Telecounseling for mental health care in the Palestinian Territories
In Nablus, in the Palestinian Territories, our specialized mental health project for people with moderate to severe mental illness and victims of violence treats children and adults, including survivors of domestic violence. Last year, as COVID-19 lockdowns restricted movement in communities around the world, survivors in Nablus were suddenly trapped at home with no escape. The only way MSF teams could reach them and continue our support was to pivot to telecounseling—something new for our therapists and patients alike.
Reports soon emerged that intimate partner violence was increasing around the world during the pandemic. The situation in Nablus was no different, and the abuse was increasing in severity as well, putting women’s safety at even greater risk. But as a testament to our patients’ resilience, they adapted and innovated. They worked with MSF therapists to develop safety plans, established self-care regimes to help reduce their anxiety, and chose code words to warn that their partner could overhear the counseling call. In fact, fewer women dropped out of counseling than was the norm before.
Once lockdowns eased, it was important to be able to see the highest priority patients face-to-face again, while observing safety protocols. But COVID-19 has shown that telecounseling can be feasible and effective, and it can be offered in addition to face-to-face therapy as another pathway to care.
Self-swabbing for HPV in Zimbabwe
Without better access to cervical cancer prevention, many women in high-prevalence countries like Zimbabwe will continue to face premature death. In Gutu district last year, MSF’s cervical cancer prevention and early treatment program, in partnership with the Zimbabwean Ministry of Health and Child Care, conducted a trial that compared the results of patients’ self-swabs for human papillomavirus (HPV) infection with swabs taken by a nurse.
The typical screening method—known as visual inspection with acetic acid, or VIA, the mainstay of MSF’s program and others like it—requires human resources, training, and equipment that can limit its implementation. We asked, what if the simpler high vaginal swab to collect an HPV DNA sample could be effectively conducted not only by nurses, but the women themselves? The answer is that it could significantly expand access to diagnosis for patients who are unable to access health care workers or clinics.
Our trial results demonstrated that nurses and patients were equally effective in collecting a sample. Most patients found the self-collection procedure comfortable, and almost all said they would recommend self-collection for HPV testing to a friend. MSF will further explore the preferences of women and nurses who have participated in this care.