 So we've got some questions up here. Sorry. Hi. What do you do? You can hear me? Is it me, or is it someone else? I dropped my phone. Thank you for the presentations. My name's Andrew Lam. I'm from Field Ready. And we manufacture a lot of medical devices in Syria, in Jordan, different places around the world. I'm curious about the costs of the prosthetic device. I've never seen a project done so well. So congratulations with that. You talked about the material cost, $20 to $50. I'm really interested in finding out. Everything we make as a humanitarian organization in disaster zones has got to be cheaper, better, faster than the traditional supply chain model. I'm interested if you've done that analysis of traditional supply chains, please. If we can take a few more questions. Hi, my name is Anne from the Displacement Unit MSF. I also have a question for Pierre and Safa. First of all, how quick would you have to replace the prosthesis, for example, in the case of the kids that you were showing? And also related to this question, what is the goal ultimately in, let's say, when we have this technique implemented in normal running projects? How many patients would we be able to help on a yearly or monthly basis? So a couple from the online audiences. To Fabian, do you have plans to pilot on other specialties? And if so, which? And one for physio. You mentioned 30 in cases. You provided prostheses for. How do you decide which patients to treat? If we can stop for a second. So, Pierre and Safa, I'm going to answer the three questions you have for the cost and the ultimate goals and how do you decide on the patients? And if Fabian can talk about the specialties, all the specialties, what do you mean? Let's start with the price. So how do you decide which patients you choose? And what's the ultimate goal of the project? And then the cost for prostheses? OK. So regarding the patient criteria and for this online question, so we said that we have 11 patients that get prostheses. We had 17 patients including in the project, meaning that some of them abandoned. So six of them abandoned, three of them with the prostheses and three of you have them without prostheses, most of the time because they had to go back to their own country because we are located in Jordan and we had patients from Yemen, Syria, or Iraq. And then the second thing is that our criteria is pretty simple, we just take patients below elbow amputation. So all the patients with other kind of amputation, we didn't take them. So if it appears to be a small sample, it's also because it's a new thing that we are trying to provide. And so it has to get to be known also. That was the first animal's question about the replacement of the prosthesis there. So there is two things. The first thing is at the very beginning we had some failure on the prosthesis, as Safa mentioned. I think if you want to jump on that. But the other thing is with the use of the prosthesis, especially with the kids, when they outgrow the prosthesis, so we need to change the socket or we need to change the whole prosthesis device. But the good thing is that we can just rescan and redo it and reprint the socket easily. So in terms of time, it can go from three months to one or two years depending on the kids. But now on the certain prosthesis, we have to replace four of them. Regarding the pediatric population, this could be a population that benefits the most. As the children continue to grow, we have a digital design that we've created for the patient. And we can quickly rescan and redesign. So the hope is that we can cut down on the time needed from the prosthetic clinician or a trained prosthetic professional. We absolutely need them involved in the project. We in no way plans to remove the clinical professionals. As you saw in the presentation, we have a multifaceted team of clinical professionals. And each one of them has a critical role in the project. So what we do hope is that as this project scales, that it can reduce the amount of time needed from, say, a prosthetic clinician as we are fully aware that there is a limited number of prosthetic clinicians available in the world. So that's one opportunity for the project. There was a question regarding the analysis related to traditional supply chain from gentlemen from Field Ready. So it's quite different between different contexts. And we were basically settled in Jordan for a year. So we asked the local clinics for information on cost and availability. What we were seeing with the prosthetic clinic that we were collaborating with in Jordan was that they actually had access to conventional prosthetics. And they were actually pretty efficient at making the conventional sockets as well. So in that context, they had the supply as far as materials go, but the cost was very high. We're talking minimum $1,000. We've heard estimates as high as $3,000 for a passive prosthetic device that we can provide material-wise at about $20 to $50. And Pierre, what was the cost, including the human resources? Yeah, so we made just an early analysis of the price, including the assessment period, the test period, the different materials. Everything except the rehabilitation. And the early analysis is around $200 to $250. I just want to add something, because I skipped the second part of the question. If we can give a chance to Fabien, and we have a few more questions, I'm sure it is going to cut you. Fabien, do you want to answer the question on the PLM medicine, or the specialties? We have five more minutes. Regarding the application to other specialties, so yes, they are hoping to replicate the model, whether we use the same technology or a tool that offers non-real-time and real-time support. In the area of specialties that are already identified, there are pediatric care, mental health, and management of burn cases, for example. Should mention also that the store and forward telemedicine platform already addressed many of the specialties in the asynchronous model, but with a very short response time. I have a question on top, please. Yeah, I'm Daryl Stelman from MSFUK. A question for Hassan and Tobias probably, and perhaps also Fabien. The conflict in Syria is characterized on the one hand by deliberate attacks on health care, and on the other hand by electronic warfare, where data communications or internet communications are deliberately attacked and subverted. So without going into any operational detail, what are you doing to protect this highly sensitive data in transmission from being intercepted or subverted, because, of course, it can be traced back to individuals or geographic locations? Yeah, one more question, please. Thank you. Hello. So my name is Hassan Zahid. I'm a medical doctor working for MSF. My question is for the 3D printing duo. So there's a very vibrant online community of open source 3D printing designs. I'm pretty sure you would have come across them, which focus more on functionality based on tension band wiring. But you guys chose to go down the aesthetic route. So my question is basically, was it driven by what the patients wanted? I mean, did they want aesthetics over functionality, or was there some other reason? So yes, data protection is a headache. And we are trying our best, especially today, with the GDPR starting. So we started, we tried in our projects, whether we are collecting data from communities, whether collecting data from facilities, to make it as much as anonymous as possible, and to use tools that make tracking this data. Or let's say, let's put it like this. We are using basically tablets to collect the data. So if you today manage to get one of our tablets, it will have multiple protection layers on the tablet itself. There is the pin code to unlock it. There is the login username password to get into the platform. And then all the completed forms, you cannot open them again. Data is protected from the first point this way. Then data transmission is through internet, through encrypted, it gets two layers of encryption before reaching a cloud-based server where there is another layer of encryption. I'm not saying that this is definitely 100% safe, because if someone wants to hack you, they managed to hack the Pentagon. So we are just MSF. But we are trying to collect data that by the end, it's still aggregate data, no unique patients identifiers, no unique household identifiers, so that even if you get the figures, our figures, you will know the situation, but you will not know who is having what and where. I just want to add on the question on the safety of the healthcare workers in the context of Syria. I can tell you for a fact that nobody has any doubt in their mind that their cell phone or the computer is hacked and accessed. As a matter of fact, in many contexts, like in Ghouta recently and other places, the physicians and nurses were getting text messages to their own, their personal cell phones, threatening them of being loud or verbal or vocal about what's going on in their town. So nobody has any doubt in their mind that this data is being hacked somewhere and the information is being leaked, being as David experienced, or others on Skype or a tele-surgery or so on that we experienced. We have no doubt that this is the situation. We have three more minutes, Fabian, do you want to add to the telemedicine security? Yeah, okay, first thing I would say that it's implement processes and policies that are designed to implement proper privacy and security. Work with service providers or company that are known to be strong in terms of security and privacy in telemedicine security and privacy is a key feature, period. Not use solutions, I understand that in emergency may want to go for solution that are not that safe, but there is a point in time where the organization has to be equipped with solution that provide privacy and security environment dedicated to telemedicine. So these are our recommendation, including end-to-end encryption. In Pakistan, the solution is fully secured, is only dedicated to telemedicine. There's a small database so there is little interest for people to hack it. You lock your expert into an environment that only then can access. I know we can use a WhatsApp, WhatsApp is widely used at MSF until we're going to have a problem because we're using WhatsApp, but it addresses specific needs. I'm not sure to create a challenge. Any one more final question before we have Fabien and Safa answer this question. Yeah, meet Philips from MSF. So I have a question for Ghassan because it goes wider than the electronic advantages of the data collection. It's really about how, because in general, I think the HIM-MS is great to report on volume, activity volumes, but not much analysis is done. So how do you see the fact that data are sent through even more rapidly, more effectively away from the health facilities? Is that not discouraging also the health facility managers, the health providers to analyze and interpret the data for better management? So we have one minute for Ghassan and so half a minute for you, a minute for Pierre and Safa. So thank you for that. Actually, this is one of them was and still one of the most interesting collaborative work. When we start the data collection within the first month, we created an account for the hospital management team, like a guest account to see their own data. And once they start to see their activity, they were so happy to follow. And they were making sure that their staff is doing proper data entry because it was the first time for them to be able to watch in a very clear way what they are doing in their facility, what's going wrong, what's going right. And they start to use those findings to improve the quality of their work. Just quickly here regarding the use of data and MSF. So people think that, okay, to follow activity is very important, but actually this project allows us to follow the quality of care. So I can tell you in a given project, a maternity project, the number of patients who had postpartum infection, number of patients who had episiotomy in your facility. But in our data, we give you those information, but we'll also tell you what is the percentage of postpartum infections that occurred after the episiotomy in our facility. So if it was high, you need to deal with your midwives to improve the quality of care that are providing to prevent this type of postpartum infections. Basically, we have details, very low-level details, very disaggregated data on very granular level. That's we start to use for operative purposes, operation purposes. So we have 30 seconds for staff over here. And then we don't. Sure, I will try to go as quick as possible. So you were talking about aesthetic and functional. I prefer to talk about passive and mechanical prostheses because everything is about what we call about functional. For me, a passive process can be more functional than any active process that you can see on one of our cases. So if you have an aesthetic prosthetic, which is passive or and allow the person to have less social stigmatization and go back outside and go back to the market, for example, it's functional. If you have a specific tool that allows this person to hit like the one we see before, it's functional, but it's passive. So it's simple and it's also giving sometimes a more acceptance. So yes, those choice were driven by the patient. But thank you for these questions, very important one. Thank you. Well, thank you, everybody. This was very informative session.