A simple, waterproof backpack, containing emergency medical supplies, including a solar charger, treatment for malaria, infections and body pain, a dressing kit for wounds and, a register to record what has been used.
Upper Nile state, South Sudan
- Portable malaria test kit
- Antimalarial drugs
- Acetaminophen (for pain, fever, and inflammation)
- Oral rehydration solution
- Solar charger
- Wound dressing materials
- Sterile water
- Antiseptic wipes
- Water purification tablets
- Nairobi Displacement Unit
- Design Lead
- Logistics Referent
- Medical Coordinator
Communities in conflict-riven Upper Nile state, South Sudan, are often forced to flee new outbreaks of fighting at a moment’s notice. In 2015, MSF began supplying ‘runaway backpacks’ to community health workers in Upper Nile who could move with them and provide on-the-go medical treatment for minor injuries and common ailments. The backpack, inspired by an OCA initiative, was a simple way to bridge gaps in access to healthcare. In December 2016, the Upper Nile community of Wau Shiluk and the MSF project based there were evacuated to escape renewed fighting. Ten runaway backpacks were in use during the evacuation, but they had only limited success.
In April 2017, after MSF restarted mobile clinics in the area, our team at the Nairobi Displacement Unit took on the challenge of designing a new strategy for the runaway backpacks, so they could be more effective when the next crisis erupted. How to craft a mobile form of healthcare that could move at the same pace as those fleeing the conflict’s frontlines?
Failing forward and learning
Part 1: The context and the strategy
At the Nairobi Displacement Unit, we began by learning more about the context the runaway backpacks were being used in. We worked with Dr Aziz, the medical coordinator in Aburoc, where MSF had begun running the new mobile clinics. He helped up to identify the issues behind why the backpacks were not used.
It soon became clear that at the root of the problem was the lack of a written strategy for the runaway backpacks. This had led to the backpacks holding items that required specialist skills to administer, which was at odds with the choice of community health workers as their assigned wearers. The health workers could not use the injectables and infusions they carried. In addition to this, many of the packs contained expired drugs that should have been replaced.
Our new strategy would cover the medical and logistical contents of the backpacks, their design, and the selection and training of their future users.
Part 2: Planning the contents of the backpack
We then started thinking about the look of the backpack and the essential materials each one would need. They needed to have the right supplies for the carrier to provide basic medical care, but be sparing enough that they weren’t burdened by excessive weight.
At first, we thought each backpack should have space for orientation and telecommunication equipment, medical supplies and personal belongings. However, we soon realised that a pack with a high-tech kit like a satellite phone or solar panels might bring the risk of targeting by an armed group, so we dropped both of these.
Working with Dr Aziz, we refined the choice of medical supplies for the backpacks. We determined the essential medicines. We agreed that each backpack should contain malaria treatment, antibiotics, medication to reduce fevers and relieve pain, and wound care supplies. A particular improvement on the previous backpacks was to replace specialist items with easier to use alternatives; for example, injectables were swapped for oral drugs.
We also added a booklet of key MSF protocols on proper use and dosing of drugs to provide a portable reference for backpack wearers.
Assessing product pros and cons
Part 3: Developing the backpack and getting them produced in Juba
We looked into having the backpacks custom-made, so they could be the perfect size and with all the right pockets, but this proved poor value for money. Instead, we concluded that best way would be to design it such that any backpack could be used, as long as they were the right size and reliably waterproof.
We also decided that they should appear generic. While most items worn by MSF staff are white, these would be plain black with a small MSF logo; identifiable, without singling out the wearer as a target.
Part 4: The backpacks go to Aburoc and Aziz fills them with the correct items
Rather than creating and shipping the backpacks centrally, we sourced them from a supplier in Juba, the South Sudanese capital. In March 2017, 10 backpacks were shipped up to Aburoc, where Dr Aziz and his team filled each one with the correct medical and logistical supplies, sourced from their stocks. The backpacks were then stored in the facility’s central pharmacy.
Compiling the contents locally helped to ensure that there would be readily available replacements for any pieces and also helped with creating buy-in from the team in Aburoc.
Part 5: Training staff in Aburoc
Dr Aziz supervised the training of 10 key members of staff who would be responsible for carrying and using the backpacks in the event of a sudden population movement. The group included doctors, clinical officers and senior nurses, nurse assistants and community health workers, all of whom were already trained in MSF protocols. The group was responsible for maintaining the backpacks and ensuring that any drugs were in date.
In the months that followed, the group continued to receive quarterly follow-up refreshment courses to ensure the packs were used properly.
Part 6: Successful field use of new backpacks
We did not know when the bags would prove useful. In April 2017, there was an outbreak of fighting between government and opposition forces. 25,000 people fled Kodok and 29 health workers, each carrying a runaway bag, followed the fleeing population in an ambulance. One backpack could provide care for approximately 10-20 people.
Now, the runaway backpack is a concept with several variations and is used in a range of MSF contexts. OCBA have several projects that are integrating the backpacks into their stocks.
Are you in a location where evacuation is likely?
If there is displacement, is it likely that MSF medical staff or community health workers will be amongst the displaced communities?
If displacement occurs in your context, what might you include in a runaway backpack?
Implementing this design requires review and coordination with HQ. Note that, at the time of going to print, OCBA (Jose Luis Dvorzak, Decentralized Model of Care Advisor) has validated the contents of this feature. If you have any technical questions, please get in touch with your medical / public health department.