 Now open for questions points about both the keynote as well as the two panelists that we've just heard so Please raise your hand. I know MSF is not shy and then We will ask you to say who you are and who you work for just in case it's not MSF We're gonna start actually with a question from online. So Pete, please Hi, this is just a clarification for Anne. Do people need to leave their homes and I assume they mean the safe area in order to obtain the material to carbonize If it's on yeah, yeah the carbonization place is within the secured enclave and In agreement with the military and the community leaders chosen in a in a central place. Yeah Thanks, so You're okay, so the women with the very attractive little box Yes, that you have The key is to have an attractive box on your lap, please Hi, my name is Tisha. I'm in MSF and I also work as a doctor in the NHS and I'm part of the governance mechanism of MSF so I I'm gonna ask my question relating to organizational culture But before I do that, I want to thank you all four of you it has been I'm sitting here in awe and inspiration So thank you first Innovation you showed that picture Ben of Uganda and all these millions of ideas and this overload of excitement and enthusiasm innovation and The response was to shut it down because we couldn't they couldn't control how much How many good ideas are coming out? You also talked about the processes of and how much money and energy and to to give to Innovation and and how does an organization stimulate it? and it leaves me a little bit confused because you want to inspire it and At the same time you are in the mess of of the picture behind you And you have to get on with your day job as well and How do we get that balance right? And how do we what is the organizational approach to to stimulate that? Thanks, and then I'm gonna ask you to think deeply on that question or we take a few more and then we'll come back next gentlemen in the center there with the blue t-shirt of about five rows from yeah Hello, my name is David MSF Sweden innovation unit. Thank you very much first of all for really inspiring Talks I have a question for um, I was just wondering How did you decide that this was The challenge you wanted to work around a bit in relation to all the other presentations I mean, we are quite quick often To think that this is what is the most important Challenge for the community. So I'm interested in the pre step a bit. Did you have Discussions with the community on our this is this really the challenge that they would like To be solved or is it something that we as MSF assumed like we do quite often that this is what they need Thanks very much MSF Sweden good, so um Ben you've had a chance to reflect and very succinctly respond great Thank you. Thank you very much. It was a hisha So I think I think it's about ethics and it's about discipline So I agree that there is something positive about that picture about the proliferation of effort and what it symbolizes But there are lots of things that aren't great about it If you think about that as the a medical equivalent of that would be Putting a whole load of products and a whole load of treatments into the field without actually constructing any basis of experimentation No evidence no basis of comparison Huge amount of duplication huge amount of potential waste No consideration of what it was actually doing to the communities or the people that were actually involved So in one instance in one community people have been given in the same community People were given five different maybe our feigns by different people going in and and they had to swap their SIM cards between them In order to get the treatment for the for the package of treatment that's available. So I think I Think it's good to channel the energy But we need to do it with discipline and with a bit of rigor and in that context It should have been some means by which in that case probably the government setting priorities and people coming with Evidence-based protocols for what they were going to do and how how they would test it Just because you're doing innovation doesn't mean you're playing tennis for the net down And I think from a medical point of view. I think it's about discipline and it's about ethics You wouldn't do anything of that kind in the NHS You wouldn't just roll out a whole range of different products without without any rhyme or maybe you would Raising our eyebrows But therefore we should we should have the same kind of system and I think it's contingent on us in places where they don't have those Accountability systems and mechanisms as a humanitarian organization to bring that to the the forefront of humanitarian innovation Thanks very much and and kind of the kind of decision-making process. Yeah, David. Thanks for the question So how the question reach us is indeed through the mission itself but of course it in the mission and in the projects the needs comes is observed and comes Hopefully fully from the from the community With this kind of cases sometimes it's challenging because especially gender-based Violence is not something that the community talks about open We see patients coming in so we have some sort of an indication that this indeed is a problem But also we hear a lot of the stories of things going on And it's not only the Nigeria mission that indicated this as a challenge But also the other missions. So this is Where we see where we get some sort of a confirmation that it this is something to work on And to dive into deeper of course when on the ground when starting the project We have to see and confirm. Is this something that people want need and aspire? Great. Thanks. We have another online question Yeah, so this question is for Lubana and Not everybody speaks the same language Did you have you faced any challenges around language and how did you resolve it? And then I'm going to abuse my power and ask a question myself The facilitator in this process seems really important. What qualities does a facilitator need to do good social mapping? Great, and Dr. Steven before you answer we'll see if we have any more questions from the audience. So I've got a gentleman a woman here on the left. Yep Who's going to get the turquoise cute box and then we'll go to the gentleman in the green t-shirt. Thank you Hi I'm Isabel I'm the founder of immersive rehab Yesterday I asked question as well about clinical trials and it's related to that again, and I was wondering so when you develop an innovation and You do run through all the ethics in the trials etc. Which is important It's already very there's lots of constraints in When you want to do it in Europe and in the US going through a C marking FDA approvals I was wondering how would you then approach it to? When you want to implement it in developing countries as well Going through those ethics within those countries, which is also very important But how to approach that from that point of view Is there one in particular that question is for I guess Ben. Yeah, okay Sure My name is Jeremy. I'm a TV doctor. I also do research Using GIS methods and things when you're trying to connect patients experiences. Could you speak louder and slower, please? Sure My name is Jeremy. I'm a TV doctor and I do GIS research using big data and trying to connect patients to experiences So my question is for Lovanna. Could you tell us about the GIS platforms that you used and What if it's You may to connect the community's knowledge outside of MSF and share with other organizations and other Social mapping platforms for example E-PAL in Maui or the humanitarian open source mapping initiative that MSF is involved in Thanks Dr. Stephen of you for two questions Okay, thank you very much for the questions The first question related to this sign language. I think Through the experience we did not meet with the Some people that needed that and for the part of for the skills for the facilitators the most important skill is see the listening skill with patients Also, like we're facilitating the group But he's not he's not supposed to be judgmental the way how he's facilitating the The group has to be really open-minded to really listen to the people and the on part of sharing the experience within the ability of the country as At first we tried within ourselves Later, we also decided that we should be involving the other people because like the second Intervention that we had We had the challenge of also language When we approach the northern part of the country where My I would not speak that language We evolved another organization Which was also dealing with the research in that area working in the community. So we shared how to do it and the quickly captured the information of the the methodology and we joined Them in the community and they were it's them who are facilitating the process of Capturing the information and also engaging the community and systematically now we Like also involving like the Minister of Health so that as we are Doing they should be also learning the process. So within the country. We have been sharing the skill now Within now our family at the international level. This is the great opportunity that we have Yes, if you people are motivated for that we are there To share the practical experience on the ground as I said, we tried in different areas the displacement The cholera the floods. It means we have tried in all angles Thank you, and to wrap up with Ben questions of ethics In other countries outside of here Yeah, there's actually quite a lot of research on this and they're three. I'm just looking at Articles but done by three ie who lead impact evaluations and that they've concluded They reviewed a whole range of different RCTs in the humanitarian context And they said while they while they're kind of practical and ethical limitations. There are some mixed approaches that can be used or blended approaches quasi experimental approaches or factorial designs There's things that can be used which are very specific to the humanitarian sector I guess I can speak that just based on work which I did looking at how MSF does has been doing innovations in emergency disease responses and The need to build and the whole range of different things from seasonal malaria treatments Through to vaccine treatments and so on and there were two things that stood out for me from the work that I was doing It was interesting actually because when I was doing the research There was the innovation wings of MSF and then you had the operational research side And I was having to look much more at the operational research side and realizing how little they speak to each other And I have some of the things that really dramatically interesting and innovative on the Operational research side weren't called innovations and I had to learn a lot of language not being a medic myself of that to Identify that this was something new and different that in itself was quite interesting But there were two things that stood out one was One was preparedness and one was parallel so on the preparedness side What what being able to Anticipate before an emergency hits before a crisis hits What would you need to do in order and to set up the necessary requirements? So you're not actually trying to design and run a trial It's when when in a crisis setting and I think that's something that MSF's been pretty good at in a whole range Of settings where they've been multi-year crises or repeated crises or where there's been a long-term presence There does seem to be some sense which people are looking at the the bases on which you can do trials and actually invest in that ahead of time The other thing I think MSF's really good at is finding partial parallels to the crises setting So that you can find for example hospitals with limited resources so you could find particular Almost developmental Programming efforts where where there are a partial parallel to a full-blown crisis and MSF in the quite examples I was looking I was actually very good at saying okay Well, we can do the trial there so that when the crisis hits we can say on the basis of the best available evidence We can now use this in a crisis setting. So those two things preparedness and parallels, I guess Both things but but I'd encourage you to read the three are you stuff. It looks really interesting Thanks, Ben and we have come to the conclusion of this session So just very briefly I want to observe that Ben likes to use the first letter of certain words So he had CCCC of all of our challengers collaborators, but then he also was using the preparedness partial parallels So I'm noting this about you Ben But really at base I think Ben has really talked to us about a history of innovation We have some real hurdles that as a community we can do better sharing Breaking out some ways that we I think have not done it Ben has also really picked up and emphasized the ethics and empathy But of course But but really quite true Lubana dr. Stephen, you know, thank you for the brilliant example of social mapping and that listening is possible in many emergencies and that sharing with Authorities with others is also a critical critical part and a creativity So you're all picking up on innovation elements and and a great example of an iteration process an important problem to solve a new idea Some trialing some challenges piloting and now a key issue in innovations, which is scale and dissemination We rarely plan for that and that I think from an ethical point of view is actually quite important So we are at the end of the first of four sessions today Well-deserved coffee and tear waiting for you and we have a huge. Thank you for our great keynote and panelists