“I have huge respect for our teams in the field who face so many difficulties and danger”, says 3D programm physiotherapist Elise Tauveron on her return from Haiti.
This isn’t the first time you’ve been to MSF’s hospital in Tabarre for the 3D programme. What was different about your latest visit?
My first visit was in 2019, when I’d just started working on the 3D programme. The security situation is worse every time I go back. But this last time was different, because even Haitians were staying home. Moving around and accessing the hospital, and therefore medical treatment, is really dangerous. I was shocked at what I consider a dire situation, and for the first time I think it’s affecting our work. Some of the team’s physiotherapists get to work really late, and others don’t make it in at all, so their schedules have to be re-organised. With this kind of treatment, that’s always a problem. Patients attending the trauma and burn units also struggle to get to the hospital for follow-up treatment. It’s a bad situation.
The research study has been launched. Can you tell us about it?
We spent two years preparing the study. The programme in Haiti dates back to the first exploratory visit to MSF’s burn hospital in Drouillard in 2019 and the implementation of 3D technology for manufacturing masks. Combined with scanners, 3D technology compensates for the lack of qualified rehabilitation staff in settings where MSF is deployed – especially when they’re particularly unstable – and helps to remove barriers to medical care.
Using 3D technology, the patient’s face is scanned and the impression sent to our expert partner in France, Léon Bérard Hospital in Hyères (which specialises in treating burn patients). (Via telemedecine) the hospital uses a computer to generate an exact 3D model. The digitised file is then sent back to the field and a mould is printed in a centre equipped with a 3D printer. A plaster cast is created from the mould and the plastic mask thermoformed onto it. The teams in the field then adapt the mask to the patient’s face, carry out tests to adjust it and make any necessary modifications. This technical phase requires time and experience and can be arduous for the patient. What we’re seeking to evaluate with the study is the capacity of an external expert (in this case our partner) to send back a file with already digitised adjustments requiring hardly any intervention or modifications to the plaster mould. This would enable the technology to be rolled out in settings where expertise is in short supply.
Can you elaborate?
We’ve been working with the teams in Haiti for more than 3 years. They’re trained and skilled in adjusting the plaster prior to molding it. But, it can be extremely complicated in some of the places we work because there’s a shortage of personnel with the necessary expertise in this kind of highly specific treatment. If the technical aspects can be managed remotely, the programme will be easier to deploy in unstable settings. The technique also ensures earlier treatment that’s less hard on the patient than the conventional one. If the results of the study are conclusive, we can continue sharing the knowledge we’ve acquired over the years with the teams in Haiti. It represents a huge step forward for the 3D programme.
To prepare the study’s launch, we trained the teams and practiced under research study conditions. The participants were asked to produce two masks because we wanted to compare two manufacturing techniques. It took a while to train the teams in Haiti because they had to repeat over and over again the different stages in the protocol that demand a lot of attention to detail.
My colleague Pierre Moreau (coordinator of the MSF Foundation’s 3D programme) and I were in Port-au-Prince for the launch. As we rapidly succeeded in enrolling the first patient willing to participate in the research study, things moved fast and we were able to proceed to the actual launch. There’s a real momentum, the Haiti team are motivated and within a few weeks we were able to include four more patients in the study.
Why was Haiti chosen for the study rather than Gaza where the 3D compression mask programme is also deployed?
I’m familiar with the two programmes as I visit both regularly. For example, last August I spent time supporting and training the teams in Gaza. But, the situation in Haiti is so challenging and access to medical treatment such a problem that we decided it would be more appropriate to conduct the study there as it’s even more unstable. Of course, the security situation in Gaza isn’t easy either, but apart from episodic airstrikes, people are able to move around the small strip of land. Year after year the security situation gets worse in Haiti and is affecting the work of our teams.
We also wanted to show it’s possible to adopt the technology and that it can be effective in challenging settings so that facilities in other places will be prompted to deploy it, which will help enhance burn treatment. Burn treatment is still highly complex and often neglected because it requires too high a degree of specialist expertise. In many places, telemedicine is a real opportunity to provide access to comfortable masks and ensure more effective treatment.
What struck you the most during your latest visit?
I have huge respect for our teams in the field who face so many difficulties and danger. Some colleagues often struggle to get to work because they live far away and it takes them a long time to get in. They have to pass through extremely dangerous areas where roadblocks are common. Some days, it takes them two hours to get to the hospital. Others live in dangerous neighbourhoods in south Port-au-Prince and are forced to go through the mountains, partly on foot. Their journeys are gruelling. Two of our physiotherapists, for example, live so far away that they spend the week in Port-au-Prince and only go home at the weekend.
When they arrive on Monday morning, they’re usually late because getting to the hospital is such a problem. But worst of all, they’re often extremely traumatised by the dreadful things they witness – shootings, people who’ve been killed, a gun pointed at them. Some of our personnel and their families have been forced to leave their homes because their neighbourhoods aren’t safe anymore. They tell us how stray bullets have hit their houses and that they’ve had to move out and stay with friends or relatives. Conditions in Haiti are exceptionally bad. Maintaining the study in a setting like this is challenging. Depending on events in the country, the process of enrolling patients and the time it takes to produce masks can be slowed down, which results in some patients getting them later than they should. But, the study is contributing to continuity of care and the hospital has a trauma unit where the teams also treat lots of victims of the violence.
It’s really hard for everyone in Haiti, and the situation is the worst I’ve seen since I started going there. But the teams are doing everything they can to ensure continuity of care, and truthfully, their work and commitment are impressive