Medical assistance in extreme situations

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In 2014, the Hilti Foundation once again supported Médecins Sans Frontières (MSF). In addition to the help in Syria, the Hilti Foundation financed the development of RISK and RDSU. This equipment for mobile emergency surgery will save the lives of numerous people.

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«I saw terrible pictures», said Thomas Nierle, President since May 2014 of MSF Switzerland. «7000 refugees arrived and, because there was no shelter anywhere, they established themselves in a residential tower, which was not yet fully constructed. Just imagine that. No walls anywhere, no protection from the wind and cold, no water. Fifteen, twenty floors up. How should the people there go to the lavatory?» Nierle is extremely worried about the situation in the Middle East.
The Syrian crisis began in 2011 – and it began full of hope. When the people in Damascus took to the streets, it looked as if the Arab Spring would find a follow-up in Syria. In 2012, President Bashar al-Assad was still promising reforms and free elections. Nothing came of these promises. What began as a democratic movement developed into a civil war that is being fought with extreme brutality. Opposition forces are fighting against the government troops and the Islamic State. The government troops bomb civilians. The international alliance bombs Jihadi bases. And the Islamic State took advantage of the power vacuum to establish a reign of terror between Damascus and the Curdcontrolled north of the country. The country, which would have had a good chance of starting afresh, now lies in ruins. «In Syria, there was a middle class, a good education system. The health system functioned. That is conveniently forgotten», recalls Thomas Nierle. «After three years of war, the families have used up all their reserves. Almost half the Syrian people, approximately 10 million people, are on the run. These are refugees, many of them well educated, who find it difficult to come to terms with their status.»

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Ice-cold winter
The situation in the Middle East is confusing and so complex that there is hardly any prospect of improvement. The neighboring countries, such as Lebanon, received the refugees at the beginning with open hearts, but have now reached their limits. Meanwhile, four million Lebanese are carrying the burden of one million Syrian refugees. The situation is similar in Jordan and in Iraq. Thus, the Hilti Foundation considered it even more important to financially support the doctors and care attendants from MSF in their work in the conflict zone. Aid organizations have a tough time finding monies that may be used in areas where crises have become chronic. The media turn their attention rapidly to new crises, so there is a danger that people in great need are simply forgotten.
The MSF is confronted with enormous challenges in the Beqaa Valley. In the meantime, about 400 000 Syrian refugees are living there in shell constructions, garages or tents. Their physical condition is appalling; the arid climate affects the respiratory passages. Bronchitis and pulmonary inflammations are rampant. Although the Beqaa Valley is Lebanon’s fruit and vegetable basin, the climate is very harsh. During winter, there can be up to eight meters of snow. At this time of the year, it is damp and muddy around the tents, which naturally increases the danger of infection for everyone. In the Beqaa Valley, the MSF operates four hospitals, provides medical care for the refugees and offers vaccinations, midwifery/obstetrics and psychological support. In addition, the teams distribute relief supplies. For the most part, MSF’s personnel consist of local employees. Amongst these are also Syrian refugees, who are themselves trained doctors and health care professionals and who are now helping their compatriots.
In addition to helping with the crisis, the Hilti Foundation has put a budget in place for winter 2013/2014 for the so-called «winterization» of 1000 families. This includes an entire aid package, which should help those affected to help survive the winter. Included are weather-proof tents, ovens vouchers for fuel, blankets, etc. As one of the last remaining aid organizations, MSF is still active in Syria. MSF runs three hospitals in Northern Syria. The aid organization is unable to work in other areas because either it has not received permission to do so, or it would be too dangerous. To support Syrian physicians, MSF has developed a comprehensive aid program, which particularly concentrates on besieged areas that are cut off from any direct help. «The situation is also very tense in Northern Syria», says Thomas Nierle. «We have very strict security management for our personnel. We therefore do not know how long we will be able to remain in Syria. But as long as it is possible, we will help the people there, because the needs are very great. Many people in Syria are caught between the fronts and the borders to Lebanon. The Lebanese have done what they could, but they are slowly closing their borders».

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As much as compassion may play a role, helping is also a profession. In extreme situations, it is essential that everyone knows how to deal with things and that the equipment is suitable for the situations that arise. In this respect, the Hilti Foundation could support an innovative MSF emergency surgery project in 2014. Mathieu Soupart, Director of Logistics, explains what it’s all about: «With every hour that passes, the surgeons are confronted with a different type of patient. If they are unable to intervene immediately, they will lose some patients. What has been lacking to date was a well thought-through, phase-suitable structure for us to be able to carry out emergency operations in conflict zones».
2002 and 2005 were catastrophic years. We think of the hurricanes, the tsunami or the earthquakes in Pakistan. MSF was confronted with missions in gigantic, completely desolated areas in which the infrastructure had been destroyed. If MSF wanted to give appropriate aid in these types of acute emergencies, this meant that its organizing capacity had to be enhanced and the quality of its equipment had to be improved. MSF took a first step in this direction in the years 2006/2007 with the development of the MFH (Modular Field Hospital).
MFH is a general hospital contained within inflatable tents. It consists of two operating theaters and allows the patients longer hospitalization. The erection of the field hospital on an area of around 20 000 square meters is, however, linked to great efforts and requires time. Time that just isn’t there when it comes down to ensuring surgical care and saving lives. To fill the time gap between the occurrence of a catastrophe and putting an MFH into operation, MSF Switzerland has developed two further solutions: RISK (Rapid Intervention Surgical Kit) for the first intervention phase and RDSU (Rapid Deployment Surgical Unit) for the second intervention phase in the aftermath of a catastrophe.

Innovation in the team
While developing innovative solutions, the team led by Mathieu Soupart encountered difficulties that were more organizational than technical in nature. Expertise between completely different professional groups had to continually flow and be adapted into the project. Architects, engineers, tent constructors, anesthesiologists, furniture suppliers, surgeons, logistics experts, aviation specialists, customs officials and surgery nurses were all involved in the development. «If, for example, an anesthetist would have liked to have had a certain apparatus, we had to possibly tell him: what you would like to have weighs one ton. That won’t do, we must find a solution that weighs less, so that we can guarantee to remain mobile», explains Soupart.

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Phase I: RISK
RISK is an ultra-light piece of equipment that is transported in the same airplane as the surgical team. It consists of a transportable operating theater and all the materials necessary for operations. Altogether, RISK weighs 400 kg, but can be carried by the surgeons and anesthetists. It was particularly important for Mathieu Soupart that volumes should not be too large, so that the airlines could guarantee priority dispatch throughout the entire journey.

Phase II: RDSU
RDSU is used in the second intervention phase. This equipment consists of an emergency admissions room and operating theaters in inflatable tents. The facility contains its own electricity supply, a water processing unit and a facility for sterilizing the instruments. Several surgical teams can work here around the clock. Laparotomies can be carried out under full anesthetic, as well as closing and treating all wounds that were identified and treated during the first intervention phase. The equipment is ready for use within a few days and can be erected within 24 hours once the operating site has been reached. And with RDSU it is of equal importance that every single module can be carried by hand. «The weight», said Soupart, «doesn’t play such a great role. What matters is that hand grips should be attached to heavy components so that one can maneuver them with six or eight people». The transport possibilities tend to get less and less sophisticated the nearer one gets to the site. «First you fly from Europe to the capital of the country; and from there, by truck or helicopter to the provincial town. And finally, you flag down a pickup or cart along the street and pay the driver something in order to continue your voyage,» summarized the Franco-Belgian.
For two years, Mathieu Soupart and his team worked meticulously on the prototypes for RISK and RDSU. The initial test run, which took place in a parking lot in Bordeaux in May 2014, was successful. The proto- types will now be improved and validated, and the emergency crews will be trained to use the new equipment. As of spring 2015, RISK and RDSU will be available for emergencies. «To date, we needed 21 days to provide help to people in the Medical Field Hospital. One may say that 21 days is not a very long time. But when someone is wounded, then even one hour is too much. Thanks to the Hilti Foundation, we are very thankful that we were able to develop RISK and RDSU and thereby provide the missing link in the chain», said Mathieu Soupart.