Let's talk COVID-19: Rising to new challenges

Avril Benoît:

Hello and welcome to this special, Let's talk COVID-19. A special series that we're doing every couple of weeks here at this particular spot on the internet, this Zoom room, Facebook room. We're going to do this all summer long, every two weeks. I'm Avril Benoît. I'm the executive director of Doctors Without Borders in the U.S., you might know us also by our international name, Médecins Sans Frontières. And from that, we get the acronym that we use all over the place, MSF. Today's focus as we continue our series about the pandemic is the indirect impacts of the pandemic. So we have health systems where we work, which we're already overburdened, perhaps under-resourced, perhaps in places of conflict or instability, you have the added challenges of the pandemic, which created shortages of supplies and travel restrictions affecting the movement of our expert staff to be able to go from one zone or one country to the other.

We've had some of our international aid teams adapting to the existing situation, trying to take the medical services we were already offering and keep them up and running while at the same time, pivoting to look after people who might have COVID-19 or are confirmed with it. Our teams all over the world have not only adapted but I'm really delighted that today we're going to focus on how they have innovated. They've found creative solutions to continue providing care to our patients. And so, today we're going to talk about this unprecedented time, these unprecedented challenges but also highlighting the innovations, the new things that we're trying out, things that we've shown to work.

So just a few quick notes about this session, will go maybe 45 minutes and wherever you're joining from today, you can submit your questions, jump into the discussion. If you're watching on Zoom, you've got the Q&A option. If you're on Facebook Live or Twitch, you can send your questions or your comments in the chat function there. And we will prioritize all the questions that are really related to how the pandemic is affecting humanitarian medical operations. I have a couple of great people here to answer your questions. They both have a medical background having trained as nurses, having trained in emergency management and in tropical medicine, public health, all the things that really make them fantastic speakers today.

Kate White is a specialist in emergency response and public health for our emergency support department based in Amsterdam. And she's now the medical technical lead for MSF's COVID-19 pandemic response. And also joining us, George Mapiye. He’s deputy project coordinator with MSF based in his Eshowe, South Africa, where our teams are maintaining lifesaving HIV and TB services, while also dealing with the new threats presented by the coronavirus. So welcome to you both. It's so good to have you. Thanks for taking the time out. Kate-

Kate White:

Thanks for having me.

Avril Benoît:

Kate. Describe where you're joining us from. What's the setup where you are?

Kate White:

So I'm in my apartment in Amsterdam. It's early evening here. It's been a really, really cold and gray day but lo and behold, the sun has decided to come out, especially for this broadcast. So I'm super happy. We still got to talk about-

Avril Benoît:

Very good.

Kate White:

... another three hours.

Avril Benoît:

And George, where do we find you today?

George Mapiye:

Yes. I'm in South Africa, the Southern part of South Africa in a province called KwaZulu-Natal. In our small, semi-urban and rural community of Eshowe where we are doing HIV and TB response.

Avril Benoît:

Okay. And I see you're in the office.

George Mapiye:

Now with COVID-19.

Avril Benoît:

Yeah. And you're in the office.

George Mapiye:

Yes. I'm in the office.

Avril Benoît:

You don't have that kind of... I was going to say you don't have that kind of décor at home with the posters in the background but look, we've got lots of potential for the questions for the discussion. We're really looking forward to hearing from our audience. We did have some people come in a bit earlier and suggest some questions for you. So if you don't mind, I'll jump right into it. Kate, for you as a COVID medical lead, really focusing on how we can adapt our services. What's your focus right now? And what is on your mind the most? What preoccupies you the most, Kate?

Kate White:

I think it's two things that the first thing really is balance between making sure we don't respond to COVID and neglect many of the other things that are happening in our projects that cause mortality and morbidities in the places that we work. And then innovating and pivoting those responses to make sure that we can continue them. So making them more community-based and really looking at how we can continue to keep services like maternity running. So, yeah, those are the two big things for me.

Avril Benoît:

George, from your side of things, what can you tell us about what's mainly preoccupying you and how you're putting all your energy into specific things in Eshowe?

George Mapiye:

Yeah. We are working with the communities that has been affected much with HIV and TB. And now overburdened with COVID-19. At the same time this is a community which mostly depends on informal sector. So they are not able to access the healthcare services, at the time the healthcare services are overburdened. So we are working with the ministry of health. We're to make sure that all the gains that we had made previously do not fall to zero and pose for us more complications than we had avoided before.

Avril Benoît:

Talk a bit more George, about the gains you had made and how that is potentially jeopardized by the pandemic.

George Mapiye:

Yeah. South Africa is one of the top five countries that is affected by HIV and there's also a high burden of TB. So, we have been working in Eshowe since 2011 and worked towards the WHO, the UN set 90-90-90 goals that were to be met by 2020. So we achieved these goals and surpassed some of them by 2018, which is two years ahead of the time. Which means the first 90 is 90% of people know their HIV status. And the second 90 is 90% of those will know their status are on ARVs and we got to 94. Then of those we're taking ARVs, they've got their HIV suppressed and we got that 95% within the community that we have had.

So we achieved this by 2018 and we kept on pushing to make sure that TB also management is achieved very well. So we wouldn't want that to go down to drain but we want it to continue being sustained. And the activities that we implemented are also reciprocated in other communities. So now the coming in of COVID-19 has impacted negatively, puts a pressure on the resources that are limited. So we are making sure that we balance the two, responding to emergence and still maintain the gains that we had.

Avril Benoît:

I guess that's one of the big preoccupations, isn't it? That if somebody already has HIV or TB, what will they go through if they get COVID-19? I'm sure you're seeing some of that already in South Africa with the burden there. Kate, can you explain to us this impact, this conjunction then of the excess illness and deaths in communities where we work and how the pandemic is playing out?

Kate White:

Yeah. I mean, there's two compounding factors. First, there is both of many of the places that we work, these illnesses or diseases have an impact on the immune system. And we know that in terms of, if someone has COVID-19 and some form of disease that affects their immune system, it puts them at greater risk of having a severe form of the disease and then a higher risk of dying from it. But separate to that, what we know is happening in many places is people aren't getting access for the care that they need on a day to day basis for whatever illness they might have underlying, whether that's because they can't move to the health center or because the health center is overwhelmed with people already and then it just can't deal with anymore cases.

So there's so many reasons why this might be happening and then people don't end up accessing care. They don't get the care that they need for HIV, TB, other forms of heart disease, diabetes. And then they end up suffering the consequences in the community and potentially dying. And that's where we see these sort of, what we call excess mortality, which is not directly related to necessarily getting COVID-19 but is an impact of not being able to access healthcare like you could before.

Avril Benoît:

And Kate, how will we know that there is excess mortality?

Kate White:

That's a really good question. So what's really important in these moments is to, for places that we've had programming in for a period of time, track. We're still seeing the same numbers of people with the same trends in morbidity. And on top of that, look at ways that we can do, what we call community-based surveillance. So looking at how many people are dying in the communities that they live in and what ways can we do that? And I think for me, that's one of the things that we've always been quite successful at, particularly in outbreaks, is providing some form of community-based surveillance, whether that's through phone, through going door-to-door in places that people live in and trying to extrapolate how many people are dying on a community level.

Avril Benoît:

And George, how is that playing out in KwaZulu-Natal? How is that happening that you're able to know what is the excess burden of the pandemic?

George Mapiye:

Yeah. I can tell you that before we did the intervention that we were having HIV and TB before, we had people reporting that every Saturday they are going to the funeral. And when we put the interventions that could help sustain their lives and help them go back to earn some income, we made great strides that we could get applauses from people to say, "Yeah, you have done well." So now with the complications that come through defaulting, we have a number of lockdowns that many countries have entered into. We also started doing a lockdown level five, which is closed down of everything in March, which means even moving. And with the low understanding of people, they didn't know what is it that they have to do and what is it that they are not supposed to be doing.

So we had a lot of lost to follow up of patients and we had to quickly come back to them to look for them through our door-to-door services, through our loud hailing, health promotion, so that they come back to continue with the medication. We know how it is that once you default the first line and it is difficult for you to maintain that again on the first line, then the second line, which is quite expensive, cannot be sustained by overburdened countries. So we have really thought about it and de-centralized the healthcare services so that people can have access within the communities that they are living, instead of for trying to get to where they can get something, but bring it closer to them.

Avril Benoît:

We are starting to get questions in from the audience now. And just a reminder, if you're watching on Zoom, you've got the Q&A option to pop in your questions about the indirect effects of COVID-19 on people's health status in the countries where Doctors Without Borders works. And of course, if you're on Facebook Live or Twitch, you can send your questions into the comment or the chat function. All right. Let's jump right into these questions now that are coming in from our audience, this one's for you Kate. How do we decide where to respond to COVID? Which countries? Where do you start?

Kate White:

That's a really good question. And I don't think it's a particularly easy one. We look at a whole bunch of factors, so where cases are happening and particularly where we see extreme increase in numbers,

what we like to call hot spots. And then on top of that, we want to factor in a few other things like how well is the system dealing with that in that place? Is it overburdened? Are there particularly vulnerable groups that have been left out? And I think we've seen in some of our responses in places like Europe and U.S., that there are particular groups, even within our home countries that are really heavily affected by this, nursing homes and those spaces where you have older vulnerable people and the system is so overwhelmed that it hasn't had a chance to look at that.

The good thing about how we operate is that we're super flexible. So our response can look different in a different place. In some countries, we might need to open up a full scale treatment center and have a response that goes from the community through to treating people. In other places, the system might need a little bit of an extra hand in how can we better support our elderly population, support in terms of infection, prevention and control. And so in that way, it can have what we might call a lighter touch, you can do multiple sites but the decision to go somewhere is very dependent upon caseload. How many cases, the vulnerability of the people living there and how well the system is able to cope. And from that we decide.

Avril Benoît:

Just a reminder to those watching, Kate White is the medical technical lead for MSF's COVID-19 pandemic response, joining us from Amsterdam. And then from Eshowe in South Africa, we have George Mapiye, deputy project coordinator, working there to expand what we're doing in so far as an HIV and TB project, to be able to also respond to the needs of coronavirus. George, one of the things that you always have to think about when it's HIV in particular is there's... I guess, TB as well. There's a dimension that's more than just physical, isn't it? It's also economic and it's psychological. We have a question here that maybe you could just describe what's the psychosocial impact of COVID-19 on our patients and on our staff as well.

George Mapiye:

Yeah. Thank you very much. That's a very nice question that shows that for sure people are concerned. Yeah. So the same consent that we have with everyone around that, this is a new disease and we don't know where it will get us to, so people are concerned to say, "Okay, how am I going to survive when I'm being taught?" If they get the needs, which they do not understand very well, they are confused to say, "Okay, what is it that I'm going to do?" So what we have done, our interventions are both prevention and curative. So in prevention, we've implemented health education to make sure that people understand exactly what COVID-19 is, the impact COVID-19 has in their lives and the potential dangers that they can get from COVID-19 and other complications. So we try to allay anxiety through engaging them directly.

We have opened a call center where people can call in when they have questions, when they've issues that they've had and they do not understand very well. And we go around the community with our health promotion team. We engage with not only the health professionals but the community health workers would live in the communities themselves. And we have also engaged with the community leaders, the traditional leaders and also the counselors, as well as the religious leaders together with the traditional health practitioners, so that at every area, people will get the correct information. And they are able to be helped whenever they have challenges.

And we have counselors. We are working with the department of social development that is also a pool of counselors who are able to engage the people in the community, one-on-one, so that their anxieties are laid. We started to hear about COVID-19 when it was far away and as it gets closer, people become so anxious. And we have tried to make sure that they get the correct information. And also de-stigmatize, those who are infected with COVID-19.

Avril Benoît:

How do you explain to someone though that they shouldn't be ashamed that they have it? How do you take the stigma away of something so unknown, so mysterious and so scary.

George Mapiye:

Yes. That's a good question. So what we are informing people is that COVID-19 does not see any boundaries, COVID-19 affects each and every person. So, whoever is infected needs the support, because we don't even know when and who is going to be infected next. So we keep on encouraging to support them. Those who are not eligible for admission in the hospital, they are self-isolated at home when their facility is there. And do we don't just let them go but we go and we engage with the family. We engage with the community that they are accepted, that there will be no stigma against them.

Avril Benoît:

One of the things that, Anya, who's popped a question into Zoom is asking, is in areas where social distancing is nearly impossible, where there's no running water, what is MSF or Doctors Without Borders actually doing to assist those people? Kate, maybe we'll start with you.

Kate White:

That's a really good question, because I think the physical distancing public health measure is something that many of the places that we work in, it's just not a possibility. It's a luxury of other places. But one of the strategies that we've taken in many places like Bangladesh, like Nigeria, is to really look at, okay, what public health measures are actually not only good for COVID-19 but will have an impact on the health status of this group but other things as well. And so, they are exactly what you talk about, making sure that they have a portable water or water supply that they can drink and use in their household to improve their hygiene, that they have the storage mechanisms for that water, so things like jerry cans, and that there are appropriate latrines.

And really looking at many other public health measures, which will have low on effects in the future as well. So they will help to reduce the risk of transmission within that community for COVID-19. But they will also help to prevent diarrheal disease in the future and other things. And then in some places, we are looking at the ability to distribute masks, cloth masks at a community level. So, that at least it will hopefully help to prevent transmission on a community level within the household.

Avril Benoît:

George. Do you find that people are generally receptive to the idea of wearing masks where you are?

George Mapiye:

It has been a challenge. And as the infections or numbers get closer to their own communities, some have started to do the correct way of wearing masks. It has been a challenge. I tell you, we have been educating people. As I mentioned before we are working in both town, which is urban and rural areas. So you'd find different acceptance at both levels, especially in the rural areas. We got way into the period of COVID-19 when they were not accepting it or that it will get through them. But now, as we start to give cases that some of them are coming from their own communities, people... you can see around people wearing masks but there's still a good number of people who are not wearing masks or they wear them on certain occasions, like if they are getting into the facility, into a building, into a shop where it is mandatory that one should be wearing a mask. So they wear a mask and get in. Once they are out, they take it off again.

And we recently opened schools. So you will find that school children as well, they can wear a mask as they're coming from home. Then along the way they do not have, when they get to school, they wear masks. So there's still a good number of people that are still not following properly but it's encouraging that quite a lot also they are accepting.

Avril Benoît:

Yeah. Look, I'm joining you from New York City, from a place that had a huge burden of COVID-19, a lot of deaths, and all the health officials and even the politicians were saying, "Everybody, please wear a mask outside." And you'd still see people not wearing masks. So it's tough to get people to adhere to that kind of instruction. But George, I'm reminded of the historic issues sometimes in South Africa around stock outs, which back in the days when I was a project coordinator in Musina in Limpopo, this was a major issue of people who needed their HIV or TB medications and the pharmacies were bare and it was just about the management and the ordering and things needed to get shaken up in terms of the structure.

Now, with COVID-19, with the pandemic, there's a lot of preoccupation around the restrictions in terms of importing the medication you might need or bringing drugs in travel bands and things. How has that played out for people with HIV and TB, who need their medication? Have you had more issues because of the pandemic?

George Mapiye:

We've had in the country, in some parts of the country that they are starting to almost run out but within the community that we are in, within the province that we are in, we still, we have... I can say enough quantities but this quantity is not beefed-up by any new supplies. So we are working with our different advocacy levels to make sure that we do not totally run out because we are pushing now with our programs to make sure that even those that had defaulted for a few weeks come back to get their medication. But if we bring them back to take their medication and to run out again, then we are not saving anything. So we are really pushing to make sure that whatever we have should be beefed-up, should be topped up so that we don't get to such kind of a condition anymore.

Avril Benoît:

Kate, we're here talking about the indirect effects of the pandemic in the places where we work. Can you speak to this issue of the shortages of medication, of supplies, things that are there for other kinds of ailments, other morbidities that have been made worse or more complicated because of the pandemic?

Kate White:

Yeah. It's been a domino effect because it's... many of our drugs that we get from antibiotics through to anti-malarials, the raw products come from China. And then they are manufactured elsewhere and then distributed out. And what's happened with the pandemic is everyone has closed down a little bit. So China has limited what products they're exporting for manufacture. The next country is also then, they want to make sure they have drugs for their population. So then they're limiting again, what they export out for others. And so, then you're left with a dramatically smaller pile of drugs than you had before.

And so for us, it's really, really trying to do a bit more longer term pushing and planning that we don't get into this situation where we are running out.

We're still currently have drugs and yes, we are trying to move them. And that's very difficult sometimes with airlines, that movement restriction. But we can get creative as long as we have the supply, we can help get people to do hand-carries in. We can get other mechanisms but it's really about in six months’ time, making sure that those that are producing these drugs, they open up to export so that we can get supplied back on track globally. And we don't have a situation where we no longer have anti-malarials to give to children who are coming in with malaria and needed to be able to survive. And I think that's really important is that the impact is not just about today. It will really be felt sometimes six to 12 months down the track if something doesn't change now.

Avril Benoît:

For sure. And from the perspective of the questions, one of the questions arising is, have you had to really innovate? Is there something innovative in just adapting? Maybe George, you can speak to that.

George Mapiye:

What we have done... I'm not sure if the question is related to the drugs or to the activities but I will just speak about the activities that we have put in place in that... Due to the lockdowns, we have created a community-based approach where we have said, okay, people who have chronic diseases, not only HIV and TB but also diabetes, hypertension, that they do not struggle to come to the facilities but we have points that we are distributing medication. We collect from the health care centers where they used to collect from then we bring closer to their communities. We have what we call Luanda sites, 12 of them and where we don't have MSF Luanda sites, we have identified the walls, the schools that were not in use, churches that are not in use now. And altogether we have 35 sites that we are bringing medication closer to the community. And people can just walk to go into collect from that site. And we also added the collection of bloods that needs for the monitoring of their conditions. And whenever they have complications or abnormal readings, that's when they have to go to a healthcare facility. So this is something that was not in place but something that we've put in place to make sure that we access all these people. And we've actually also added the secondary activities, like familiar planning, like immunization that we have brought closer to the communities.

Avril Benoît:

Kate, we have a question here from Borchueh, I believe. How does MSF's headquarter offices like where you are help the many projects around the world adapt to new protocols, new ways of working involving protecting the staff, protecting the patients?

Kate White:

That's a really good question. A number of different ways, I think, a nice link, a little bit to your question before around innovations, we actually have a team, a small team dedicated to that, really looking at ways that we can do things differently or access different resources globally. They've looked into 3-D printing and so we've done some great partnerships with different local universities in countries that we work in places like Addis in Ethiopia and Goma in Congo. And they are helping us do things like 3-D printing face shield, so that we have extra personal protective equipment. A part of the team that I work with here in headquarters is a group of infectious disease clinicians. And I mean, this is a disease that in terms of treatment options, how it looks in different groups of people all over the world changes almost on a daily basis. And trying to keep up to date with the scientific research that is coming out is quite exhausting. So, that's their responsibility. And they really look at making sure our protocols and our clinical guidance are up to date and in line with the best evidence. And on top of that, we've been able to create and innovate ways that that can get to the field faster. So we have an online platform, which is a community of practice and it's for our clinicians and our nurses in the field to be able to ask some of the questions that are really puzzling them and get not only support from their fellow peers in other countries in terms of what they're seeing and how they're dealing with it but also support from your expert specialists back in headquarters. And so those are a number of the different things that the headquarter functions do in order to make sure that our projects can run as smoothly as possible.

Avril Benoît:

And Katie, we have a question from Facebook about, for all of the efforts, what is MSF actually doing to stop the spread of this virus? Are there any innovations or approaches that you want to share with us? Things that have worked?

Kate White:

Well, things... I think that the biggest things that have worked are things that are very local and very contextual because different groups of people behave differently. And you really need to take that on board when you look at trying to reduce risk. I think one of the best things that all of our teams did at the beginning is they really engaged with communities at a local level to see what's going to work for them. Because I think the big take home lesson that I've learned from every single outbreak that I have ever worked in is unless you have your local community on board, wherever that may be, you will not stop transmission. And so that is really the foundation. And so they've really worked with communities to say, "Who are your most vulnerable? How can you protect them? And how can we facilitate that as MSF." Whether that be helping to provide your water, sanitation and hygiene for that community, ensuring they have a referral pathway for healthcare, that we bring healthcare to a community level, they have the means to be able to provide some form of protection for themselves. And all of those public health measures, when communities are on board and accepting and will really take them on and do them, that's how you reduce transmission. Unfortunately, just implementing things and telling people what to do, never works. I know when someone tells me what to do, I generally don't have the best attitude.

Avril Benoît:

Yeah. I can understand. But... George, we've got a great question here and I keep muting myself because there's somebody suddenly doing construction in my backyard, in the building next door. But George, one of the things that you always have to deal with and this is a question from the audience is how do you help communities to stay up to date with the real factual information and counteract what might be disinformation or those who are just trying to create a lot of mistrust toward the people like you, who are trying to help?

George Mapiye:

Yes. So our intervention here in Eshowe is at three levels, like at the hospital level, secondary healthcare and primary care level, and in the community. So we train the health care workers the capacity building to make sure that they are well-informed. They implement the correct ways of prevention and managing COVID-19. At community level, we have got the... at primary healthcare level, we have health desks at the entrance of each facility that, whatever you have come for, you are able to get information.

You are able to get flyers, you are able to be tested. At community level, we have the health promotion team that goes around the communities loud hailing.

We have also a community that has been doing... a team that has been doing community screening. And ahead of the community screening team, we've been loud hailing, we've been giving health education to make sure that people are informed and it just, this week we are starting on... we have a local radio station where we have engaged with them. And soon we'll be having slots every Tuesday to make sure that people are informed and people call in and we give them information. We have, like I mentioned before, we have a call center where people... it's a toll-free number, people can call in and get information.

So we are making sure that at every level, at every opportunity, people get access to that. Like I mentioned before, we have engaged the community leaders, which include the counselors in urban areas, the traditional leaders in the rural areas to make sure that they are well informed and people can get information from them, whatever they do not understand. We have community health workers where they can walk into the facility or to their homes to get more information. So this is how we have made sure that whatever that is spread is taken out.

We are working very well with a local Muslim community who have allowed us to use their Mosque mic that we can share the message through the mic and because it is high up, everyone in the town can hear the message. And they continuously play the message so that people are well informed. And whenever are gathering in town, we have all these last days of the months where people are queuing, we have been engaging with people, putting hand washing points, educating people, whilst they're in the queue to maintain physical distance, to distribute flyers, to explain to them individually and in a group.

Avril Benoît:

I can see how those things where you have a strong team, that the community knows that I've always been there for people, how that would work and be essential. You've got the trusted relationship already. Kate, you are also keeping an eye on places that are in conflict and knowing your previous work with Diphtheria and Ebola and so forth. I mean, right now in Yemen, just to pick one spot, what would be your concerns about the indirect effects of the pandemic and this difficulty of you can't just move around in a conflict zone to do all that kind of community work that George was describing that they're able to do in Eshowe. Tell us what it's like for the teams in Yemen.

Kate White:

Yemen is... Yeah. Yemen is really feeling the impact of this pandemic and of COVID-19. And I think part of what you see at the moment is people not being able to access health care for all of this until they're really, really at the end of their disease process. And so in terms of how do we turn it around? There's a few things, whilst we, and sometimes healthcare workers that are working for us are not able to access different communities, there are still ways that you can get a message across or have interactions with them. And so in many complex zones, there are people within those communities that are trusted for those communities. And you'll generally have some phone contact with them. You can set up surveillance groups or on... WhatsApp is a wonderful thing that I think, since its invention, we've used it in so many different ways.

And you're then able to help both guide the information that is flowing in there and also look at other ways in which you can support that community to respond itself. But Yemen is an extraordinarily difficult one. There's multiple frontlines, getting supplies in is across those front lines is difficult. There's no easy fix but we're really looking at ways that we can tap into different networks in different communities and try and use those to get people unities and try and use those to get people our health facility because if we can pick them up early, then you have a much better chance of survival.

Avril Benoît:

We are coming up to the end of this session talking about the indirect effects of the pandemic on medical work that we do as Doctors Without Borders, Médecins Sans Frontières, MSF. Kate, you've got the big picture view of things. How has this response trying to really stop the pandemic, help people with it, through it? Has it affected our operational expenses?

Kate White:

It's massively affected our operational expenses. We've seen the cost of basic protective equipment triple in a very short space of time. And we know that, that we'll also see that increasing cost in terms of getting suppliers in, also HR, we have an impact there in the terms that we have many staff that have been affected by this and they are at home on sick leave. And so, we have to reduce sometimes the services that we provide but the expenditure is still the same. It will have a massive impact in the future. And I really hope that with the support of people around the world, like my mum, my mum is a donor, she gives $50 a month, that we can continue at the same rate that we have but us, we are, we will potentially just be as affected as many others in this, in terms of the economic impacts of this pandemic on the world.

Avril Benoît:

Oh, please thank your mother for us.

Kate White:

I will.

Avril Benoît:

George. Final question to you for those who are watching, what can they do to help?

George Mapiye:

Yeah. One of the things that we have actually done locally is to form a task force of all stakeholders so that they can support. And we encourage everyone around the world that, yes, this has affected the whole world but the interventions that we are doing also save ourselves as well, so whatever service that you can give, whatever donation that you can give in, will you help us, like what we have heard from Kate, that it has affected the healthcare workers, it has affected each and every one at every level, at every... I can say profession that works to make sure we deliver what we need to deliver, needs to be supported. And we are running out of funds. So we would encourage donations towards the activities. And as you go to our websites, you can see how massive our works have been and they are now being affected and we would want to continue to do more.

Avril Benoît:

Yeah. Well, we will do more. We're not running out of funds to the point that we're not... but we do appreciate all the help. No, we're doing a ton. But thank you so much for all the work that you're doing, George. And to you as well Kate. It has been absolutely a pleasure to have you both sharing your wisdom, your insights and your experiences with us. So, thanks again. And just to let you know that Kate

White is medical technical lead for MSF's COVID-19 pandemic response. George Mapiye is MSF’s deputy project coordinator in Eshowe in South Africa. So thanks again to both of you. We'll be back in another couple of weeks for another, Let's talk COVID-19, I don't know why I was doing the air quotes, in the two weeks.

But in the meantime join us next Thursday at this time for a special live event in honor of World Refugee Day, registration is on our website under the upcoming events part of it. And you can also search for World Refugee Day on that website. The website is doctorswithoutborders.org. And also the global website is msf.org. You can also find us on Facebook in many languages, including MSF.English, on Twitter it's @MSF_USA, Instagram Doctors Without Borders, pretty easy to find. And for more specific information or questions that we may not have gotten back to you on, don't hesitate to contact us. Our email address for this team is event.rsvp@newyork.msf.org. I'm Avril Benoît, executive director of MSF-USA. Thanks very much for watching and we'll see you in a couple of weeks. Bye for now.

George Mapiye:

Okay. Thank you. Bye.

Avril Benoît:

Bye.