Uganda. In the future, Pesh called for NCDs to be integrated into emergency preparedness within its own planning pillar.

Dr. Evans Mecha (language department, Kisii University) reminded us that ‘Medical contact is systematically an episodic affair’ yet a holistic approach to chronic disease care requires long-term planning horizons and the involvement of people beyond medical practitioners

Dr. Endashaw Aderie reflects on his experience with @msf.ca and the challenges of sustainability in a hospital supported by MSF in Eastern Africa. What could MSF have done differently? Did it create dependency on high-tech tools, not sustainable by local health systems?

Roundtable 1: What Future for ‘Chronic’ Emergencies? Challenges and Possibilities of NCD Management in Humanitarian Contexts is chaired by Jemaiyo Chabeda (Medical anthropology Analyst, MSF Eastern Africa) and Bertrand Taithe.

Professor Darren Walter: The LEAP summer school in Kisii University started from the aspiration to combat the Euro-centric nature of the LEAP MSc programme on humanitarian practice. Kisii was selected as the host for many reasons, not least that Kisii is the lead county for health in Western Kenya.

Bertrand Taithe has recognised that this conference is the product of a long partnership between Kisii University and The University of Manchester, along with Liverpool School of Tropical Medicine

Endashaw Aderie of MSF Eastern Africa : ‘Humanitarian medicine is an art as much as it is a science’ which must take account of long-term sustainability and patient engagement. The Anthropology Unit in MSF Eastern Africa is a central plank of the 'art' of humanitarian medicine.

@msf.ca

Opening remarks from Kisii University: this conference brings together delegates from four continents in the hope that our discussions can have an impact on the value accorded to NCD prevention in Kisii and further afield.

We are being treated to a beautiful choral performance from Kisii University to kick off the first day of the conference on Non-Communicable Diseases and Humanitarian Medicine.

@msf.ca

🏥 Non-Communicable Diseases & Humanitarian Medicine

🌍 A 2-day online conference (25–26 June)

🎓 Hosted by Kisii University, in collaboration with @msf.ca, the LEAP programme & HCRI’s @dhm-manchester.bsky.social project team.

👥 Request Zoom links: tinyurl.com/ynfek3jh

#HumanitarianHealth #NCDs