All across the Globe, long-lasting conflicts are leaving local populations with no, or very limited access to health care. To improve the situation for the populations, MSF has been running several Primary Healthcare Projects. One was in India in the state of Chhattisgarh. Here, there were several barriers to addressing non-communicable diseases. They would have to either walk all the way to town, where they didn't know the language, and weren't really that welcomed. Where they would depend on us coming once a week, and coming once a week to place where they had to maybe a few days to get. That's not a good starting point for treating NCDs, a chronic diseases because you can give someone medicine or stock of 3-4 weeks. But, then what happens, if it takes another six months before they go again or a year? Is that worth it? Will that give them complications? Was Mobile Clinics really setting up? That means packing your cars in the morning with your medicines, and your equipment and then driving for a few hours into the jungle, and then setting up. Then, people would know, "Okay. On this day, this group of doctors will come and sit up." So, they would be standing there waiting. Someone would be walking for days to get there on the right day. Then, we would set up small tents having our little pile of boxes with a certain amount of medicines, and kinds of medicines, and then people would start coming in and be treated. We would treat for malnutrition. We would examine pregnant women, and then you'd have your little clinic for whatever they came with. But we didn't have the screening for if people had diabetes or if they have hypertension. Because we didn't really have an offer for them. So, it didn't really make any sense to just give a diagnosis and say, "This is what you have. Now, go live with it." It was two worlds clashing, and one example was this woman that came in with some kind of respiratory symptoms. The doctor saw her. It was not myself but she was seen and diagnosed with what could be Asthma. I mean, we didn't have the possibility of an X-ray. We didn't have the possibility to do lung function examination. This is a Stethoscope and interview with a patient through an interpreter. But then, she was standing there, in the middle of the Indian jungle with this inhaler, and you could just see that she had no idea what that was, that was an alien to her. That illustrates a little bit how difficult it is to. One thing is to diagnose, and the lack of diagnostic tests that you can have in some of the settings. But then when you have a diagnosis, to explain to the patient, you have to take this tablet, two times a day for seven days, and sometimes they have to take two tablets, different times, for different amount of days, and when you think about it, I mean, it's almost like it doomed to fail. Again, it can be difficult enough for an obtained educated Danish patients to control what they're taking of medicines. They have it written down. They can read and everything, but they still managed to take it wrong. These are patients that we cannot write down for them, because they cannot read and they don't have the concept of taking this medicine. For NCDs, diagnosis, treatment and patient education can be very complex, needing sophisticated equipment, services and training. This can be even more difficult, if follow-up is not possible. The settings definitely affects how you can treat and, and if you should treat. I would say as well. So what could be done, to improve the treatment of NCDs in humanitarian settings? You need to be there for a longer time. You need to sit in on different levels. One thing is to guarantee the access to the medicine, to the right medicine, to the right quality of medicine, and the followup with the patient, the education of the patient. All these things, and we're not therefore all that time. That is probably in the main program. We are in a setting or in a country for a limited time. There are of course, some places where we probably will never leave. But that creates the problem of, do you start treating chronic diseases when you know that you're only going to be in this place for some months? Or maybe some years? Do you start something that you know you cannot finish? That has been historically something that we've been reluctant to do, because being an emergency organization, but seeing these a rising problem in people coming with complications to chronic diseases and, and deteriorations of them, you're kind of forced into,to dealing with it. So, we are having guidelines and we do have projects now dealing with NCDs, and also knowing that. Well, maybe traditionally, the most of the emergencies and conflict that we saw, would be in countries where it will be malnutrition and diarrhea. Cholera would be the big threat. Now, we seen conflicts in countries as in Syria, where they'd been used to high standard of care, and you meet more people who have NCDs, and that also means you have to deal with it.
