Médecins Sans Frontières’ history is one of constantly striving to adapt, improve and expand our medical care for people in crisis or excluded from healthcare.
Throughout we have been driven to improve the safety, effectiveness, timeliness and equity of our care—four important domains of quality care. But 50 years on, it is in the fifth domain of patient-centredness, one that both intersects with and underpins the other four, that we hope to achieve our greatest cumulative impact.
As Dr Claire Fotheringham, head of the Medical Unit in Sydney, explains: “Médecins Sans Frontières is traditionally a medical organisation, which means we have had a quite medical conception of disease. Yet patient-centred care is much more holistic than that: it considers the patient as someone with their own desires and needs but also as a person who is part of a community, rather than just someone with a disease.”
Only through anchoring our care in a deeper understanding of patients, their priorities and their broader communities can we achieve our ambitions, as expressed in the three, formal action areas below.
Humanising the patient experience
Our first action area is adapting our medical approach to be more humane and holistic, and thus improve patients’ experience of care.
One recent initiative is the “Pain Think Tank”, with its emphasis on multi-disciplinary partnership to improve pain management and other complex problems for patients in our surgical projects in Jordan and Palestine. Formed in 2020, the Think Tank brings together advisors in anaesthesia, mental health, nursing, rehabilitation and patient education, as well as an operations medical manager, to identify gaps in care and methodologies to address them. What we learn will then be adapted to pain management in patients in trauma projects from Africa to the Caribbean.
Challenges like these are not exclusive to Médecins Sans Frontières, however. “Even in my lifetime as a doctor working in Australia, the importance of pain and the continuum of pain relief has become better understood: more people are aware of it, and they think about it earlier,” says Claire.
Widening accessibility to care
The second focus relates to our operational approach: ensuring that the healthcare we provide is accessible, and supporting our patients to successfully manage their illness.
The best outcomes in chronic disease treatment are achieved if patients, as well as their parents or carers where applicable, are brought in as partners in their management. The earlier prevention and care are available, the less likely patients might reach crisis point.
One illustration of this is self-care, with health system back-up. Claire explains, “It might be that someone prefers to do their own HIV test, but we will explain how to do it, and how they are going to know whether it's positive or negative. It’s always important to have the medical system in the background—if someone finds it's positive, then they can come to us for medication.”
Accessibility also means moving outside the hospital to consider the pathway to care from the moment a problem occurs. While care in Médecins Sans Frontières’ hospitals is free, a patient may encounter significant barriers to accessing that care whether it is transport costs, physical barriers from things like flooding, risks like roadside bombs, or simply the cost due to time spent not working.
“We believe that we can contribute more to improve social and financial support to the patient, as well as removing physical and social barriers. Some projects already do this really well, but we need to push to for it to be universal, to be inquisitive and not to accept ‘the patient arrived too late’ as an inevitability,” says Claire.
Sharing operational decision-making
The third action area is about adapting our operational policies to routinely involve patients and their communities in our medico-operational choices.
“We’ve already been working on how Médecins Sans Frontières can be better integrated into the community and with other organisations that already exist to make sure that care is available,” says Claire. The next step is to work more often with communities to problem-solve together.
As Claire explains, “For too long, communities have been seen as victims and vulnerable—and they can be those things. But they can also be resourceful and resilient, and working with others is really tapping into that, saying ‘You know, this is a problem that we've seen. How could we address this as a team?’
I'm really excited to see where and how we go with that, because I think that's going to be really vital to the continued success of Médecins Sans Frontières.”
VALUING THE COMMUNITY’S ROLE
Abdoul-Aziz Mohammed is executive officer in charge of Médecins Sans Frontières’ West Africa regional office in Dakar, Senegal, which is highlighting inclusivity and proximity as it develops its patient-centred approach.
"We have seen the limits of the old model of medical humanitarian aid, which sometimes could be a very top-down approach, especially when communities’ opinions were not considered or valued.
We need to consider our patients and communities as partners, and take time to explain what we do and listen to their needs. It is important that a mother understands the medical act performed on her child, and that she is given the space to contribute when possible.
An example of community inclusion that still inspires me today comes from a project at the border between Tahoua and Agadez in Niger and Ménaka in Mali. Here we set up village committees made up of women and men designated by the community. These committees have played a crucial role in our understanding of the transhumance route of the nomadic populations [involving movement with their livestock], which changes according to the seasons. Thanks to the exchanges with the committees, we could better follow the movements of people and better plan the interventions of mobile clinics in order to treat tuberculosis, pregnancy complications or to carry out surgery to nomadic people and migrants expelled from Algeria."