[APPLAUSE]
SOPHIE DELAUNAY: Thanks a lot,
Nigel, for these kind words.
Can you hear me well?
OK.
So I'm Sophie Delaunay.
And indeed, I'm absolutely
delighted to be here
with you today.
When I was preparing for
this meeting, I though,
you guys are the most informed
people that we can meet.
So how can I talk about MSF in
terms that can be new to you,
or what is the
kind of information
that you may not have, and
that could be of interest.
So I'm going to try to start
with a brief presentation
of the institution as a whole.
And then I will focus
on the operations.
But I'd like to share with you
mostly the debates, the issues,
the questions, that
animate the organization,
and the challenges that we face.
Things that you wouldn't find
on our website or on the web.
So I represent the
US branch of Doctors
Without Borders, MSF,
Medecins Sans Frontieres.
The US is one of the 28
chapters of the organization.
Within these 28
chapters there are
five what we call
operational centers.
They are actually the first five
historically created chapters.
And they are the ones to run
the operations in the ground.
And the additional
chapters that have
been created over
these past four years
are supporting those operations.
There's been a sort of a deal
negotiated in the organization
that anybody who
wanted to create an MSF
chapter in a country would
have the ability to do so,
according to a number
of criteria, of course,
but that we would stick to
five operational centers
on the ground, so
that the countries--
it's already hard to negotiate
with five MSF sections.
So imagine if it
proliferates without control.
So we have five
operational centers.
And the US is not an
operational center,
but it's the largest
chapter in the MSF movement.
And it supports the
movement in terms
of financial contribution,
but also human resources,
communication, advocacy,
and some medical expertise.
And the reason why we're able
to play such a role for MSF
in supporting our
field operation
is actually because
in the US, we
benefit from enormous
contributions from the public
and from organizations like you.
Our partnership with Google has
been going on for many years,
as Nigel said.
And it's been in the form
of both technical support--
technical expertise,
and financial support.
And I have to say that both
are equally valuable to us.
In 2015 only, MSF has
received $5 million
from Google, mostly in the form
of matching gifts, so from you.
And we also received
in 2015 $2.5 million
from Larry Page and his spouse.
So needless to say that you are
a very important contributor,
and it's an opportunity
for me to thank you
for your loyal and
generous support.
So as you will see
in my presentation,
there are, of course,
many challenges
that we need to address if we
want to respond effectively
to humanitarian crisis.
But we all know, because
we all are very pragmatic,
that we can't move ideas,
we can't move good ideas,
and mobilize committed people
without the financial means.
So that's why I wanted
to start with this aspect
and express our
gratitude for the trust
that we've received from you.
Now a quick introduction
on the organization.
As I said, we have about 28
offices around the world.
Those offices are
supporting the operations.
And we're working in
about 70 countries.
The model that we've
chosen for our organization
is a very decentralized model.
And there is no real
headquarters in MSF.
There is a secretary
in Geneva whose goal
is to coordinate and to ensure
that the police to our policies
are aligned.
So we have a human
resource policy.
So that's to make sure
that a US physician
and a Japanese physician,
when they meet in the field,
and if they compare salary, they
don't enter a big fight, right?
That they are treated equitably.
So we have a number of
international policies
to make sure that we're a
responsible employer, to make
sure that we're using the
same medical protocols,
to make sure that we
develop some tools that
can benefit everyone.
But at the same time,
we are very much
attached to our
decentralized model.
And I have in mind
a few examples
that have proved over the years
that the decentralized model is
hard to manage, because, of
course, when everybody has
a say in the decision,
it's not easy.
But it's also very
valuable in terms
of advancing the
quality of medical care.
For example, we've been
able over the years
to develop a treatment
for malnutrition
that has been a
real game-changer.
I'm sure you've heard about the
ready-to-use therapeutic food--
the Plumpy'Nut-- and
how it has completely
changed the treatment
for malnutrition.
This would not
have been possible
if we had had one
operational center.
Because it's because one
operational center decided
that what the other
was doing was not
good enough that we ended up
challenging our own protocols.
And it's true in many
areas where we work.
In malaria we've also-- because
some operational centers
decided to take the risk of
exploring different approaches,
and then confronting-- having
a sort of healthy competition,
and constantly critically
challenging ourselves,
that we've been able to
improve our own practice.
Ebola is also a good
example, because as you know,
we also have to make sure that
we spend our money effectively.
So there's always a tension
between the right balance
between redundancies
and duplication.
And some years ago, based
on our operational volume,
we agreed that we all needed
to keep a strong capacity
in surgery, a strong capacity
in malaria and vaccination.
But there was some
disease for which
we didn't need five operational
centers or 28 sections
to invest in.
And hemorrhagic fever was one
of them, because at that time
we were confronted with
very small outbreaks here
and there, every two,
three years in West Africa.
And we say, OK, why wouldn't we
ask MSF Belgium, because they
already have a sort
of expertise to be
in charge of hemorrhagic fever.
And they've been in charge.
And they've developed
their know-how.
And whenever there
was an outbreak,
it was the Belgium who were
going for the response.
And the other
sections, actually,
did not really
invest in this area.
We first started to have a
problem with that some years
ago when there was an Ebola and
Lassa fever outbreak in Uganda.
And it was the French
section that was there.
And the team was very
powerless in dealing with it.
And it took several
days and weeks
to actually catch up
with the knowledge that
had been accumulated in Belgium.
And it's been even
more difficult
recently in West Africa.
It has actually
slowed our ability
to scale up, because we
didn't have capitalized
enough within the organization
the knowledge of Ebola.
And the Belgium, who are
very prompt to respond,
they did fantastic work.
But if we had had the full
movement up to speed on Ebola
at that time, I think we
would have done better.
So it's a lesson for
us that we should not
duplicate everything.
But redundancies
are very important
in order to respond to massive
and large-scale operations.
Now when you hear about
MSF, I'm sure you've
heard these
sacrosanct principle--
neutrality, impartiality,
and independence.
It really defines our
culture and our identity.
But let's be honest.
These words mean nothing if they
are taken out of the context.
What's important in
these words is more
the practical implication
that they have,
if you implement them.
So impartiality is at the core
of medical ethics, of course,
because if you provide medical
care, regardless of race,
political agenda,
regardless of gender, then
you are able to do
medicine in an ethical way.
But in our own situation,
if you practice medical care
with impartiality-- that is, if
you don't ask for which faction
the person work-- then you are
able to access the conflict
zones.
So impartiality for us
is not just a principle,
it's also a very
practical way to access
those dangerous areas,
and to demonstrate
that we are neutral,
and that we are not
taking sides in the
conflict, and that we have
no other agenda than
treating the people.
And actually, those principles
are our main negotiation tools
in the field.
So how do you get trust
from the communities
and from the factions
that are present there?
If you are able to demonstrate
that you can effectively
provide quality medical care,
impartial care, and that's
regardless of who they are.
But how are you able to do that?
You are only able to do
that if you are independent.
If you are prompt enough in
responding to the conflict.
If you're not
effectively affiliated
with political powers.
It's not just about saying it.
It's really about
being in the situation.
And how do you avoid
being affiliated
with a power is with your
financial independence,
most of the time.
So that's why independence is
also a tool for impartiality,
that itself is a
tool for access.
How do we achieve our
financial independence?
We made the choice
a number of years
ago, not to exceed
a certain portion
of public institutional funding.
What I mean by public
institutional funding
is government funding.
So we don't exceed
15% of funding,
which means that
85% of our resources
come from private funding,
which gives us a lot of leverage
and ability to react
in emergencies,
without being perceived as
affiliated with a power that
may be involved in the conflict.
So there are governments
we don't take money
from-- the US government,
the French government,
because they have so
many stakes in most
of the conflicts where we work.
And there are
governments we take money
from based on their
distance and if there's
no risk of perception that
we would be affiliated.
The second aspect that
allows us to be independent
is the nature of the funding.
We've opened these
28 offices, as I
showed in the previous slide.
And this was a way also
not to be dependent only
on one or two.
The US is already a
very, very big player,
but we don't want the US to
become the largest contributor
for MSF, because if there is
a financial crisis in the US
tomorrow, we would have
to close our operations.
And this is not what we want.
So we've experienced
this in the past.
Spain was our third largest
contributor, MSF Spain.
But with the economy
crisis, we've
been able to compensate from a
growth in Hong Kong, Australia,
and some successes in the US.
So diversification and
also general funding,
un-earmarked funding, is what
allows us to stay independent.
Because when an
emergency occurs,
you don't need to wait for
your team to write a proposal.
You don't need to
wait for government
to give you the grant.
You can intervene
right away based
on the needs that you
identify on the ground.
So I just wanted to put a bit of
flesh around these principles,
because they are actually
very practical principles that
allow us to do our work.
Now let's move to operations.
So this is the
slide that shows you
how our international
funding is separated.
So in 2013, we
have a cap of 15%,
but actually in 2013, we
only have 9% of our funding
that would come from
institutions and governments.
And the rest would come from
individuals or corporations,
what we call private funding,
which gives us a lot of ability
to operate and a lot of
independence and freedom
to focus on the
humanitarian issues.
It depoliticized our funding
and our intervention.
So what are the main contexts.
Here on the slide, you
see all the countries
where we have operations.
2/3 of our presence
is based in Africa,
which is where you have most of
the context that define an MSF
operation.
So what would trigger
an intervention of MSF,
it's mostly conflict
or unstable areas
with a number of humanitarian
consequences like displaced
and a lack of access to health
care, or violence and wounded.
The second context is
neglected disease or epidemics.
so the conflicts,
of course, you all
have in mind are Yemen, Somalia,
South Sudan, Sudan, Syria.
But also the
neighboring countries.
For example, Ethiopia
is not at war,
but Ethiopia holds a very large
number of displaced people.
So we're working in Ethiopia
as a result of a crisis.
Same for Jordan and
Lebanon, at the moment,
who receive a large
amount of Syrian refugees.
Neglected disease and
outbreaks are also
a number of issues that
would trigger intervention.
Of course, Ebola
is a good example.
These countries were
not at war, but they
faced an unprecedented crisis
for which the National Health
System was not capable
of responding alone.
We also intervene in
times of outbreaks.
For example, for
many, many years,
until there was a vaccine
that proved effective,
we intervened every
three years almost
in the meningitis
belt of Africa.
There were meningitis
outbreaks all the time.
And we'd to every year
and use this vaccine
that would be effective
for three years.
And then every three
years, we had to go back.
Now we have vaccine that
is effective for 10 years,
so we have less
reasons to do so.
But you have
constantly, especially
in countries at war
or unstable countries,
the health system
is dysfunctional,
so you regularly have cholera
outbreaks or measles outbreaks
that necessitate
an intervention.
And neglected
disease is something
that we want to keep an
eye on, because there
are a number of diseases
that kill millions of people,
although we don't experience
them in our countries.
And therefore there is very
limited attention to them.
So this is the case of
Chagas, of sleeping sickness,
of kala azar, who
are very neglected.
And for us it's a kind
of a political statement
to continue keep an eye on this.
It's not a matter of
covering a whole population,
but it's really shedding
a light on this neglect.
So just to finish with
the scope of activity.
And then I will move
to the challenges
that we face on any
given day, to give you
an idea of the scale.
We have about 35 volunteers and
staff on the ground to work.
MSF is perceived very much as
an international organization--
which we are-- and as
a western organization.
Actually, when you
look at these figures,
you have to know that
90%-- nine zero percent--
of these 35,000 volunteers
are national staff.
Only 10% are international.
So the lion's share
of the work that
is being done by
our organization
is being done by the local
population who work with us.
We work in about 70 countries.
And we have usually several
projects per countries.
And also it
oscillates, depending
on the years, between
300 and 500 project
locations for our programs.
We could do more,
but our goal is not
necessarily a goal of
covering all the needs.
We don't want to be the
Ministry of Health of the world.
Our goal sometimes is really to
identify the most acute places.
Our goal is also to
have other organizations
being able to get involved,
take over the needs.
Being alone in a
place is certainly not
satisfactory for us, because
we feel that then this place
becomes totally
dependent on MSF.
So it's more about
testing new approaches,
challenging the status
quo, shedding a light
on a problem that will define
the scale of our operation.
And of course is there is
nobody-- like Ebola again,
is a good example-- if you
have no other organization,
and you are overwhelmed
with the need,
you're going to constantly
scale up your operations.
But it's not an end
in itself for us
to do large coverage
in a country.
In terms of result, I don't know
if we can talk about impact,
but it's the result.
Every year we do between eight
and 10 million consultation,
medical consultation.
And the figures that follow
are actually interesting,
because if you talk about
malaria case treated
surgical procedure, a baby
delivered measles vaccination,
or severe malnutrition,
you talk about life saved.
Because if you don't get treated
for measles, or vaccinated,
it's very lethal.
The baby delivered-- you know
that in the countries where
we work, most women
deliver at home.
So the babies we are taking
care of are the complicated
deliveries, are the deliveries
that if they are not assisted,
either the mother, or the baby,
or both, are going to die.
So this is why we actually
have a particular focus.
We follow a very large number
of figures and indicators.
But these ones are
really the ones
that mean a lot to
us in terms of lives
that we've been able to save.
So now I'd like to
move to the challenges
that we faced over the years.
The first challenge-- and maybe
let's go back to this conflict
in high security-- is the
accumulation of crises.
I have the feeling every year
at the end of the year when
I meet with a number
of donors, and I'm
always asked, so
how was this year?
Every time I hear myself saying,
it's been an exceptional year.
But actually I know why it is.
It is because most of the crisis
we're working rarely stop.
Even in Haiti.
Haiti is still suffering
from the aftermath
of the earthquake.
Most of the crisis do
continue, because if you're
talking about heightened
security context,
it's usually because there is
no political solution inside.
Think of the Congo.
Think of Somalia, South Sudan.
It's been going on for years.
And the problem that we face is
that we deal with these crises.
And every year, there's at least
one or two additional crises.
So this year it was Central
African Republic and the Ebola.
This is why it's always
more, and it always
feels like it was
an exceptional year.
So the accumulation of
crises is definitely
something that we
feel very strongly,
and we experience very
strongly, both in scale
and in number of countries where
we have to respond to violence.
A second challenge is
related to this slide
here, is actually a constant
need for simplified adapted
versions of medicine and tools,
because you can have the best
diagnostic tool, the most
sophisticated diagnostic tool
will do no good in
a place where there
is no electricity if the
machine is very sensitive,
we won't be able to use it.
So we don't want to do
the medicine for the poor.
We don't want to use
very basic stuff.
What we want is to be able
to take the best technology
and to simplify it
as much as possible,
and to make it field-friendly.
So for example, we want
to latest vaccines,
but we want these vaccines
to be heat-stable.
We want these vaccines not to
necessitate a heavy cold chain.
We want these vaccines
to be uni-dose.
We want these vaccines
to be needle-free,
because it's dangerous.
Because if you have a needle
you need trained health workers.
Whereas if it's just a patch,
or a Listerine, or whatever,
then it's easier.
So we're trying to look at what
the new science is bringing,
but also challenge the
way it is designed,
so that it would be more adapted
to the countries where we work.
What we also want to challenge
is the fact that-- and I raised
it earlier-- the fact that
when a disease kills millions
of people, but that
none of these people
are in our countries, there
is very limited investment
in research.
It's the case for the
disease I mentioned earlier.
But it's also been the case for
HIV AIDS, until HIV reached us.
It's the case for
TB-- tuberculosis.
It's been years without
any single investment
in tuberculosis,
because we thought
it had been kind of
eradicated in our countries.
So we're trying to
challenge these status
quo, because
there's nothing more
frustrating for a
physician than not being
able to treat patients
because the drug is adapted,
or because it's too expensive,
or because it simply
does not exist.
So challenging
the status quo is,
I think, very much
part of the identity.
And it forces us, therefore, to
test constantly new regiments,
to advocate for certain
types of research,
and to try to promote research
and development based on needs,
rather than on
market opportunities.
And this is something
that in trying
to define the most
adaptive tool,
Google has played a
very important part.
And I hope that we
can continue to find
ways to get your expertise.
We have also engaged
ourselves in the development
of our own tools.
For example, we've just
finished testing value load
point of care test for
HIV AIDS in Malawi.
We are engaged Ebola clinical
trials in West Africa.
We believe we are in a good
situation to test these,
but we also don't want to
subsidize the whole R&D
community.
And so it's always
also a balance
to find between where
to invest our resources,
how to take the opportunity
of the cohort, the field,
and the ability to
advance the medicine
we use with the need to
actually challenge the system,
and make sure that
research and development is
made in this direction.
And the last challenge that
I'd like share with you--
there are many more, but I
chose those ones because I
though they would maybe
resonate more with you based
on your field of expertise--
is the logistics.
Because even though we
are medical organizations,
nothing can be done
without the logistic.
And I know that
someone in the room
has his brother as a logistician
in Monrovia, as we speak.
And he would the be able to
say more eloquently than I
do how critical it is
for every single aspect
of the operations.
From feeding the
teams to setting up
the hospital to ensuring the
transportation and supply
and everything.
So logistics also requires
constant adaptation
and innovation.
We have three supply centers
for the organization.
Again, three.
And it's a strategic
decision, because imagine
if we have just one
supply center in France,
and there's a strike in France.
What happens?
Right?
So we realized
very early that it
would be quite dangerous
to try to centralize this.
And having three has proved very
helpful, again for the Ebola,
because the supply center in
Belgium became overwhelmed.
And we were happy to be able
to use the other ones for it.
So the supply center's
role is first to identify
the best tool for the fields.
So they are constantly
exploring the market,
but also in a constant back
and forth with the fields.
So imagine a physician
from Bellevue Hospital
is coming for a field
assignment with MSF.
And during his
mission he realizes
that we use a tool that
is not very practical.
And he himself has
used a tool in Bellevue
that is much more convenient.
So there are systems--
he would be in a capacity
to actually write to the
medical director and so on.
And who would transfer
the information,
and then would ask
the supply center
to ask for this type of tool.
So we have a constant
back and forth.
And the catalogs are
updated every year.
And there are teams working on
trying to improve and refine
the tools that we are
using in the field.
The second role of
the supply center
is, of course, to
ensure that there
is sufficient supply
in the long run.
Because it's not just about
be preparing an order.
It's also making sure
that the supplier
is going to be able to catch
up with potential increase
in the needs.
You've seen all these
pictures with the PPE--
the personal
protective equipment
that we use for the Ebola.
Actually there's been
a very, very big issue
in terms of supply,
because we have identified
one supplier as the best
quality supplier for it.
And this supplier
has been constrained
by production capacity
after a few months.
So this is really
a challenge that we
have to face for every
single tool that we use,
making sure that there is
an appropriate supply chain.
What we've done also, and
what you see in these boxes
is we've created some what
we call ready-to-use kits.
So instead of having
to send each item
to the field in a
separate fashion,
we know what is needed to
respond to a cholera outbreak.
We know what is
needed to perform
an investigation of measles.
We know what is needed
in case of an earthquake.
So we've designed
some kits that's
we've called measles kits,
cholera kits, earthquake
kits, surgical kits,
that contain everything
from the pen, to the bucket,
to the empty biotechs,
to the for a number of patients.
So for example, we
have Cholera 1,000
is a kit for 1,000 people
affected with cholera.
So that the teams on the
ground, since there is also
a lot of turnover,
they don't have
to relearn about everything.
It they know that they're
facing a measles outbreak,
they know that they just need to
figure out how many people they
need to cover, and they
ask for a measles kit.
And those kits are also
updated constantly.
And last but not least,
the logistic centers
are in charge of ensuring
the safe transportation
for the goods, which
is another challenge,
because it's not as if you're
just using a regular airline.
And you take the next Delta
flight from Paris to New York.
It's really about
finding your own planes,
getting the authorization to
enter some countries where
it's not so easy.
Ensuring the cold chain,
also in those areas.
And the logisticians
in the field
play a very critical
role in negotiating
the entry of the goods,
especially the drugs,
of course, because
it's a sensitive item.
So sometimes one
obstacle might be
that the boxes are stuck in
the airport or the harbor
for several days.
And it's a matter
of life and death,
of course, that you
receive the items.
So this is why I wanted
to insist on logistics,
because it has
always been an issue,
but it is very, very difficult.
In West Africa,
for example, there
were less and less airlines
willing to travel there.
So if you don't have a
plane and some person
ready to bring the
supply, it's an issue.
There are numerous barriers
to access in a growing
number of countries in
terms of regulations
and so on, that make our
work simply a big headache.
So this is something
we are working at.
But it's definitely a challenge
in every country where we work.
So I want to finish with
Ebola, because Google
has been very much-- the crisis
team has been involved in it.
You've supported us all along.
And again, I'm sure you've
read a lot about Ebola.
so what I want to do is
maybe to share with you more
how we've lived it from inside.
Because for me, this
outbreak of Ebola
exemplifies all the
dysfunctioning of the system
and all our own
limitations and weaknesses.
I mentioned the fact
that we had made
the choice of not investing
in hemorrhagic fever,
of just having a centralized
hemorrhagic fever unit.
Too bad.
It was a bad choice.
We've corrected it since
then, but it was a bad choice.
The Ebola outbreak also
illustrated de-medicalized, not
responsive, humanitarian system.
It took six months
for organizations
to acknowledge that
there was an issue,
and realize the
seriousness of it.
It also exemplifies
how risk-averse
the community is
to the situation.
It's a disease-- Ebola is
a disease for which there
is no drug, no diagnostic
test, no vaccine.
I mean you can't
find worse, right?
There's nothing.
So you had to invent.
You had to create and try
what works and what doesn't.
And finally, Ebola
happened in a country--
which is what we
experience in many places--
where the health
system is very, very
weak, if not disfunctioning.
So you see on the map
the number of programs
that we've opened in
those three countries.
We've also done some work
in Senegal, Mali, and Cote
d'Ivoire, and Nigeria,
mostly in the form
of technical assistance.
The Ministers of Health were
willing and very strongly
involved in trying to contain.
They needed the expertise.
So in those countries
we've actually
provided this expertise, and
not engaging in a full program.
And so far, they've been
able to contain the outbreak.
How we've lived it from-- I
will finish with the activities.
So we're engaged
in clinical trials,
both for vaccines and drugs.
We are trying to bring a sort
of comprehensive approach
to the Ebola outbreak, both
in the form of treatment-- we
can't even talk about treatment,
because there's no treatment--
but it's more isolation
center and palliative care
for the sick patients.
But also the community
outreach, the contact tracing,
surveillance, education.
We've provided disinfection
kits for the people
to at least try to mitigate
the risk of contamination
if they have some sick
patients among them,
until they are able to bring
them to a health facility.
The side effects are huge.
The health system has collapsed.
And actually we don't
have the figures.
But when we do some
studies, I'm sure we
will be shocked to see
the number of people who
died of other health
issues than Ebola.
But because of Ebola,
because the health
facilities are not functioning.
So what we did recently
was to also distribute
some prophylaxia
against malaria,
because first, at least
people can be protected,
and also because malaria has
the same symptoms as Ebola.
And if you have
fever, you don't want
to be in an isolation
center, take
the risk of being
contaminated with Ebola
if it's only malaria.
So we've tried to get
engaged in those aspects.
I don't see what's written,
but psychological support
and anti-malaria
program, I mentioned.
Yes.
Psychological support
is very, very much
needed for the families, for
the patients, and for the staff.
I mentioned at the beginning
that 90% of our teams
are national staff.
What does it mean?
It means that in
the Ebola outbreak,
those teams have been
there since day one.
They are the ones,
they have no break.
Our international teams, they
rotate every five, six weeks.
But for our national
staff, there
hasn't been any single-- I mean,
there's been a few days break,
but it's been
extremely demanding.
So how have we lived
it from inside?
I have to say that in the
US we've sent about 90 staff
out of the 800
international staff
that we've sent on this crisis.
And I've never felt such a
high sense of responsibility.
Although we've sent our people
to very dangerous places,
but there we have
security protocols.
We have always a
capacity to evacuate.
It's one of the criteria
when we open a program,
we want to make sure
that we're going
to be able to
withdraw and close.
But in West Africa,
we have no guarantee
of medical evacuations.
And that really consisted
of a very big challenge.
The limited science
was a big problem.
When you claim to
treat patients,
but you don't actually
have a treatment,
the high mortality
rate in our center
created a lot of
frustration and tensions
inside the organization.
There was this big tension
between clinical care
and public health, because
you want to isolate.
You want to break the
chain of the outbreak.
But you also want to
treat the patients.
And you have to
choose where you're
going to put your resources.
And I can tell you as we
speak that and there's
a huge debate-- a
very heated debate--
inside the organization
about the choices we've made,
and how to go about this.
The cultural tensions
around the burial practices
were very, very big.
The countries decided
to go for cremation.
It was very poorly
accepted by the community.
And we had to deal with that.
Even when we know that the
main source of contamination
is through the burial practices.
As we speak, we still have 70%
of the people in our treatment
center who attended a funeral
in the past few days, which
gives a sense of how
this is sensitive,
but also a key in the
management of the outbreak.
But I want to finish
on a positive note,
and say that Ebola
also made us grow.
We learned more on
the disease than we've
done in the past 20, 30 years,
because we've been confronted
with such a large scale disease.
We also take pride
of having been there,
standing with this population.
I think that everybody
in the organization
feels very, very
good about it, even
though we're very frustrated.
One of you was mentioning
the "Business Week" paper
that prompted actually, the
invitation of MSF here today.
We have fantastic
stories of survivors.
Everyone coming
back from the field
has amazing stories to say about
solidarity, about mobilization.
And then finally,
I want to believe
that this global
awareness, because finally
the international
community mobilized itself.
The financial means, the fact
that the scientific communities
that the mobilized together.
I hope that it's going to be
an opportunity for the system--
for the global health system--
to be more responsible, to be
more driven by the
needs, and more visionary
about the future
of global threats.
Now we stop here, and I'm
happy to answer your questions.
[APPLAUSE]
AUDIENCE: My question
is, how do you think
of organizations
like Google.org,
that invests or
supports young start ups
in the social open
space can be helpful.
Like, what can we do?
The technology aspect
drives [INAUDIBLE].
SOPHIE DELAUNAY: I think
that what you can do
is clearly identify the gaps.
So making sure
that this is a gap.
And making sure that it's going
to be helpful, either for us,
but not necessarily for us.
I think that being helpful
for the communities,
for the local NGOs is something.
We've had several discussions
with Nigel [INAUDIBLE],
because they came
with ideas sometimes.
And they say, what about
this, and what about that?
And we're saying, well, we're
not sure there is a need there.
We're not sure it's
going to be helpful.
We're not sure it's ethical.
It might pose some ethical
problems, perception problems,
that are actually
counterproductive.
So I think that it's
really about trying
to understand where the needs
are, and how it can contribute.
But it's more of a conversation
on a day-to-day basis
and with see organizations that
are involved on the ground.
I am sorry I don't have
a clearer answer to that.
AUDIENCE: How often
do individual members
on the ground breach
your impartiality?
And what do you do about it?
SOPHIE DELAUNAY: I'm going
to give you an example.
I don't know if this
policy is still standing,
but for many years
we had a policy
that our international
staff based in Gaza Strip
could not stay more
than six months.
Because we had experienced
that after six months,
they were losing their
impartiality because they were
under so much stress,
they were exposed
to a certain facet
of the problem.
And so the way we do
that is definitely
to anticipate the risk, but
also when we are-- sometimes
it's the person
himself or herself
who has to be evacuated,
because they can't stand it.
And they don't trust their
local partners anymore.
They don't want to work there.
I remember I worked in Rwanda
in 1995 after the genocide.
And I witnessed a
massacre in Kibeho.
It was May 1995.
And I was in the
coordination team.
I was dealing with the
Rwandan authorities.
And I was personally
very shocked
and disgusted by the way--
you know-- it was handled.
And I asked the organization
to stop my mission after that,
because I didn't see how
I could responsibility
engage with the
local authorities
after what had happened.
And I has lost my
impartiality, let's say.
So it's really more
about responsible.
And sometimes it's going to be
your boss who's going to say,
you're losing it.
It's better that
you go back home.
NIGEL: Can you ask the
people to go to a microphone?
SOPHIE DELAUNAY: Maybe I should
repeat the question, right.
Sorry.
I forgot.
OK.
AUDIENCE: I have a question
regarding impartiality,
as well.
So a few years back there
was a high profile incident
of the CIA using a
vaccination program
to gather genetic information
and conduct military strikes.
How has that impacted
people's perception of Doctors
Without Borders, especially
in Middle Eastern countries?
SOPHIE DELAUNAY: This
incident-- I mean, this tactic,
let's say-- has not had an
immediate and direct impact,
but has largely
contributed to a growing
perception against humanitarian
aid workers performing
vaccinations.
But it's not just these
tactics We actually
reacted against it
when it happened.
We expressed our
concern by the fact
that humanitarian and medical
aid was instrumentalized.
And it is de facto more
difficult to gain acceptance
and trust if you
claim that you're
going to do vaccinations, and
the CIA just came by the week
before and using
vaccination as a tactic.
But in the incidents
that happened afterwards,
you know there's been a series
of killings of vaccinators
in Pakistan, but
also in Nigeria.
The CIA tactic is not
the only reason for that.
The approach of the
global health community
toward vaccination is
also largely responsible,
in our view, for the loss of
trust in vaccination practices.
The urge, for example,
to eradicate polio,
and the amount of resources--
so polio is not good.
We all agree with that.
We need to address polio.
But there's been
so many resources
devoted to polio compared
to other health issues,
that it also has created
a perception that it
has contributed to the
attacks on vaccination.
In Pakistan there are
people who are suffering
from a number of health issues.
And they might not think that
polio is a priority, right?
So this is to say in
answer to your question
that we are very much
against and concerned
by those practices of using
humanitarian aid to cover
military or political action.
But that the discredit on
health workers cannot be only
attributed to these practices.
We also have our
own responsibilities
when we choose the type of
global health agenda and action
that we put in place.
And we have to
make sure that when
we decide to enter and
vaccination or eradication,
it is also considered a priority
for the communities that
are affected by these issues.
AUDIENCE: Hi.
You talked about
evacuation earlier,
as one consideration before
you set up a treatment center.
What are some of the
other major questions
that you think about before
setting up a treatment center?
And are there places
that you simply
won't send your staff to?
SOPHIE DELAUNAY:
So your question
is only about security, right?
Or it's about the
global criteria?
AUDIENCE: Yeah.
SOPHIE DELAUNAY: OK.
So evacuation is a criteria
in a high security area.
It's not a criteria
everywhere, of course, right?
But the main criteria for
deciding to open a center
is mortality, of course.
So are we going to
have an added value?
There can be high mortality,
but we know nothing
about this disease, right?
Or we can't do
anything about it.
So its our own added value.
And is there anybody
else who can do it?
Is there is another
organization better
placed to respond than us?
So this would be the
first criteria to decide.
So neglect is very
important, as you see,
because it's both
can we do something
about it that others can't do?
And is it really killing people?
AUDIENCE: Thank you.
SOPHIE DELAUNAY: Yeah.
AUDIENCE: Hi.
You mentioned the concept
of operational neutrality
and keeping your donations
from governments to 15%
to sort of safeguard that.
What about investment
neutrality?
And what I mean
by that is, well I
guess there's really
two questions here.
So number one is, is
there government money
that you're saying
no to to guarantee
your operational neutrality?
And number two is, the concept
of investment neutrality
would be you mentioned the
fact that there a lot of things
you'd like investment in, but
the problem is those things
don't happen in maybe,
like the West, right?
So there isn't an
investment in those things,
because people don't see it.
So is there a way to
maybe-- you're not
taking operational
monies, but you're
taking investment money that can
be redirected to those causes?
SOPHIE DELAUNAY: Yes.
There are definitely
investments that we
wouldn't take from government.
It's not just about taking
funding from government or not.
It's about-- we may, for
example, receive funding
from the field for some
research, for medical research.
But we may not
want the funding--
we would not want the funding
from defeat for Afghanistan,
for example.
Right?
So depending on the
nature of the funding,
we will make some arbitration.
If I understood your
question, is there
a way not to get the money, but
to ensure that this money is
invested so that it
serves our purpose, right?
Well, this is what we try
to do through advocacy.
And this is why I
said we don't want
to be constantly
filling the gaps.
If there is no drug for
TB, it's not for MSF
to develop a drug for TB, right?
We have at dedicated some
resources to our advocacy
so that we can try to influence
and mobilize the stakeholders--
so, big pharma, the large
organizations like Garvey,
like the Gates Foundations.
And we have actually
people who are working
on trying to influence their
agenda, and making sure
that they are paying
attention to those aspects.
We also where I think we
are the most successful
is trying to demonstrate
that the protocol work.
And then having WHO-- the
World Health Organization--
adopt this as
normative protocol,
because then it's the
best way for the countries
to demand that those
protocols be applied.
And when you have
a protocol, you
need to have medicines that
also is adapted to them.
We're also worked at
providing some specification.
For example, we're working
with a number of lab
who are working at
point-of-care test.
And we provide them
with the wish list
of what would be an
ideal point-of-care test
in the countries where we work.
AUDIENCE: Thanks.
AUDIENCE: I was wondering
whether in MSF there's
any group-- small
or big-- related
to information technology.
Basically our cousins.
Is there any group either
absorbing technologies
or inventing some for
the scenario Cerf by MSF?
SOPHIE DELAUNAY: So we
have in New York, actually,
a team that has been asked
to develop health information
system for the field.
And I think it would be
super helpful to connect you
with them, definitely.
We have a number
of people working
on some specific technology.
So we have information
system, but I
have to say that we're very--
we're vintage in MSF on this.
And it takes time to get even
up to speed in our headquarters
with what would be
the good system.
So I don't think it's
a good use of people
like you to actually
mobilize you on that.
We need to catch up
on a number of things
in terms of our systems.
We're better at medical
technology, of course,
because this is our priority.
We also have a number
of people working
on innovations in logistics.
This is an area
that is interesting.
I've been supporting
one of our teams
who was asked to look,
for example, after Haiti,
at the management of
waste, because in most
of the countries, you actually
don't have the industry that
can eliminate some waste.
Right?
So we have our own incinerators.
But an incinerator does
not eliminate everything.
And we needed to
figure out whether it
was better to create our
own management on site,
or to export our
waste, and make sure
that it is done in a safe
way in another country.
In the case of
Haiti, we've actually
concluded that it was better
to reexport the waste.
And it's been done.
We had a contract with
a company in the US
who has imported the waste
that we made from Haiti.
So there are so many,
so many different areas
where we look at possible
technical solutions.
But in terms of
telecommunication and health
information system,
it's really something
we definitely
welcome some support.
And in terms of the
usual communication
for the regular functioning
of the organization,
we are far behind, and
we need to catch up
before we can be a
valuable partner to you.
NIGEL: This is probably
the last question,
if that's OK because
we're coming up
to the limit of our time.
AUDIENCE: Real quick.
One question, one
request for comment.
Question-- what do you
guys use for communication
and collaboration
type technologies?
Are you using Google
Apps or Microsoft?
Or what's your email?
SOPHIE DELAUNAY:
It's Lotus Notes.
AUDIENCE: Lotus Notes?
SOPHIE DELAUNAY: It's awful.
AUDIENCE: We should talk.
We should talk.
The second is, any comments
on the situation in Myanmar?
I know you guys were in the
news quite a bit on the Rohingya
situation.
SOPHIE DELAUNAY: Yeah.
It's a dramatic situation.
And we're still in negotiation
with the government.
We have got the
authorization to be
working in [INAUDIBLE] state.
So there's a line
of communication
with the authorities.
But the acceptance on the
ground is very, very difficult.
So there is so much tension
within the communities
that even with a
political agreement,
it's very challenging
to work there.
The situation is explosive.
AUDIENCE: Thank you.
NIGEL: I was going to
probably make a comment,
having worked with MSF offices
in the field over the years,
and had run my own.
There's some very good reasons
why Lotus Notes persists
in many organizations
that operate in the field,
partly because the way
it does synchronization.
Though there are often
better solutions now.
But organizations still
trying to jump out of that,
and figure out where to go.
But that's one of
the big constraints
is that they might be archaic
systems in some sense,
but the web just doesn't work
in most of these places, right?
I wish.
But I was going to say, thank
you very much for coming.
I had a question myself, which
is really about how you manage
innovation, because
humanitarianism
is a very difficult
place to do innovation,
because of the consequences.
The downside risk is so huge.
And you talk about sort of
running in parallel situations
as a chance for allowing
different solutions to emerge.
But one of the things
I say, I'm on the board
of the Humanitarian
Innovation Fund,
is the way you organize
that critically
makes a huge difference
for how things work.
So that was going
to be my question.
We probably don't have time
for a lengthy answer on that,
but I was just going to say,
thank you so much for coming.
We all really, really
appreciate your insights,
and what you've
been able to share.
SOPHIE DELAUNAY: Thank you.
Thanks.
[APPLAUSE]
