INNOVATIONS WITH IMPACT

How Doctors Without Borders is pushing medical boundaries to save lives.

Doctors Without Borders is dedicated to providing the highest-quality medical care to people trapped in the worst-imaginable crises—no matter how remote or unforgiving the environment.

Delivering the best possible care to our patients demands constant questioning, unsparing self-examination, and a relentless drive to push the boundaries of medical practice when we know we can do better. Here are a few of the ways we've been innovating to reach more people, deliver better care, and save more lives.

3-D PRINTED PROSTHETICS:
Healing Wounds of War in the Middle East

Ahmed (left) during a consultation for his new prosthetic arm © Economist Films

Ahmed was 14 years old when he lost his left arm.

“I had gone out to press olives,” remembers the young Syrian. “We were on our way home. A plane flew by and dropped a barrel bomb that exploded, and shrapnel hit my hand. I looked at my arm. It was completely torn off. I asked myself, ‘What’s going to happen to me now? It’s finished. I’m dead.’”

Ahmed made it to a hospital run by Doctors Without Borders in Amman, Jordan. Through the hospital’s reconstructive surgery program, Ahmed was among the first patients to receive a custom-designed prosthetic arm created by a 3-D printer.

Printed layer by layer, from shoulder socket to fingertips, the multi-part device was made to fit Ahmed’s body and lifestyle.

To make sure it works well, the new arm went through a testing and refinement process. For Ahmed, it’s a step toward a future he once thought had been taken from him.

“When I grow up, I would love to become an engineer and build a house,” he says. “Just as soon as I go home to our country. I want to live a proper life. A beautiful life. That’s it.”

Testing 3-D Printed Prosthetics

Haidar, 42, arrived at the Amman hospital in early 2017 with his right forearm amputated and left leg severely injured and infected following a car bomb explosion in Baghdad. Six months and eight operations later, Haidar is walking independently
 and able to move his arm without pain. © Florian Seriex\/MSF

Haidar, 42, arrived at the Amman hospital in early 2017 with his right forearm amputated and left leg severely injured and infected following a car bomb explosion in Baghdad. Six months and eight operations later, Haidar is walking independently and able to move his arm without pain. 
© Florian Seriex/MSF

In 2017, the MSF Foundation introduced the 3-D printing project to develop prosthetics. Over the past decade, the Amman hospital has become a hub for medical innovation, offering a holistic package of services and cutting-edge solutions to the extraordinary medical challenges that its patients face.

For war-wounded patients in need of prosthetics, 3-D printing has become a game-changer. They can be created in less than 24 hours at a fraction of the cost of traditional devices, and 3-D printed prosthetics are tailored to each patient’s anatomy and needs with the help of a physiotherapist.

Using digital imaging techniques and software, the team works with the Irbid Fab Lab to quickly and inexpensively design customized, modular prosthetics using a combination of plastics. Costing as little as $30, these tailor-made options are designed to be more useful to individual patients and save time and money.

“For each patient we sit down and interview them to determine their current condition and the specific activities they would like to return to their lives—such as driving a car, working in the field, or working at home.”

Safa Herfat, Doctors Without Borders biomedical engineer

The process is quite a departure from using traditional prosthetics, which cost hundreds of dollars, require extensive maintenance and demand a one-size-fits-all approach.

“We are looking to design devices … that can be delivered to patients in austere environments or areas where there is limited or no access to prosthetic care,” Herfat says. While the Doctors Without Borders project is still a work in progress, the goal is to expand to meet the needs of more of our patients.

POCUS:
Bringing the Revolutionary Potential
of Ultrasound to South Sudan

MSF health workers perform an ultrasound examination at Aweil General Hospital, South Sudan. ©Yann Libessart/MSF

If a patient at Aweil General Hospital in South Sudan needs an X-ray, it’s a bumpy, 15-minute drive along an unpaved road to the nearest working machine.

“The risk of transporting an unstable child is frequently too high, even if it can get us additional clinical information to guide the proper treatment.”

Dr. Adi Nadimpalli, former MSF-USA Board vice president.

In this remote corner of the country, some 1.5 million people depend on the Aweil hospital where Doctors Without Borders runs the pediatric and maternity departments in cooperation with South Sudan’s Ministry of Health. But a lack of trained medical professionals and basic diagnostic tools means relying on observed and reported symptoms—and educated guesswork— to make a diagnosis.

A Technology Revolution

To address these limitations, MSF’s Transformational Investment Capacity (TIC) initiative is funding a project to implement point-of-care ultrasound (POCUS) in the field.

An MSF doctor examines an ultrasound image at Aweil General Hospital. © Adriane Ohanesian\/MSF

An MSF doctor examines an ultrasound image at Aweil General Hospital.
 © Adriane Ohanesian/MSF

Older ultrasound machines were large, expensive, and complex, meaning only experts were trained to use them. But newer models are highly portable, affordable devices that use a simplified process of evaluating POCUS images. This means that general clinicians at all levels can learn basic ultrasound skills, making it possible
to deploy POCUS technology in the most remote locations.

The project launched in early 2017 with a feasibility study in Aweil hospital and aimed to show how all medical staff, not just doctors, could use ultra sound simply and accurately.

Stephanie Mayronne, the New York-based medical operations manager for South Sudan, says the goal is to empower local staff. Previously, only the hospital’s OB-GYN or the midwife supervisor—typically international staff—could perform ultrasounds. “Now, South Sudanese midwives will also be able to utilize POCUS—a huge asset in a hospital that delivers 400 babies per month,” she says.

It’s a MUST:
Providing Emergency Surgery on the Go

Construction of the MUST in the Netherlands. © Piotr Hleb-Koszański/MSF

As fighting flared in Mosul, Iraq, in late 2016, Doctors Without Borders faced a challenge: How could medical teams get the wounded into surgery in time, despite shifting battle lines? The solution—to bring the operating room to the front—would require ingenuity.

The job fell to project coordinator Arnaud Badinier, who envisioned a mobile surgical facility that could be packed up and moved quickly if the fighting got too close.

Working with a team that included two other experienced logisticians and a nurse, he had just two weeks to design the MUST—a Mobile Unit Surgical Trailer.

Within months, the MUST was built and deployed to a village just south of Mosul, making it the closest surgical facility to the front line. The first patients were treated on February 16, 2017.

MUST fully deployed. ©Piotr Hleb-Koszański \/ MSF

MUST fully deployed. ©Piotr Hleb-Koszański / MSF

Designed to act as an operating theater, intensive care unit, pharmacy, and storage on wheels, the mobile unit gives Doctors Without Borders staff the flexibility to quickly reach people in need of lifesaving trauma surgery while ensuring hygienic, temperature-controlled conditions. Getting the space ready to treat patients takes less than three hours.

“The benefit of this project is the mobility. It’s easier to reach patients in really complex situations, and that gives the team the ability to deploy a full set of tools quickly and efficiently.”

Arnaud Badinier, Doctors Without Borders project coordinator
Inside the operating theater of the MUST deployed in Iraq. © Piotr Hleb-Koszański

Inside the operating theater of the MUST deployed in Iraq. 
© Piotr Hleb-Koszański

In its first five weeks of service alone, the MUST in Mosul treated more than 1,800 patients, including 1,200 in need of surgery.

Based on feedback from staff in Mosul, Doctors Without Borders has now created the MUST2, a higher-capacity, 16-module unit that’s currently waiting to be sent to the field. The new unit gives doctors more room to operate and doubles the number of operating theaters and intensive care units.

“We are not changing how we provide care... We are only changing how we go to the field to provide that same quality care regardless of the environment around us,” says Olivier Delbauve, project coordinator for the 16-module MUST. “Now we can be completely autonomous. Now Doctors Without Borders is able to reach patients everywhere in the world—by road, by boat, by air.”

Building hospitals, pushing boundaries

© Yann Libessart

Slashing the time it takes to reach patients

Doctors Without Borders deploys inflatable hospitals to reach patients quickly during emergencies. Photo credit: Caroline Van Nespen

Doctors Without Borders deploys inflatable hospitals to reach patients quickly during emergencies. Photo credit: Caroline Van Nespen

Imagine barely surviving an earthquake, or narrowly escaping a brutal armed conflict, only to find the nearest hospitals destroyed or overwhelmed at the very moment you desperately need medical attention. That is the reality for many of Doctors Without Borders' patients.

So in 2004, when Doctors Without Borders teams saw the Italian Army using inflatable tents during the response to the tsunami in Southeast Asia, we immediately recognized their potential for us. We searched out the manufacturer, adapted the design, and began equipping our teams with state-of-the-art inflatable field hospitals—dramatically reducing the time it takes to begin providing trauma surgery and post-operative treatment.

The future of hospital design

Jean Pletinckx, Director of Logistics with Doctors Without Borders, explains the proof of concept behind the 3D printed hospital. © Alex Yallop

Jean Pletinckx, Director of Logistics with Doctors Without Borders, explains the proof of concept behind the 3D printed hospital. © Alex Yallop

Based on the success of our MUST, our technical teams are now hard at work adapting virtual reality and 3-D printing technology to improve how teams design, build, and train to work in brick-and-mortar field hospitals.

Standard practice for Doctors Without Borders when designing a hospital involves the medical and logistical teams working around 2-D drawings, but this could soon be a thing of the past.

“The idea of this project was really to see how we can make use of 3-D printing technologies and virtual reality to help better design our hospitals,” said Elvina Motard, Technical Team Leader.

To complete the proof of concept, Motard worked with expert consultants to digitize existing plans for a hospital built by Doctors Without Borders in the Philippines following Typhoon Haiyan in 2013. Then, they used 3-D printing and developed a virtual reality experience to enable anyone equipped with a headset to walk through the hospital.

"There is no doubt that this is the way we will work in the future."

Jean Pletinckx, Director of Logistics with Doctors Without Borders

“Such technologies will undoubtedly make discussions more efficient, more vivid, and more graphic,” said Jean Pletinckx, Director of Logistics. “They will allow people to really see themselves inside our future hospital, and this will improve hospital design as well as training and briefings. It will also allow our partners, like local ministries of health, to better understand what we can provide and better feed back on our suggestions.”

While this first effort was a proof of concept modeled on an already built and working hospital, soon Doctors Without Borders will be able to send 3-D models digitally anywhere in the world during the planning stages. Field staff will be able to view and evaluate designs before they're built, ensuring construction is done as efficiently as possible.

The virtual reality hospital experience will allow users anywhere in the world to visit a hospital in the field, offering the potential to improve hospital design, trainings, and briefings.  ©  Alex Yallop

The virtual reality hospital experience will allow users anywhere in the world to visit a hospital in the field, offering the potential to improve hospital design, trainings, and briefings.  ©  Alex Yallop

“As the project develops further, it will be possible to create a dynamic environment, simulating patient and staff movements,” says Jean Pletinckx. “We are at a stage now where our staff will really be able to feel or see what they will face in the field before they leave and indeed, even before the structure is built. There is no doubt that this is the way we will work in the future.”

DRONES:
A game-changer in emergency response

© Morgana Wingard

No maps. No way to find people in need. No time to waste. When crisis strikes an area that doesn’t appear on any map, it’s time to innovate.

From the skies, lightweight Unmanned Aerial Vehicles (UAVs), also known as drones, offer Doctors Without Borders an efficient, low-cost way to fill in the gaps in existing maps. This dramatically enhances our ability to find and treat patients in underserved, remote regions.

In Makhanga island in the south of Malawi, we’ve used UAVs to capture detailed images of an area frequently cut off from aid during seasonal floods. With the help of local partners, we now have a clearer picture of the area, which will save valuable time and resources the next time flood season strikes.

“We could even imagine using imagery to create virtual reality apps to remotely support people in emergencies when human access is impossible.”

Raphael Brechard, Doctors Without Borders mapping coordinator

In the remote communities outside Kerema town in Papua New Guinea, periods of heavy rain caused an unpaved access road to turn to deep clay mud. Without any other method of safe access, Doctors Without Borders trialed the use of small quadcopter drones to transport lab samples from patients with suspected tuberculosis back to Kerema general hospital.

Drones offer huge potential to anticipate and enhance emergency responses, especially in hard-to-access areas.

Looking forward, drones could help Doctors Without Borders address many complex problems, from monitoring volatile situations on the ground, to transporting medicines and lab samples in areas with no roads, to planning the layout of a large camp in an isolated area.

“We could even imagine using imagery to create virtual reality apps to remotely support people in emergencies when human access is impossible,” says Raphael Brechard, the Doctors Without Borders mapping coordinator in Makhanga. “The possibilities are endless.”

SMARTPHONES:
Putting Patients on the Map

On MSF's new app ‘MapSwipe’ users choose a crisis prone part of the world they want to help, such as spotting villages at risk from a cholera outbreak in the Democratic Republic of Congo © MSF

To deliver lifesaving services in a humanitarian crisis, you need to find the people most in need. But for millions of people around the world, their homes aren’t represented on any accessible map.

That’s why the Missing Maps Project, a partnership between Doctors Without Borders and other humanitarian organizations, created the MapSwipe mobile app.

By letting users search satellite imagery for features like houses and roads, the free app helps to map the most vulnerable places in the developing world, identifying population centers so that groups like Doctors Without Borders can plan humanitarian responses.

Microscopic Photography

Lab technician Christophe KIKWABANTU at the laboratory of Walikale Hospital, North Kivu © Gwenn Dubourthoumieu

Lab technician Christophe KIKWABANTU at the laboratory of Walikale Hospital, North Kivu © Gwenn Dubourthoumieu

Imagine you’re a Doctors Without Borders doctor. You’re working in a basic hospital in a remote location and a patient arrives with a dangerously high fever. Over the next few days you cycle through the most likely treatment options, but nothing seems to work. Your patient’s lab tests show results that no one at the hospital has seen before. What do you do?

Until recently, biomedical scientists in Doctors Without Borders projects had to pick up a phone and verbally describe the images seen through microscopes to get advice from colleagues overseas. To solve this problem, Doctors Without Borders is testing adapters that will enable medical field staff to use their smartphone cameras to capture high-quality photomicrographs—images of specimen slides as seen through a microscope. Using telemedicine, these photos can be shared with Doctors Without Borders staff and other experts around the world for quick and effective consultations.

Better ways to combat deadly outbreaks

© Michael Goldfarb

Cholera: building on breakthroughs that save lives

A boy in Zambia receives a dose of the cholera vaccine. Photo credit: Laurence Hoenig / Doctors Without Borders

A boy in Zambia receives a dose of the cholera vaccine. Photo credit: Laurence Hoenig / Doctors Without Borders

While treatment for cholera is simple, often requiring nothing more than rehydration, outbreaks can spread extremely fast and untreated infections can kill within hours. So when we saw people around the world affected by the millions and dying by the thousands year after year—with no way to shield themselves from infection—we knew we had to do better.

One of our biggest breakthroughs came in 2012, when Doctors Without Borders teams mounted the first-ever large-scale vaccination campaign at the onset of a cholera outbreak in Guinea—a radical new approach now proven to be effective, and poised to save countless lives.

"We were faced with an outbreak and we wanted first to protect people by vaccinating them, and to limit the spread of cholera," said Dr. Dominique Legros, Doctors Without Borders’ innovation initiative manager in Geneva. "Doctors Without Borders is regularly involved in responding to cholera outbreaks and it is always difficult to control the disease. Because cholera evolves quickly, oral vaccination provides us with a new tool to try to contain [it]. If we can control the most active spots, we can reduce the spread of cholera."

Building on that discovery, our teams continue testing new ways to fight cholera: distributing home water filters, using half the vaccine doses on twice as many people to rapidly maximize herd immunity, and, most recently, ensuring that more people take their second vaccine dose by sending it home with them to administer themselves. In 2016, in response to an outbreak in Zambia, our teams launched the largest-ever "single-dose" cholera vaccination campaign, targeting over half a million people.

A child in Democratic Republic of Congo receives a measles vaccine. Doctors Without Borders proved to the World Health Organization that measles vaccination campaigns can halt otherwise devastating outbreaks—even after they've begun. Photo credit: Haavar Karlsen

A child in Democratic Republic of Congo receives a measles vaccine. Doctors Without Borders proved to the World Health Organization that measles vaccination campaigns can halt otherwise devastating outbreaks—even after they've begun. Photo credit: Haavar Karlsen

Measles: changing the way the world fights back

Measles is one of the leading causes of death among young children. It's also highly contagious—90 percent of people who share living spaces with an infected person will catch it. For years, World Health Organization (WHO) guidelines assumed that measles was simply too contagious and fast-moving to advise vaccinating people once an epidemic has begun. Despite a cheap and effective vaccine, our teams watched as this disease killed too many of our patients—many of them young children.

So we decided to test WHO's recommendation for ourselves. We vaccinated hundreds of thousands of children for measles after outbreaks had already begun—and it worked. Through field research across multiple studies, we documented the clear preventive benefits of widespread vaccination after an outbreak starts, especially for children. We made our case to WHO and they changed their guidelines in 2009, just one year before a major measles resurgence across Africa.

Today, with global measles deaths down 75 percent, Doctors Without Borders continues mounting mass-vaccination campaigns to fight measles outbreaks around the world, even in the most remote settings. During a particularly devastating epidemic in Democratic Republic of Congo last year, our teams vaccinated nearly a million children against this potentially fatal disease.

An MSF doctor consults with a patient receiving treatment for extensively drug-resistant tuberculosis in Mumbai, India. © Atul Loke/Panos Pictures

An MSF doctor consults with a patient receiving treatment for extensively drug-resistant tuberculosis in Mumbai, India. © Atul Loke/Panos Pictures

Drug-resistant Tuberculosis

Imagine taking nearly 15,000 pills over two years, with possible side effects ranging from deafness to psychosis. For years, that has been the reality for patients living with drug-resistant tuberculosis (DR-TB).

In 2013, we implemented a shortened treatment course for DR-TB in Uzbekistan. We saw that the shortened regimen was easier for patients to stick to, reducing disruption in their lives. By 2016, after large-scale studies conducted by Doctors Without Borders and other groups, the World Health Organization recommended that all countries move toward shorter regimens.

An unwavering focus on patient care

Will it produce higher-quality care? Can we scale it up to reach more people? Will it help us respond faster and save more lives?

These are the questions we ask ourselves about every new approach we consider adopting in the field—always focused on what will make the biggest difference for our patients.

All too often, the humanitarian crises we face are compounded by tools, techniques, and medicines ill-suited to the challenging conditions in which we work. So if there is an opportunity to respond faster, deliver better care, or reach more people, we need to seize it.

Because our teams are on the front lines of medical emergencies all across the globe, we have a direct window into the daily realities of our patients' lives. We not only see firsthand the difficulties they confront in trying to reach emergency medical care, we experience for ourselves the challenges of providing first-rate care in the field.

As a result, we are constantly examining our models of care, challenging medical norms that fail our patients, and inventing or adapting the best available tools and technology to some of the most unforgiving environments on earth.

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