 My name is Ghassar Aziz. I'm a medical doctor from Iraq, kind of ex-surgeon. And I'm based in Amman, working with MSF in an entirely different topic, which is more or less collecting medical data for operational purposes. I wish my colleague, Arthur, here, Dr. Ziad, who's our medical coordinator assistant, would be here to present. But he's so precious for even his mission to be let down to attend here. I'm glad that Dr. Ahmed was presenting the issue of language barriers inside Syria, with the medical staff in Syria. Because this language barrier, the Arabic practice of medical practice in Arabic inside Syria, was the leading cause for us to do what we have done in the project that I'm presenting today. And in Syria, we are supporting too many health facilities in different ways. But mainly in the opposition-controlled areas in the south of Syria, across Jordan, we don't have direct access. So we are having some kind of remote support or remote collaboration with some health facilities. And the main hospital that MSF Spain was working with is Busra Hospital, which is kind of a big hospital, covers an area with a catchment population of more than 100,000 people. That hospital had been targeted and even bombed once before. In 2015, we started supporting the hospital in a way of providing medical equipment, some medical guidance, and to try to help the staff in that hospital, the brave staff who are continuing to work there, with the support that they need to perform their work. And afterwards, we start to ask the hospital to send us the data about their patients, the patients that they are treating. In MSF, we have a standard tool to collect data. And what I'm going to explain today is going to be very interesting for MSF medical staff who are aware of this internal MSF data collection tool. While for medical professionals who did not have the experience to work with MSF, they will see that, OK, this is simple. But in MSF, it was not that simple. We have a standard tool to collect data, yeah. It's called HMIS, Health Management Information System, and HMIS is Aggregate Data System that you look into tally sheets of activities of the facility by the end of the week or by the end of the month. Those tally sheets, this HMIS system is in English, at least the versions we are using. There are other languages in French also. And what you need from your facility to do is to fill the HMIS tally sheets, and then you can do direct entry to the HMIS platform so that you can follow the activity of your facilities. The problem is that we are dealing with a facility inside Syria. There were, first of all, you need medical staff to do that, to be able to collect the important findings. And medical staff, they were having a huge human resources problem, so it was not easy to ask doctors and nurses to spend time to work on data rather than dealing with patients. Plus, they were not speaking English. Very few of them were able to speak English. They were busy in the OT or in the emergency department. What did our team do in MSF Spain by that time? They translate those tally sheets into Arabic, asking the hospital to send tally sheets by the end of each month filled in Arabic about the numbers, the activities that they are doing. And we had no clue about the source of the data being sent from the hospital. So I start today because the team was facing problems in receiving the HMIS data on time. Sometimes they were receiving the data of one month by the day 10 or two weeks after the end of the month. The first thing we discover is that this is the standard tally sheet that we used to translate and send for them. And instead of having registry books and departments, they start to use the tally sheets we send for every day and just tallying how many consultations, how many surgeries, how many, even for the age, they were just saying, putting how many new patients, how many follow-up patients in each category. So they start to lose any history of registry books. They were unable to confirm whether patient A had been treated in this hospital or not two weeks ago. What we start to do by that time, I start designing physical registry books, simple ones, paper-based, just to carry all the needed information to fill what we need in the HMIS, the Health Management Information System, the internal MSF tool. We build those physical registry books, we print them, we send them for them, and we train the staff in each department of the hospital how to properly fill the registry books through Skype from Jordan. And the registry books were very nice in a way that, for example, this is in Arabic, but we have the categories, headlines in English. When it comes to, for example, category or diagnosis, we were putting the possible diagnosis at the bottom of each registry book. When it comes to the discharge status, it was the same. So we were leading the staff on how to fill the information needed inside those registry books. So training the medical staff on properly filling the registry books was really easy. The nice registry books had been printed and sent to be enough for one year. And we start putting, recording, patients' data from all the departments by March 2017 into those registry books. In the meantime, we start to build a data entry system using one of the platforms that we're using for different projects, called Dharma Platform. So we start to rebuild a project that allows you to collect data in which you do entries using mobile tablets from those physical registry books into the tablets. And at the beginning, the data was kind of very big, 161 different questions, more than 720 possible answers for the whole questions. And the flow of data in those mobile forms is exactly similar to the flow of information on the registry book. So always the next question was the next column on the physical registry book. And there were two non-medical staff who are dealing with data and teaching them how to transfer the data from physical registry books into the platforms. The mobile devices was very easy. So they were doing data entry from every single department day by day using the tablet. Okay, what did we have? We have a big project. So we use that first phase project for 11 months. And in those 11 months, till the end of January 2018, we have records of more than 46,000 patients treated in different departments of one hospital, Chisbusra Hospital in Syria. There was an interactive dashboard that you can use. You can see, you can follow the progression of the data of your patients across different departments. This is, for example, the NCDs department. You can see the ups and downs between different diagnoses in that hospital. And that was very nice, but we decided to upgrade it for 2018. So we made it even more compatible with the standard tool that we use in MSF, the HMIS. So we had more questions, more answers. The possible scenarios for those 180 questions, almost 1,000 answers, is more than 15,000 possible options on a database. So this is how big it is. We introduced, we upgraded the physical registry books. We introduced the physical registry books into another facility. So we start to use those new upgraded physical registry books into two facilities. We trained staff into those two facilities to use this system. And now we have two hospitals using this system. And we started in February 2018 to use the upgraded version in those two facilities. And till today, I was checking like one hour ago. We have even more. We have around 18,000 patients data from the two facilities being included in our system. And by average, for each one of those 18,000 patients, we are recording eight to 10 data entry points. So those are the two locations or two facilities we have the data from. This is like, you can see the data of this is... It was on May... So no, sorry, this is on May 5th. On May 5th, we have 16,000 plus patients, but today we have more than 18,000. And we have more interactive dashboard that you can filter per time, per activities, per whatever. But it's even more beautiful because you can extract from it a detailed line list like this. So the line list that you can extract can give you even more information. Our team was enjoying filling the standard MSF tools, the HMIS. We did not stop there because extracting this line list was very ambitious for us. So our colleague, Ziad, he developed a converter tool. The converter allows you to take this line list that you exported from the platform you use called Dharma and to import it into a macro excel sheet that automatically calculates the tallying, do automatic tallying of the data required for the standard MSF data management tool, the HMIS. So exporting, importing, doing all the calculations nowadays takes around few minutes by the team. So by the start of each month, we just make sure that the staff at the hospital, they manage to do all the data entries and you work for one to two hours as a medical activity manager or nursing activity manager to export the data from Dharma to import into the converter tool to get tally sheets and then to fill the HMIS which requires one to two hours. The converter was very nice. You export the data as Excel and as CSV forms and they are usually big. So three months data was almost 90 megabytes of data on your computer and then you export it into the converter tool. After that, you choose the month, you choose the facility, you choose the year, press calculate, takes five minutes. It does automatic data verification to make sure all the data is normal. If there's any illogical data, it will be shown in, right? So you can make sure that this data is part of what I'm collecting or not and then all the data required for all these departments is available. You just need to enter it into the HMIS. So emergency room, data, operating theater, everything is there. And this is just an example to show you how much encoding is required just to get one cell. Number of life bars, all these data encoding within the converter tool. And then for scaling up for this year, we added, so we developed English version of the physical registry books that we can, let's say theoretically, we can use it in any MSF facility because it's compatible with the HMIS. Then we put the option of patient number, which means that if you have any facility that you can generate patient numbers, you can track the patient even across different departments using mobile tablets, not necessarily having any more physical registry books. So you can do this with mobile devices in every single department and instead of having physical paper-based registry books, we're trying to have a Spanish or English version soon of the physical registry books and with the cooperation of our colleagues in the headquarter in Barcelona, we hope that we can test this model of data collection in standard MSF facility. I need to thank the brave people. I couldn't put their names here, but the amazing team that works in Busra Hospital, the brave surgeons and nurses who had been bombed, had been threatened, were always under risk and they stay to continue to work in this hospital and in all the health facilities in Syria, despite all the risks that they are facing. Thank you so much. Thank you.