The Methanol Poisoning initiative (MPi) is a joined venture between Oslo University Hospital (OUH) and Medecins sans Frontieres (MSF/Doctors Without Borders).
It was established in the fall of 2012 when OUH and MSF signed a memorandum of understanding to define the start of a new initiative looking at mechanisms to improve survival of methanol poisoning victims globally. The initiative combines OUH's expertise in clinical toxicology in general and methanol poisoning in particular, and MSF's experience as a humanitarian organization skilled in providing the infrastructure and the overall handling of such an emergency.
The MPi originally consisted of a task force to be launched on very short notice during large methanol poisoning outbreaks in areas of the world where MSF is already settled. (MSF is today in approximately 70 countries, many of which are endemic for methanol poisonings.)
The main goal is to support diagnosis, treatment and educational needs in the areas in high burden areas. At present, this task force is supplemented by a field mission initiative, aiming to increase the awareness, knowledge and treatment facilities in areas where methanol poisonings often occur ahead of outbreaks.
This training is aimed both at the level of MSF field mission to develop a First Responder Group, and at the local health care authorities/MOH to raise awareness and knowledge.
In addition to contributing with training, diagnostics and treatment in the form of buffers and sometimes antidotes, the MPi has also developed simplified, locally adapted treatment protocols, posters and an educational video.
Finally, the initiative has a central role in the development of a simple point-of-care diagnostic tool to be used for the screening of methanol poisonings.
The project’s aim is to reduce the harmful effects of methanol poisoning globally by strengthening medical emergency knowledge and response capacity. The purpose of the project is to develop a model that brings together experts in methanol poisoning, clinical toxicology and intensive care medicine with a global medical humanitarian organisation – namely MSF.
The OUH team are world-leading experts on toxicology with more than 15 years’ experience in research and response to outbreaks of methanol poisonings across the world. The project includes access to patients and health authorities, and enables networking that can be adapted to different contexts.
The project team also develops simplified treatment protocols and posters adapted to the local conditions. Due to natural logistics and time constraints, response would be fastest from a local MSF team or ministry of health (MoH). Thus, the project supports MSF missions and local health authorities in handling methanol outbreaks.
This is done by the methanol team training health professionals, building Emergency Preparedness Plans (EPREP), and by developing and implementing locally adapted treatment protocols. In addition, a “task force” can leave Norway almost immediately for direct support interventions to MSF missions where outbreaks occur. We can also support via tele-medicine.
An ongoing and expanding project
So far, the team has supported MSF in three outbreak interventions. In Tripoli, Libya (March 2013), over 1,000 patients were poisoned with a reported case fatality rate of 10% (101/1,066). In Kenya (May and July 2014), two outbreaks resulted in imately 341 and 126 patients respectively, with case fatality rates of 29% (100/341) and 21% (26/126).
The team has also conducted two EPREP and response capacity visits. In Kenya (September 2015), the team trained MSF staff from three Operational Centers (OC’s) and several hundred local MoH personnel. In Indonesia (November 2016), the team trained MSF staff, local NGO’s and participated in several workshops.
We have also had the chance to support missions and influence local methanol treatment protocols in countries with high prevalence of methanol poisoning. In 2017 and 2018 the team visited Russia and Indonesia several times, holding lectures and trainings for MoH health professionals and MSF staff, including a visit to Irkutsk in the wake of the December 2016 outbreak that claimed almost 100 lives. In 2019, we supported the mission in Cambodia, working with local health authorities to develop a new national protocol for methanol poisoning. Most recently in 2021, we supported the mission in Bangladesh and the health authorities with locally adapted educational materials and a training webinar. Through the years, the project has been a door opener for MSF missions in general, connecting MSF to government officials, MoH, NGO’s and experts.
It is also important to ensure that the project is properly anchored in the MSF movement internationally, and in Oslo University Hospital and the Health Department of Norway.
With the increasing demand for the project’s expertise, we need to develop and ensure the continuity and sustainability of the project by maintaining an operational, functional and wide project base. This includes a pool of available experts and project staff, as well as necessary and practical working conditions in place for the participants.
Operations Support Unit, Medecins sans Frontieres Hong Kong (based in Singapore)
Professor and Senior Consultant
Dept. of Acute Medicine
Oslo University Hospital and
University of Oslo, Norway
Dept. of Acute Medicine
Oslo University Hospital