On the ferries: the unmet health care needs of transiting refugees in Greece.

Background: In 2015, over 850 000 refugees, asylum seekers and migrants arrived in Greece. In response to an overwhelming need for access to healthcare for them, Doctors of the World established the Refugee Ferry Project, which comprised of a clinic providing primary health care, and integrated mental health and psychosocial support on board a commercial ferry. Methods: Of the 1405 service users, 87.5% (1229/1405) originated from Syria, Afghanistan and Iraq. The majority were women 801/1405 (57%) and children 511/1405 (36%), including 50 pregnant women and 19 unaccompanied minors. Results: The most common diagnoses were respiratory tract infections, dehydration, nausea and vomiting, and musculoskeletal pain with 39.4% of the disease burden being classified as non-communicable. Exposure to violence was associated with an increased risk of developing mental health issues. Conclusions: Humanitarian actors face huge challenges trying to respond to the needs of transiting populations. It is only by continuous reassessment and having the capacity to mobilize and adapt to an ever-evolving situation that we can try to meet these needs. Having an integrated, flexible and multidisciplinary approach remains crucial, despite the shift from a transit to static population. With over 62 000 refugees stranded in Greece, the need to develop innovative ways to respond to their needs is greater than ever.

Diagnosis and management of a ruptured rudimentary horn pregnancy in a low-resource setting.

A 22-year-old woman presented with amenorrhoea, lower abdominal pain and brown vaginal discharge. She was noted to be in hypovolaemic shock with a distended and peritonitic abdomen. On bimanual examination, the uterus was not palpated, the posterior fornix was full and cervical excitation was present. A clinical diagnosis of a ruptured ectopic pregnancy was made. She was resuscitated and an emergency laparotomy was performed. Intraoperatively, a ruptured rudimentary horn with an ex utero pregnancy was discovered. The right horn and tube were removed, as was the non-viable fetus. There were no postoperative complications and the patient was discharged after 5 days of observation.

A mistaken diagnosis of Molluscum contagiosum in a HIV-positive patient in rural South Africa.

A 25-year-old gentleman presented with multiple small ulcerations and papules covering a large portion of his face and neck, associated with general malaise. He was HIV seropositive with a total CD4 count of 78 cells/µl. A diagnosis of Molluscum contagiosum was made and the patient discharged. He re-presented 3 weeks later with a 2-day history of progressively worsening headache associated with photophobia and diarrhoea. The generalised skin eruption had worsened, now involving his torso and upper limbs. Cerebrospinal fluid examination was highly positive for cryptococcal antigens and the patient was started on amphotericin B. Skin biopsy confirmed cutaneous Cryptococcus neoformans. After 4 days, the headache and photophobia resolved. A mild improvement in his skin was seen after completing 14 days of treatment. He was discharged with lifelong fluconazole therapy.