MSF Paediatric Days https://paediatrics.msf.org/rss.xml en Treating children with chronic diseases in Hawija, Iraq https://paediatrics.msf.org/news/treating-children-chronic-diseases-hawija-iraq <span>Treating children with chronic diseases in Hawija, Iraq</span> <div> <div> <div class="my2 md-my3"> <div><article> <div> <img class="fit" src="/sites/default/files/styles/embed_medium/public/Iraq%201.jpg?itok=DoCCh4PZ" width="980" height="652" typeof="foaf:Image" /> </div> </article> </div> </div> </div> <div> <div class="my2 md-my3 bold"> <div><p>A nurse during a consultation with a patient affected by a chronic disease, in Hawija Primary Healthcare Centre supported by MSF  ©MSF</p></div> </div> </div> <div> <div class="my2 md-my3 bold"> <div><p><em>Hawija district, in northern Iraq, has been profoundly affected by years of conflict and insecurity, and most recently the long siege and subsequent military offensive of 2017. <strong>Dr Britta Koelking, </strong>MSF’s medical activity manager in Hawija, describes her team’s work with children with non-communicable diseases.</em></p></div> </div> </div> </div> <span><span lang="" about="/user/54" typeof="schema:Person" property="schema:name" datatype="">Elise D</span></span> <span>Mon, 08/26/2019 - 11:03</span> <div> <div> <div class="my2 md-my3"> <div><p>“Seven percent of our current patients are children under 18 years old. The three main diseases we treat among children are epilepsy, diabetes mellitus type 1 and asthma.</p> <p>For each patient referred to us, MSF double-checks the diagnosis; sometimes this requires a referral to the hospital for specialised diagnostic testing.</p> <p>After the diagnosis is confirmed, we make a treatment plan and provide the medication required. Sometimes we also diagnose and treat acute and long-term complications such as hypertension, blindness and chronic infections.</p> <p>One of the most common chronic diseases in children is diabetes mellitus type I, a chronic condition in which the pancreas produces little or no insulin, a hormone needed for glucose to enter cells to produce energy. </p> <p>With diabetes, it’s very important for patients to understand the reasons why their blood sugar levels change so much. This helps them deal with the disease, understand the long-term need for a special diet, and understand the reason for injecting themselves with insulin regularly. But this process isn’t always easy, especially with children.</p> <p>With diabetes in children, a high level of self-discipline is required at a young age. It imposes a need to pay attention to what they can or can’t eat, for instance, and a different lifestyle. They have more responsibilities for their self-care than other children, and they have to realise that they’ll be dealing with this disease for a lifetime. This can be hard to accept at such a young age.</p> <p>Sadly, we see severe complications at a young age, for example impaired vision or even blindness. These can be avoided through good health education, proper follow-up and adapting their treatment plan.</p> <p>I have also seen chronic ulcers on the feet and cardiovascular diseases in this young group of patients.</p> <p>Children in our clinics tell us that they often feel shy about injecting insulin when they are at school. We have seen cases where parents take their children out of school because they are afraid that the child might be stigmatised or might suffer one of the acute complications of diabetes, such as hypoglycaemia – a severe acute side effect of treatment with insulin. Mild hypoglycaemia shows symptoms like sweating, shaking, dizziness and confusion. Severe hypoglycemia may lead to coma, brain damage and death.</p> <p>It breaks my heart to see these children taken out of school, as the lack of education could create additional problems for them.</p> <p>Adapting the lifestyle of a child with diabetes means adapting the lifestyle of the whole family. Meals have to be prepared differently and food must be eaten regularly. Sweets and sugared drinks should be avoided. Families here in Iraq generally live and eat together, so it can be difficult for them to change the diet of a single person in the family.  </p> <p>A big challenge with chronic diseases in general, and with diabetes especially, is that patients often do not understand the danger of the disease, as the long-term complications are not evident at first. The complications often do not start to appear for 10 or 20 years. This can make it very difficult to convince a person that she or he needs to take their medication or stick to their diet plan – particularly when some families are still facing the aftermath of the conflict. They may have lost loved ones or be struggling to get back to normal. Many households lack incomes because of unemployment. For the children, who depend on their parents and wider family, patient education needs to be carried out not just for the child but for the whole family.</p> <p>Even though children with chronic diseases don’t seem, on first sight, to be that sick, neglecting their health education on lifestyle changes and the proper treatment of chronic diseases may result in severe life-threatening complications at a young age.</p> <p>Severe complications include cardiovascular disease, as there is a high risk of heart attacks at a young age; cerebrovascular disease, as there is a particular risk of strokes at a young age; diabetic nephropathy, or renal failure, which makes dialysis necessary; severe infections, especially in the feet, which can no longer be treated by antibiotics and could lead to amputation of the feet or legs. All of these could have a big impact on the patient and their family.    </p> <p>Chronic diseases are conditions which normally have a long duration and may have lifelong consequences. In addition, patients often don’t feel unwell and, for this reason, they may deviate from the agreed treatment plan.</p> <p>This is why we provide not only treatment and medications in our clinics, but also psychosocial support and health education. They are all part of our holistic approach to chronic disease management. Mental health counsellors support the patients through their medical process, while health education sessions are a fundamental tool for raising awareness about  the importance of taking treatment regularly and having a healthy lifestyle.”</p> <p><em>MSF started activities in Hawija in 2009 and is currently responding to the lack of healthcare services in the district. MSF teams currently work in Hawija and Abassi primary health centres, where they provide treatment for non-communicable diseases, health promotion sessions and mental healthcare. MSF also supports the district’s main referral hospital with maternity care, emergency care, laboratory activities and infection prevention and control measures.</em></p> <p><em>In 2018, MSF provided consultations and treatment to more than 2,900 patients living with chronic diseases in Hawija and Abassi.</em></p></div> </div> </div> <div> <div class="my2 md-my3"> <div><article> <div> <img class="fit" src="/sites/default/files/styles/embed_medium/public/Iraq%202.jpg?itok=Yc56h_HF" width="980" height="649" typeof="foaf:Image" /> </div> </article> </div> </div> </div> <div> <div class="my2 md-my3"> <div><p>Hawija Primary Healthcare Centre supported by MSF. An MSF health promoter runs an education session about non-communicable diseases in the waiting room.  © MSF</p></div> </div> </div> </div> Mon, 26 Aug 2019 09:03:18 +0000 Elise D 58 at https://paediatrics.msf.org Treating children with chronic diseases in Pulka, Nigeria https://paediatrics.msf.org/news/treating-children-chronic-diseases-pulka-nigeria <span>Treating children with chronic diseases in Pulka, Nigeria</span> <div> <div> <div class="my2 md-my3"> <div><article> <div> <img class="fit" src="/sites/default/files/styles/embed_medium/public/Nigeria1.jpg?itok=6UGPClqm" width="980" height="654" typeof="foaf:Image" /> </div> </article> </div> </div> </div> <div> <div class="my2 md-my3 bold"> <div><p>People walk around a compound in Pulka town, northeast Nigeria, where MSF runs a hospital  © Igor Barbero/MSF</p></div> </div> </div> <div> <div class="my2 md-my3 bold"> <div><p><em>Pulka, a town in the Nigerian state of Borno, hosts more than 40,000 internal displaced people who have fled the long-running conflict in the area. Dr </em><strong><em>Kathrin Kramer, </em></strong><em>MSF’s medical activity manager in Pulka,</em><em> describes her team’s work with children with non-communicable diseases.</em></p> <h4><strong>"THE FIRST CHALLENGE TO ASSISTING THESE PATIENTS IS TO IDENTIFY THEM"</strong></h4> <p><em>By MSF doctor Kathrin Kramer in Pulka</em></p></div> </div> </div> </div> <span><span lang="" about="/user/54" typeof="schema:Person" property="schema:name" datatype="">Elise D</span></span> <span>Mon, 08/26/2019 - 10:54</span> <div> <div> <div class="my2 md-my3"> <div><p>“The cases I have seen during my two-month stay are mainly children with sickle cell disease and asthma. In this situation, where are ability to diagnose and treat patients is limited, helping parents, carers and wider families to detect and prevent the possible complications of chronic diseases early is a very important tool.</p> <p>The first challenge in this setting is to identify children with non-communicable diseases. Many parents and carers only seek medical help when there is an emergency and the child is already in very bad condition. For example, I recall several cases of children who, in the beginning were treated for respiratory infections. It was only later, after frequent visits to the outpatient department for coughs, and later in the emergency room with asthmatic attacks, that we recognised them as chronic asthmatic patients.</p> <p>We usually see children with chronic diseases during an emergency so we treat them in the hospital. After that, we invite them to come back for follow-up consultations. But access to good chronic treatment is also a challenge, as the proper medication is not always available. We provide child patients with chronic asthma with inhalators and teach them how to use it. For children that are too young to use the regular inhalers, we provide improvised spacers, a device or tube used to increase the ease of administering medication from an inhaler. The most important part is that we teach both the parents and children how to use it in case of an asthmatic attack.</p> <p>A key component in the treatment of child patients is educating their parents, so they are able to identify the early symptoms of complications and emergencies linked to the disease. Our goal is for carers to be able to provide good assistance to their child at home and to quickly seek out for medical treatment at the hospital in case of difficulties. We explain them how they can detect early on that the child is having difficulty breathing. We also inform them about some risk factors that are related or known to trigger or worsen complications, for example cooking with fire in a closed room.</p> <p>Sometimes it is difficult to explain to them the condition of the child and the disease. We are working in a place where education levels are low and, in some cases, there are problems with language barriers. As with a lot of displaced communities, there are often households with only one carer for several children. There are multiple daily challenges, like shortages of water, that they also have to deal with. In these conditions it is sometimes hard to focus on one child that needs more attention. However, we receive strong support from our social workers, and mental health and health promotion teams. They are able to explain to carers what is important to take into consideration and can support them to cope with the challenges that are caused by a chronic disease.”</p> <p><em>Pulka is completely controlled by the military and people’s movements are limited. There have been severe shortages of food, water and shelter, and some basic needs remain unmet. In this context, with no presence of governmental health actors, MSF is providing primary and secondary healthcare to displaced people and the host community. Among the patients MSF is treating in Pulka, there are cases of children with non-communicable diseases. There were up to 13 consultations for chronic asthma child patients per months in 2018.</em></p></div> </div> </div> <div> <div class="my2 md-my3"> <div><article> <div> <img class="fit" src="/sites/default/files/styles/embed_medium/public/Nigeria2.jpg?itok=gnjGJbXt" width="980" height="551" typeof="foaf:Image" /> </div> </article> </div> </div> </div> <div> <div class="my2 md-my3"> <div><p>MSF’s hospital in Pulka town, northeast Nigeria.  © Santiago D. Risco/MSF</p></div> </div> </div> </div> Mon, 26 Aug 2019 08:54:46 +0000 Elise D 57 at https://paediatrics.msf.org Pediatric hackathon - addressing pediatric field challenges https://paediatrics.msf.org/news/pediatric-hackathon-addressing-pediatric-field-challenges <span>Pediatric hackathon - addressing pediatric field challenges</span> <div> <div> <div class="my2 md-my3"> <div><article> <div> <img class="fit" src="/sites/default/files/styles/embed_medium/public/Social%20Media_Hackathon-05_0.jpg?itok=PESG_goq" width="980" height="582" typeof="foaf:Image" /> </div> </article> </div> </div> </div> <div> <div class="my2 md-my3 bold"> <div><p>The Sweden Innovation Unit (SIU) initiated the Pediatric Innovation Hackathon in April 2019 in an effort to capitalize on the external and internal knowledge base available in Stockholm for the annual MSF Pediatric Days which were held with a global MSF pediatric cohort the day after the hackathon.</p></div> </div> </div> </div> <span><span lang="" about="/user/54" typeof="schema:Person" property="schema:name" datatype="">Elise D</span></span> <span>Mon, 08/26/2019 - 10:37</span> <div> <div> <div class="my2 md-my3"> <div><p>At the MSF Sweden Innovation Unit (SIU), we practice a human-centered design approach to innovation projects. Essentially this means that we strive to consistently put end-users first and ensure their needs are properly researched, understood and analysed as the first stage of any MSF SIU innovation project.</p> <p>Since 2015 the SIU has been exploring different innovation cases brought forward by MSF field staff, and others within the organisation, looking to scale potential solutions for challenges they have identified first hand. In order to do this, the SIU champions a three-step process of initiation, development, and implementation.</p> <p>The SIU initiated the Pediatric Innovation Hackathon in April 2019 in an effort to capitalize on the external and internal knowledgebase available in Stockholm for the annual MSF Pediatric Days which were held with a global MSF pediatric cohort the day after the hackathon. The presence of the core Pediatrics Days being held in Stockholm meant that broader Pediatric challenges, current care practices, and incoming priorities were being discussed by a broader MSF community signalling an opportune moment to engage this group and the wider movement in the Innovation Unit efforts to accelerate pediatric care practices of the future.</p> <p>Through a series of semi-structured interviews with key stakeholders across the movement the SIU shortlisted a number of themes identified by stakeholders and grouped these into challenges that could fit the structure of a Hackathon.</p> <p>The challenges identified through interviews with MSF stakeholders were the following:</p> <p>1. Non-insecticidal community-based Malaria Prevention</p> <p>2. Creative Wound Dressing and Management</p> <p>3. Fluid Management in Neonatal Care</p> <p>4. Child-Friendly Spaces and Interventions</p> <p>Read the Pediatric Hackathon Round-Up Document: <a href="https://static1.squarespace.com/static/5a8e96a9017db281d70a3ace/t/5d495debb398e50001d863ea/1565089313247/Round-up_V3.pdf" id="yui_3_17_2_1_1566808719457_5017" target="_blank">VIEW PDF HERE</a></p></div> </div> </div> </div> Mon, 26 Aug 2019 08:37:48 +0000 Elise D 56 at https://paediatrics.msf.org Pediatrics in a humanitarian context: the work is just beginning https://paediatrics.msf.org/news/pediatrics-humanitarian-context-work-just-beginning <span>Pediatrics in a humanitarian context: the work is just beginning</span> <div> <div> <div class="my2 md-my3"> <div><article> <div> <img class="fit" src="/sites/default/files/styles/embed_medium/public/2017ok1.jpg?itok=-GV3t43S" width="980" height="654" typeof="foaf:Image" /> </div> </article> </div> </div> </div> <div> <div class="my2 md-my3 bold"> <div><p><strong><em>In December 2017, Medecins Sans Frontières invited the pediatric community for a 2-day conference to investigate ways of providing better care in humanitarian contexts for the most vulnerable patients: children.</em></strong></p></div> </div> </div> </div> <span><span lang="" about="/user/54" typeof="schema:Person" property="schema:name" datatype="">Elise D</span></span> <span>Mon, 08/26/2019 - 10:32</span> <div> <div> <div class="my2 md-my3"> <div><p><strong>"How to deliver quality pediatric health care in humanitarian settings without pediatricians?</strong></p> <p>This is the question that was posed during the Pediatric Days, organized in Dakar on December 15th and 16th 2017, by the international medical humanitarian organisation Médecins Sans Frontières (MSF).</p> <p>Children are one of the most vulnerable groups in humanitarian settings. They are at risk in regard with diseases, complications and death. Conflicts, political insecurity, natural disasters, displacement, and challenging economic conditions all restrict access to health care and thus increase the vulnerability of younger patients. In addition, limited resources in the field, such as insufficient paediatricians and pediatric nurses, poorly trained caregivers who lack knowledge in the specificity and needs of children, limited context-specific protocols and tools, and a shortage of medication, all create many challenges that complicate interventions on the ground.</p> <p>"We have done a lot to increase our paediatric capacity within our emergency medical organisations. However, insecurity - which characterizes many of the contexts in which we operate - limits our capacity to send paediatricians to these areas”, explains Cristian Casademont, Head of the Operational Medical Unit, MSF. "If we only have one paediatrician, which priorities should we focus on? That is the big question: how can we do things effectively to better care for our youngest patients?"</p> <p> </p> <p><strong>Sharing experience to improve the quality of paediatric care in humanitarian settings</strong></p> <p>Participants exchanged their experiences and insights on paediatric work in low resource settings. The main topics included perinatal asphyxia, paediatric neurocritical care, pain management, and supportive care. All of them are areas in which great improvement is both needed and feasible. Additionally, free paper sessions have been offered, including one focused on malnutrition, as well as two training workshops.</p> <p>According to Marc Gastellu Etchegorry, former international medical secretary of MSF and researcher at Epicenter, who also participated to the conference, "MSF has a responsibility to conduct more research and always look for ways to innovate. But the research should not end with publications: it must lead to the implementation of tools adapted to our areas of intervention, or a critique to ultimately improve our practices to better support our patients”.</p> <p><strong>Results of this second edition</strong></p> <p>210 people gathered for this second edition of the MSF Paediatric Days and more than 1.500 followed the online streaming. Physicians, paediatricians, midwives, nurses and researchers have drawn some recommendations in order to improve paediatric health care in humanitarian settings.</p></div> </div> </div> </div> Mon, 26 Aug 2019 08:32:57 +0000 Elise D 55 at https://paediatrics.msf.org The MSF paediatric days: an opportunity to acquire new paediatric knowledge https://paediatrics.msf.org/news/msf-paediatric-days-opportunity-acquire-new-paediatric-knowledge <span>The MSF paediatric days: an opportunity to acquire new paediatric knowledge</span> <div> <div> <div class="my2 md-my3"> <div><article> <div> <img class="fit" src="/sites/default/files/styles/embed_medium/public/MSF233533_Medium.jpg?itok=lZjjfgW9" width="980" height="654" typeof="foaf:Image" /> </div> </article> </div> </div> </div> <div> <div class="my2 md-my3 bold"> <div><p><em><strong>Dr Nematoulaye Toure graduated in Bamako in 2012 and quickly started working with Médecins Sans Frontières in Ansongo,  Mali. Dr Nematoulaye is currently in charge of neonatology and paediatrics in this project. She participated in the MSF Paediatric Days, held on 15 and 16 December 2017 in Dakar, Senegal. This conference was an opportunity to share her field experience with the medical community in West Africa and to gain experience in organised training; knowledge which she now shares with her team in Mali. </strong></em></p></div> </div> </div> </div> <span><span lang="" about="/user/54" typeof="schema:Person" property="schema:name" datatype="">Elise D</span></span> <span>Mon, 08/26/2019 - 10:25</span> <div> <div> <div class="my2 md-my3"> <div><p><strong>What are the main challenges to improving the management of childhood diseases in West Africa and, more specifically, in Mali?</strong></p> <p>Ansongo, in the region of Gao in eastern Mali, is today a very volatile area in which insecurity prevails due to the conflict that erupted in 2012. The biggest challenge is getting access to patients. There are still numerous cases of women giving birth without medical care, which poses great risks for newborns. There is also many young children with severe malaria.</p> <p>With a night-time curfew and a distance of several hundred kilometres to the nearest health centre, who would take the risk of leaving in search of medical attention?</p> <p>That is why it is necessary to adopt medical strategies to reach the greatest number of people, especially young children who are the most vulnerable. We need to approach this similarly to the strategy for treating the nomadic population that MSF has carried out since 2015.</p> <p> </p> <p><strong>As a medical professional, why do you feel it is important to participate in conferences such as the MSF Paediatric Days?</strong></p> <p>The training in Dakar helped me acquire a solid foundation in neonatology, which I could then pass on to my teams. The reference health centre where I work has recently seen the addition of a neonatal unit. But we are a team of general practitioners and we had no knowledge about caring for premature children, so we used to refer them to a hospital that is 100 kilometres away. We now have some knowledge around simple actions to respond to infections in newborns, anoxia (lack or decrease of oxygen in the cells, organs or blood) and other medical cases.</p> <p>It is very important for the doctors working on the projects to be able to participate and benefit from this type of exchange, and also to compare our experiences with other contexts.</p> <p> </p> <p><strong>Can you give a concrete example of good practice or an intervention strategy that you have learnt about at the MSF Paediatric Days that could be useful in Mali?</strong></p> <p>One of the recommendations was to involve the communities more in medical care, such as traditional birth attendants. This is something that we have already started doing in Ansongo, where we have invited traditional birth attendants to accompany women to the health centre in order to keep them calm and reassure them. An increasing number of patients have come and since the start of the project, the number of women giving birth at home has drastically decreased. This is an indicator of success for us. Benefiting from medical care allows them to avoid many complications. This shows that women in the region trust us. However, we must continue to raise awareness of the importance of monitoring pregnant women in order to detect problems early on. Also, to enable this vulnerable population to benefit from access to free and quality medical care and to reduce mortality overall.</p> <p>The MSF Paediatric Days session on the use of new techniques, such as telemedicine or the E-care project, was of particular interest to me. These techniques allow caregivers to get closer to the patients, and could be integrated into a nomadic medical strategy to help reach these vulnerable people. It is inspiring!</p></div> </div> </div> </div> Mon, 26 Aug 2019 08:25:43 +0000 Elise D 54 at https://paediatrics.msf.org The MSF paediatric days: sharing experiences to improve paediatric care https://paediatrics.msf.org/news/msf-paediatric-days-sharing-experiences-improve-paediatric-care <span>The MSF paediatric days: sharing experiences to improve paediatric care</span> <div> <div> <div class="my2 md-my3"> <div><article> <div> <img class="fit" src="/sites/default/files/styles/embed_medium/public/DSC_0029.jpg?itok=UmuWwauM" width="980" height="692" typeof="foaf:Image" /> </div> </article> </div> </div> </div> <div> <div class="my2 md-my3 bold"> <div><p><em><strong>Since 2011, Dr Didier Mukeba Tshialala has carried out several assignments in different countries in West and Central Africa with Médecins Sans Frontières (MSF). Currently, Didier holds the position of medical coordinator in Niger. He recently participated in the MSF Paediatric Days, held on 15 and 16 December 2017 in Dakar, Senegal. Didier considers this conference an essential platform for aid workers to share their experiences working with patients aged under 15 in contexts with limited resources.</strong></em></p></div> </div> </div> </div> <span><span lang="" about="/user/54" typeof="schema:Person" property="schema:name" datatype="">Elise D</span></span> <span>Mon, 08/26/2019 - 10:22</span> <div> <div> <div class="my2 md-my3"> <div><p><strong>What are the main challenges to improving the management of childhood diseases in West Africa and, more specifically, in Niger?</strong></p> <p>In addition to malnutrition, the three main causes of childhood morbidity in our projects in Niger are: malaria, respiratory infections and diarrhoea. Fortunately, we are already aware of a series of solutions to tackle these. If, on the one hand, we manage to improve access to drinking water for the populations, and we also effectively implement chemoprophylaxis against seasonal malaria between August and November, we should already have an impact on two of the main causes of childhood morbidity in Niger. In addition, by increasing routine vaccination coverage in children of 0–11 months of age, we will significantly improve the health status of children in Niger. </p> <p>At the same time, we must continue to guarantee the ongoing training of our medical teams, doctors and nurses, so that they can offer the best possible care to children, despite the occasionally limited resources.</p> <p> </p> <p><strong>As a medical professional, why do you feel it is important to participate in conferences such as the MSF Paediatric Days?</strong></p> <p>These days are an ideal forum for sharing experiences with medical staff from other humanitarian organisations working on similar projects under similar conditions. These exchanges allow us to enrich our practices to help overcome the many challenges (both organisational and cultural) that each of us are faced with, taking into account that not all of us are specialists in paediatrics, but that we all work at different levels with patients under the age of 15.</p> <p>These conferences also allow us to highlight the ideas that should be explored within an operational study framework. This represents a real added value for our projects as these studies help us to improve the care of our patients through simple but innovative strategies, which the health authorities can then continue to implement.</p> <p> </p> <p><strong>Can you give a concrete example of good practice or an intervention strategy that you have learnt about at the MSF Paediatric Days that could be useful in Niger?</strong></p> <p>One of the main things I learned was the need to strengthen collaboration and integration between the community (through traditional birth attendants), maternity and the neonatal unit to significantly reduce the mortality rate in newborns, which is generally very high, as well as reduce the number of maternal deaths during deliveries. This issue is particularly close to my heart, because unfortunately it is a reality that we have to face on a regular basis in the maternity and neonatal services that we support in Madaoua and Diffa.</p> <p>Beyond medical care, I am convinced that we should also invest in health promotion in close collaboration with the leaders and midwives of the community, who are true opinion leaders in their communities. The preventive aspect is essential to raise awareness of the importance of arriving on time for consultations in the communities in which we work. It also allows us to inform mothers about the importance of monitoring pregnancy to ensure the future health of their children, while providing them with the knowledge to detect the first symptoms when their children are sick.</p> <p>Since the beginning of the year, we have started working with traditional birth attendants in our projects in Madaoua and Diffa. We work with them to highlight the importance of referring women from the community to medical facilities in order to reduce the number of home deliveries, which pose greater risks for the mother and the child. We also train them on the danger signs during pregnancy to avoid complications due to late treatment. In just a few months, we are already seeing progress. This shows the importance of developing community-based approaches to increase access to care!</p></div> </div> </div> </div> Mon, 26 Aug 2019 08:22:54 +0000 Elise D 53 at https://paediatrics.msf.org