Welcome to this session, that we have named "Making the Invisible Visible."
My name is Stephane Du Mortier.
I'm working at the ICRC.
I'm in charge of the primary health care programs all over the world,
more than fifty-nine countries,
more than three hundred health center all over the world.
I take two examples to put you in the context.
We are in Kirkuk,
with many displaced Iraqis people seeking health care.
Or we are in Kaga Bandoro
in Central African Republic.
These two places have just been attacked last week.
Kirkuk by the Islamic State,
and Kaga Bandoro by recent rebels attack.
All teams are in troubles on both sides.
Who is even more in trouble are the population.
When we go in the diverse health centre,
we find people queuing.
We feel we are overloaded.
We feel we are overwhelmed.
Still, we have to ask ourselves some questions.
Do we have a good representation of
the local population attending the health system, the health centre?
Why did I took these two different ones?
Kirkuk is in town,
it is complex to know who is supposed to come in the health center.
Kaga-Bandoro, nevermind it is named a town,
in Central Africa, is a big village.
We have a better idea of who is supposed to be there,
who has been displaced.
We have an idea of the denominator.
The denominator is something because we expect a certain number of pregnant women,
we expect a certain number of children,
we seek for elderly.
When we don't have a denominator, it's even worse.
In Kirkuk, the denominator will be a problem.
There are many health centres, few are open.
The population is in town,
they have easy access,
suppose easy access to different health structure.
Is this health centre empty because another one is full?
It's a very difficult overview to have.
What is important as health delegate?
We are trained, we know what is International Humanitarian Law,
we know the concept of vulnerable.
Who is the more vulnerable, the displaced?
The child who is alone?
The elderly? The women? How do we seek them?
What are the questions we ask ourselves in order not to miss the vulnerable,
not to miss these one who are invisible?
How do we make the invisible visible?
Our approach is two-fold: with qualitative dimension and quantitative dimension.
The qualitative is quite easy: is the health centre I
support delivering qualitative care?
It means do we have medicine according to the needs?
Not expired?
Quality consultation?
Privacy?
Respect of the individual?
And I can tell you it's not easy.
When you have hundreds of people queuing,
you use your voice,
your 'public health' voice,
to deal with the crowd.
When the individual is in front of you,
sitting in an isolated place,
your voice should change.
You are back to the individual;
you go from the big number to the individual.
The best health service as we can do.
Obviously, it is not
a private clinic in Geneva.
Obviously, it is not Washington DC.
Obviously, we are not in a private clinic in Geneva.
We have to try the best according to the situation we are in.
The best quality care possible.
It is our aim to deliver the best service as possible.
So we have to review from the personnel, the staff,
the material, the medicine,
the access; all dimension that will guarantee quality of care.
And then there is this issue of quantity.
And quantity is a bad word,
but it means do we have the quantity of population I was
expecting to meet at the health centre level? The health centre is the last step.
People have left home, kilometers away,
problem of security, gender issue.
Is the child able to go alone?
Is the physically handicapped able to walk?
Is the mentally handicapped supported?
By the way, will he understand the medicine that is prescribed to him?
So, you see quality and quantity are always two poles we have to respect.
What are the questions we ask ourselves to be sure we do not miss
the people who are supposed to consult?
For women, it's quite easy.
We have demographic data.
We know in a normal situation,
the percentage of women who are supposed to be there,
more than 18 years old, reproductive age.
In some countries according to fertility rate,
we have a targeted expected number of pregnant.
So if I organize pre-natal care,
I'm supposed to know what is my denominator.
What will be my rate?
Number of women consulting divided by the number of expected women consulting.
This is quite easy.
Who would be the population we should not miss?
To trigger there is a problem,
you should go back to the health centre,
to help the person to go back to the health centre.
These are the questions we have to ask ourselves.
Another population, that is most of the time forgotten
are the deprived of freedom.
And then we have also, in the ICRC,
a complete department taking care
and framing the support and the help to the victim of violence.
And I will let them do their part
you will have it in a session,
but on the other hand,
there is a rule of thumb? we need to have the victim of violence in a shorter time
according to the countries
48 to 72 hours,
consulted at the health centre.
Treatment has to be given to prevent.
This is a dual center.
This is the quality dimension.
The quantity dimension is: how do we make ourselves visible to the invisible?
If I'm a victim of violence in Kirkuk, in Kaga Bandoro,
I have many steps to go through.
The first one will definitely be in the family. Do I recognize.
