Background 

Doctors Without Borders/Médecins Sans Frontières (MSF) is an international, independent, medical humanitarian organisation that delivers emergency aid to people affected by armed conflict, epidemics, natural and man-made disasters and exclusion from healthcare in more than 70 countries. MSF offers assistance to people based on need and irrespective of race, religion, gender or political affiliation.  

MSF has worked in India since 1999, providing free-of-charge essential healthcare to people in remote areas, and specialist care for people affected by HIV/AIDS, malnutrition, hepatitis C, tuberculosis, kala azar and sexual and gender-based violence. We also respond to natural disasters and other emergencies, provide mental healthcare and advocate for the development of more effective and affordable medicines to improve access to treatment for people everywhere. 

We currently run projects in the states of Andhra Pradesh, Bihar, Chhattisgarh, Delhi, Jammu and Kashmir, Jharkhand, Maharashtra, Manipur, Telengana, and Uttar Pradesh. 

MSF was awarded the Indira Gandhi Prize for Peace, Disarmament and Development in 1996 and the Nobel Peace Prize in 1999. 

 MSF OCBA in India 

In West Singhbum district of Jharkhand, MSF runs a project for the community-based management of acute malnutrition.

In Patna, Bihar, MSF is focussed on the treatment of Kala Azar–HIV co-infections including generating evidence for better treatment protocols so as to aid Kala Azar elimination efforts and provide care to a neglected population.

 Project Summary  

One-third of all HIV patients worldwide live in regions where Leishmaniasis is endemic. Visceral Leishmaniasis (VL) caused by the parasite L.donovani is endemic to Bihar, a populous state of 110 million people in East India, which carries an estimated 40% of the world’s VL burden. Although Bihar has a relatively low prevalence of HIV (between 0.22 – 0.33%), its high population density means that in absolute numbers an estimated 300,000 people in the state live with HIV/AIDS. 

Moreover, Bihar is one of the few states in India where the rate of new HIV infections is increasing. This has major implications for VL co-infection: like other opportunistic infections in HIV patients, Leishmania amastigotes have evolved strategies to survive which are enhanced by HIV co-infection and accelerate the progression of the disease. This may help explain why the risk of developing VL is estimated to be between 100 and 2300 times higher in HIV-infected individuals than in those who are HIV-negative. Evidence on the prevalence of HIV-VL co-infection in India is scarce, although estimates range from 2-6%. HIV-VL co-infection, therefore, appears to be an emerging public health issue in India.

The evidence base regarding best treatment practices for co-infected patients worldwide is limited, due to a lack of randomized trials and to the fact that most available data comes from observational studies with relatively short follow-up periods, and often with high rates of loss to follow-up. Nevertheless, worse outcomes in almost every respect have consistently been reported in this patient group when compared to patients not known to be HIV-positive – for example, in terms of higher relapse rates, mortality, and VL drug toxicity and treatment failure.

All of the existing evidence regarding co-infected patients treated with AmBisome® in the Indian context has been generated from retrospective programmatic observational data by Medecins Sans Frontieres (MSF) and the Rajendra Memorial Research Institute (RMRI). The outcomes for these co-infected patients were substantially worse than for VL patients not known to be HIV-positive receiving the same VL treatment in the same setting, where the estimated all-cause mortality and relapse rates at 15 months for patients not known to be HIV positive were 2.8% and 1.2% respectively, compared to 18.1% and 16.1% at 12 months respectively for co-infected patients. 

Considering the lack of quality evidence surrounding treatment for co-infected patients in the Indian context, MSF along with RMRI is conducting a study examining the effectiveness of 40mg/kg AmBisome® — as recommended by the WHO for VL-HIV co-infection but never tested in India or on L. Donovani in the Indian subcontinent — and a lower dose combination of 30 mg/kg of AmBisome®  and Miltefosine (100 mg daily for 14 days) be formally evaluated in order to provide the Indian policymakers with evidence to develop specific guidelines for the treatment of co-infected patients. 

 General 

No. of Posts Available: 03

Location: Patna, Bihar

Project: Kala Azar-HIV co-infection 

Availability: Minimum 1 year, annual renewal of contract

Expected Start Date: ASAP

Last Application Date: 31st December 2018

Monthly Gross Salary: INR 23,507/- 

Email: msfe-delhi-recruitment@barcelona.msf.org AND msfe-patna-fin@barcelona.msf.org 

 Purpose of Post 

• To provide day-to-day medical care, to HIV/VL patients. To supervise, coaching and training to the MSF ANM assigned to the ward. 

 Functional and Hierarchical Lines 

• Hierarchically accountable to the Nurse Supervisor 
• Functionally accountable to Medical Activities Manager

 Main Responsibilities and Tasks 

• To provide and ensure the correct nursing care of the HIV/VL patients in the MSF Kala Azar ward and assist Doctors in the care, procedure and treatment of the patients 
• To provide correct nutritional screening, drug dispensary, give IV fluids and injections to HIV/VL patients according to prescriptions and protocols
• To attend and ensure the implementation of correct protocols concerning follow up of the HIV/VL patients 
• To provide instant emergency treatment to emergency cases in consensus with Doctors 
• Participate actively in medical rounds and provide the updated information about HIV/VL patients status 
• To observe and ensure correct follow-up of patients. 
• Perform rapid laboratory tests according to MSF protocols when needed and confirm the result with MD/MAM 
• Record the required medical data accurately and collaborate in the reports. 
• Keep proper records and ensure their safe custody. 
• Respects the principles of asepsis and sterilisation. 
• To respect and promote absolute confidentiality of any information related to HIV/VL patients. 
• Participate in, and when required facilitate, medical/nursing training sessions, both internally and externally. 
• Participate and give correct health education messages to patients and their attendants. Specifically giving appropriate information about Kala Azar, signs & symptoms, correct treatment, follow up, nutrition, and prevention. 
• To respect and promote the medical ethics. 
• Give support to the laboratory activities when it’s needed. 
• Give support to the pharmacy activities when it’s needed.

 Reporting 

• Filling in the register book/patient card, noting everything that happened during the shift and any changes in prescription or patients to be followed up 
• Ensuring to give oral/written handover at every shift change, drawing attention to any notable events during the shift
• Participating in departmental meetings.
• Collaborate in the reports as needed
• Participating in data collection for the HIV/VL Study

 Managing Medicines and Departmental Material 

• To understand, maintain and improve the MSF medical stock management systems. 
• Handing over stock cards of medicines and material at every shift change 
• To ensure that the daily consumption is in line with stock and place an order if necessary 
• To guarantee the proper sterilisation process is being done 

 Producing Statistics  

• Filling out registers and health files correctly
• Participating in data collection with the departmental manager 

 Other Responsibilities 

• Performing any other tasks as required by your Supervisors
• Maintains a flexible approach and responds to the needs of the project even if outside of this job description
• To assist in the assessment of humanitarian needs and emergency interventions arising in the region and if needed, showing flexibility, adaptability and commitment.
• To respect MSF internal regulations, the contract and the present job description

 Required Working Days 

The nature of the work requires presence on Sundays and Public Holidays as per duty roster. Sundays are considered as a weekday. Special arrangement are only considered for official Public Holidays (as per Internal Rules and Regulations) 

 Requirements 

 Qualifications 

• BSc  (Nursing) or General Nursing & Midwifery (GNM) recognized from a Nursing Council of India

 Work Experience 

• Minimum 2 years of work experience as a nurse or midwife, preferably in rural areas.
• Experience with HIV/VL patients is an asset 

 Specific Skills 

• Ability to organize and prioritize workload & taking initiative when appropriate
• Good spoken & written English; Essential good understanding of local language(s)
• Able to integrate into a multi-cultural team and cooperate with co-workers
• Able to work independently as well as part of a team
• Ability to manage stress 
• Demonstrates flexibility in taking up tasks outside of regular job responsibilities as required
• Willingness and ability to live and work in a rural setting
• Good Punctuality and ability to act with responsibility
• Understanding of MS Office especially Word, Excel & PowerPoint
• Must be proficient in medical nursing procedures including IV Cannulation, administering IV, IM, SC injections; use of IV fluids etc.

 Desirable Skills 

• Good knowledge of MoH policies and general system of health management 
• Knowledge of MSF principles 
• Work experience with at least one MSF project 

 HR & Benefits 

• Salary: Rupees 23,507 gross/month
• Benefit of 13th Month Salary
• PF and Gratuity are applicable as per law. 
• Total Leaves: 27 leaves + 12 public holidays per year. 
• Relocated staff will be provided with Accommodation & Shifting allowance. (Only for out of state candidate). 
• Wide Medical coverage (Employee + Direct Relatives), as per organization policy.

 Application Procedure 

To apply please email your CV and a motivational letter mentioning why you would be interested to apply for the position with the subject Ref: Nurse (GNM) to msfe-delhi-recruitment@barcelona.msf.org AND msfe-patna-fin@barcelona.msf.org on or before 31st December 2018.  

Applications that are no completed (CV + Covering letter) will not be considered.

ONLY SHORT-LISTED CANDIDATES WILL BE CONTACTED AND INVITED FOR INTERVIEW.

Médecins Sans Frontières/Doctors Without Borders India is an equal opportunity employer. Women candidates are encouraged to apply.