 Gweithio allwch cyffredin, gyda unidod, yw'r gweithio'r gweithio. Rydyn ni'n gallu gweithio cyfnodd ar y gweithio. Gweithio arall, mae'n gweithio'r cwysig, oedd yna'r ddif wedi'u gweithio. Mae'n ddif yn ddif i'r ddif i'r gweithio, oedd yna'r ddif i'r gweithio. Mae'n gweithio ar y cael ei ddechrau. Mae'n ddif i ddif i'r gweithio, o'ch ddif i'r ddif i'r ddif. It's a question about the site. It's a question about the insulin. What type of insulin you were providing to the patient? I mean, it was in the vial or it was like a pen insulin? What kind of insulin was provided? A vial one. Next, just behind. Yes, thanks. Is it working? Florian from the Institute of Tropical Medicine. A question for Charles. Because you mentioned that your cards were quite big and that the interval was three to six months. In other settings and stable settings it was much smaller groups and monthly visits. So in the end if you have a group of ten patients and they come monthly or one group member comes monthly you in the end see a patient at least once a year for the checkup. Would that not be the case in your setting if I understood it correctly? So how was the clinical monitoring done in this setting? Thanks. Our cards haven't yet started coming back but we anticipate that groups will be seen once a year and they should be coming in a group. So once they come to the clinic a vial order will be taken and drugs will be dispensed and during that consultation then they will pick the next person who will be picking the medication in the next six months if they pick drugs every six months. If they pick every three months then they will choose members that will be picking the drugs before the next appointment, before the next group appointment which is once a year. We had a question further back and then coming down to the middle after that. Thank you. I'm Tina. I'm setting it so as enough. I've got a question for Bagawi. Sorry if I mispronounce that. So if I understood correctly UNICEF is probably the largest measure of malnutrition in children and women still used the old strap and I was wondering if you talked to them about your findings at this stage or if you plan to do it. Thank you. Absolutely we have. We sent them the results of our little standardisation exercise and in fact we invited them to come today but I hope that they're watching. They were really positive and really welcoming. They have said they'll show their results to their development unit and then take things from there. We still have to do a field trial but I think that the results have raised some issues hence a lot of agencies have contacted us about this. But UNICEF know and they were very welcoming. Ciaran? Thank you. It's a question for Said. This is fantastic results and really important work and I just was thinking about the last line when you said this can be used in other MSF and non-MSF settings and I wanted to ask so has it now been implemented in the other camps in Dadaab and if so how did you ensure that they changed their practice and if not why do you think they haven't? They have not yet enrolled the same way we did but they are issuing the patient with just insulin with no follow-up on their blood sugar levels monitoring. They are just giving the insulin with their injectable items so they don't have a clinic for follow-up and these tests of HBO and CE there's no proper follow-up of this patient in the other camps so some of them opted to move to the Gahle so that they can be enrolled in our clinics. Yes. Hi, I'm George from Amsynoa. Regarding the strap of malnutrition. Everyone is from somewhere. Well, not related to anything. Just out of my own interest. The malnutrition strap. How does anyone know when to stop using one side and then start using the other side? So there'll be one day where suddenly you're using the child strap and then the next one, your definition of malnutrition is completely changed? Yes, that's actually a great question. The basic Malak strap is for children of six months to 59 months and then we suggest that following that you flip over. The problem is that there are no defined cut-offs in many of these age groups and the cut-offs we were using were based on a consensus from 2013. Things are constantly evolving. The colour classes we've used on our strap are just for guidance. We're not saying those are the definitive cut-offs. We just wanted to prove the concept that we had. I leave it to nutrition experts to decide on where the cut-offs ought to be and we can print a new batch. But you're absolutely right. We need more consensus on those cut-offs in older age groups. Over on this side. Daniel O'Brien from the Manson Unit. Charles, thanks for that presentation. That's very interesting. The advantage of having six months' drug is if there is interruption. They've got much bigger supplies at home so they don't need to access the clinic as often. I'm sure it will help a lot. Do you still give patients a wash-out pack if they do end up running out of medication to try and stop safely to minimise the risk of resistance developing if they have to stop? The wash-out used to be applied to combinations with either AZT or D40. The current combination of TDF3TC, there's no need for wash-out because TDF itself has a very long half-life. So if it's combined with the fervorants and they stop suddenly, at least we have two drugs in the system running. So there's not a risk that the patient will be on a monotherapy. And in the centre. Thanks, Daryl. Anthropology implementer MSF UK. Charles, can you tell us a bit about the social perception of HIV in the community because it seems the groups aren't faced with any stigma because they're large and public groups? Thank you very much. In November, when we were actually planning to start this innovation, basically we were quite concerned about stigma because we started a similar programme in Chad which actually had, it failed because of stigma per se. So we ran a survey which was an exit survey and basically from all the locations, we didn't see that stigma was that a major issue. But now that the groups, when we started to implement the actual curgs, we actually see even the population actually encouraging patients to come in and also even the actual population is coming for testing. So that's quite encouraging. Maybe because they hear that MSF is leaving so maybe they just want to come and test and then get on treatment and enter curgs. But we are yet to investigate that when we run qualitative surveys. While you're thinking about your next questions, I've got a question for Saeed. The experience that Charles has told us about is very interesting from the point you view the benefits of patient self-help groups or patient support groups. In his case, he was telling us about the benefits for treating people's HIV with antiretroviral drugs. Have you helped to set up either formally or informally a patient self-help patient support group for the people with diabetes? Thank you. We have set groups of patients with their age and sex because these communities are culturally sensitive to mixing with men. So we have young ladies group, support group. We have children support group and older patient support group. So we meet with them after every two weeks. We have session with them and they talk of the challenges and the experiences and they share what they have seen and some of the lessons we learn from them is we just keep on having them in groups so that they support one another on issues of how to overcome certain challenges. So they share ideas and we have groups for them. Thank you. Any remaining questions? Yes? Thank you so much to all the speakers. My question is to Saïd. Thank you very much for your presentation and congratulations for the job because this is something that can change the life of too many people. My question, you have a very small court and I may wonder if you are going to continue with the study or do you have any plans or what's going to be next steps? Be the next steps of your study for having more patience and role or having more data for more powerful analysis. We have not completed the study. It's just ongoing. As you have seen, we are meeting every new patient who comes and fits the criteria. We admit them to the programme and as long as MSF is still in the camp I think there will be help through this programme. I think I'll sum up fairly shortly and comment on the two characteristics that I picked up during these two days of MSF staff. First of all, I strongly developed humanitarian instinct and then secondly the enquiring mind and these are not independent variables. I think these are linked so that as I see it MSF has a commitment, a professional commitment to excellence which I understand is really providing the best possible care to the populations who you serve given the difficult situations in which you work and part of providing excellence, the best possible care under the circumstances I think it really depends on using your enquiring mind to ask questions, you're sitting under the mapundu tree, you're seeing the problem, you're thinking of the solutions and then you want to do research to try to figure out how to provide even better care. So I see the humanitarian instinct and the enquiring mind is really going hand in hand and our three presenters today I think have really illustrated that joining together of the humanitarian instinct at its best and enquiring mind at its best I'd like to thank you all very much and according to my list of instructions I only have to encourage the worldwide audience to continue tweeting and to send your comments online so keep up the barrage of contributions and over and out, thank you very much. Thank you very much Dan Mitz as well.