Can you tell us more about Bassikounou and the MSF projects in the country?
Located in the Sahel region, Bassikounou is very isolated. It is a two-day drive from Nouakchott, the capital, and the Mbera camp itself is another located 17 km from Bassikounou. MSF has been present here since early 2012 following an influx of Malian refugees. With fewer refugees arriving in Mauritania in recent months, MSF is now preparing to hand over this project to other organizations.
Since January 2013, MSF has been managing an operating theater at the Health Center in Bassikounou for emergency surgical interventions, mainly following obstetrical complications. For the 50,000 people living in the Mbera camp, MSF runs a 60-bed Health Center with a fully equipped laboratory. MSF also used to operate two Health Posts within the camp, but has since handed them over to the Ministry of Health.
The Mbera camp Health Center is where MSF has been treating patients with NCDs. It is the only place that offers specialized care for diseases like hypertension or diabetes, and some patients travel from Bassikounou to the camp to receive treatment.
Can you tell us more about the focus on treating non-communicable diseases in the project?
This was a very interesting program component, and it grew within the project. Doctors and nurses noticed patients often came to the health center with complications due to NCDs such as diabetes or hypertension. The project shifted its priority in order to care for these patients: instead of only treating the consequences of the NCDs, the project treated the NCDs directly.
NCDs impact all other aspects of health. For example, if a patient suffers from high blood pressure or diabetes, that needs to be taken into account during a surgery. NCDs can also affect a person’s mental health, and MSF previously provided psychological support to patients in the Mbera camp.
What role does operational research play in the project and its transfer to the local health authorities?
LuxOR was asked to evaluate the NCD program in the Mbera camp, as well as document NCDs in this community as people shift from a nomadic to a settled lifestyle.
A majority of the people in the Mbera camp belong to the Tuareg tribe, a traditionally nomadic people. Over the last six years, they have become more and more settled, and have experienced shifts in their habits and diet. They do not need to travel to access facilities such as schools, water, food, and healthcare as these are available in the camp. However, some people still maintain herds and travel to look after them.
In order to effectively treat NCDs, the patients need to return to the clinic regularly for follow-up. Our research project plans to evaluate the effectiveness of the clinic by analyzing the trends of patients’ blood pressure and blood sugar levels over time, assessing how many patients do not return, and examining the complications and side effects that are reported.
Once published, how will these results be used?
At the moment, there are two data encoders transferring the data from the hard copies of patients’ files into an electronic database. Once the data is available in January, we will start analysis, and the results will hopefully be ready around March 2019.
The results will help to guide and adapt NCD programs within similar refugee contexts for future MSF projects. We may also use findings for improved health promotion activities or trainings, and share them with other health actors.
What particular challenges did you encounter during this field visit?
Even though more than 50,000 people live in the camp, Mbera feels extremely isolated. The camp is quite literally in the middle of the desert, and access can be difficult. Getting to the camp from Nouakchott required flying in a tiny propeller plane, followed by driving a further 30 minutes through empty desert. This was my first time visiting a refugee camp, and although I have been to remote regions before, Mbera was desolate: I really had the feeling of being “disconnected” from the rest of the world, both in a geographical sense as well as in a technological sense. It was a reminder that part of MSF’s mission is to provide healthcare to people in remote regions, going where others do not go.
Header picture: Mbera Health Center, Mauritania, where MSF has been treating patients with NCDs. © Anita Williams / MSF