Off the cuff
Medicine and Public Health

Based on a reflection regarding how patient rights have changed, in France in particular, Fabrice Weissman discusses humanitarian medicine’s shortcomings in that regard and proposes several avenues for improvement at MSF.  This text was originally posted on MSF’s associative website, The Souk.

“Death is an extremely grave non-emergency; its only treatment is mourning”. That is how doctor Miguel Martinez Almoyna introduces his concept of emergency. The retired 92-year-old anaesthesiologist played an active role in creating France’s SMUR, and later SAMU, emergency medical systems. Still quite active overseas (in Brazil and Mexico), where he has exported the French pre-hospital model, he explains his approach to régulation médicale, whose purpose is to guide patients to the medical services their condition requires while offering a range of responses corresponding to different degrees of severity and urgency.

All the warning lights are flashing red this year: drought, the high prices of grains and fertilisers exacerbated by the war in Ukraine, reduced imports and speculation, numerous armed conflicts, a record number of refugees to be fed, disengagement of institutional donors,… With the exception of locusts, all the determinants of severe food scarcity are there, from Afghanistan to the Sahel, including Yemen, the Horn of Africa, and the Indian subcontinent. To the point of threatening all of the progress that was made in treating undernutrition after the 2005 crisis in Niger, which was the starting point for global advances in managing malnutrition in places where it is commonplace. It is time for a general mobilisation to limit the scale of the coming catastrophe. Interview with Jean-Hervé Bradol by Elba Rahmouni.

We can all agree that the emergence of Covid-19 vaccine is “an absolutely astonishing development”, but vaccines are unlikely to completely halt the spread of the virus, let alone eradicate it. Yet even without achieving herd immunity, the ability to vaccinate vulnerable people seems to be reducing hospitalizations and deaths from Covid-19. 

Blog written by Jean-Hervé Bradol, director of studies at the Crash.

Today, in order to obtain supplies of vaccines against Covid-19, there is neither a major difficulty related to price, nor a major obstacle related to intellectual property rules, nor a deficit in bio-medical research. However, these three topics are generally at the heart of MSF's communication in the area of access to medical care for those in most need. Our discourse must therefore evolve.
With the emergence of worrying variants of the virus present in the early stages of the pandemic and, as a consequence, the need to vaccinate on a global scale as quickly as possible, the world is facing a double challenge: biological engineering and ultra-industrial production – “ultra” echoing the need to produce on a global scale in a short period of time.

In this paper, the two authors examine certain aspects of the French response to the epidemic in the light of the experience of Médecins Sans Frontières (MSF) in that field, primarily with respect to the relationship between the actors of the response and the beneficiaries.

After a few months of respite the coronavirus epidemic has resumed its spread. With the second wave becoming a reality in many European countries, the Crash team decided to share some recent reading on the biomedical, political and social aspects of the pandemic in an attempt to shed some light on this tragic Season 2. As in previous editions, some articles are in English and some in French, and they are taken from both mainstream and specialist sources.

In France, from March onwards, many sociologists regularly appear in the media. Based on this observation, Marc Le Pape analysed 37 articles written during the containment period, dealing with the Covid-19 pandemic.

Crisis situation, response strategies, hydroxychloroquine, interventional epidemiology and the state of scientific research in Africa: Elba Rahmouni interviews Emmanuel Baron, Director of Epicentre, Médecins Sans Frontières

Crisis situation, response strategies, hydroxychloroquine, interventional epidemiology and the state of scientific research in Africa: Elba Rahmouni interviews Emmanuel Baron, Director of Epicentre, Médecins Sans Frontières

The biggest oversight in the response to this epidemic has been the EHPADs. For the staff, the directive was clear: continue to work and provide an alternative to hospitalisation. No matter the conditions. For the residents, it was to die alone without treatment to alleviate their suffering.

In exceptional circumstances where the demand for care exceeds the supply, how do you decide who to start with? Triage is necessary where there is exceptional demand, leading to the use of a specific procedure to establish priorities. Interview of Jean-Hervé Bradol conducted by Elba Rahmouni based on the article “In a disaster situation: get your bearings, triage and act” published in the book La médecine du tri. Histoire, éthique, anthropologie edited by Céline Lefève, Guillaume Lachenal and Vinh-Kim Nguyen.