Program for improving care of diabetics in Phnom Penh
Training health care personnel:
20 physicians and 60 health care auxiliaries have been trained over 1900 hours
4 physicians + 4 nurses are now trainers
All the teaching documents have been handed over to the doctors trained in files data
Improving access to medication for the poorest:
1,5 Millions U. Metformine + 1 Million U. Glibenclamide + 150.000 U. Furosemide and Captopril were bought at a very low price from IDA Foundation (Amsterdam) and sent. They have been sold at a price about 50% lower than in the chemistry of the city.
80% of the patients can buy it, according to the prescriptions
About 20% i.e. people with the lowest incomes can have the drugs and the HbA1c test for free.
Diabetes education and awareness:
12 educational posters and 6 index cards of nutrition were created and printed to be shown and distributed in numerous copies.
4 articles were published in newspapers ( “Cambodia Daily”, “Cambodge Soir”, “K set” , “Courrier international”)
Collaboration for “Diabetes guidebook” – Peter Starr (IJF)
1 DVD animation was released in khmer language and can be seen every day on TV screen by all the people attended in Kossamak hospital diabetes department. It is also used by the staff of MoPoTsyo.
The individual book handed to every patient contains 3 pages with images and information about the disease and its management.
This phenomenon can be explained by the fact that the patients with diabetes in developed countries have a longer life expectation leading to longer duration of care and treatments.
To obtain the same results in developing countries, even with enormous efforts in terms of prevention, it is obvious that the costs of cares and treatments for Diabetes will increase considerably.
So, what is the solution for developing countries and poor populations?
30% of our patients have high blood pressure, when in the literature; the prevalence in Asia is on average between 15 and 20%.
In developed countries (UKPDS) this prevalence is of 39%. The longest life expectation is also the main factor there.
However this percentage is even higher in Maghreb in 2000 Pr. Chraibi found 65% of diabetic people with high blood pressure.
We estimate this impact by comparing the data of the patients coming for the first time in consultation between 2007 and 2009.
It is interesting to notice that, during the first consultation:
In 2007, 53% of the patients had very strong imbalance (HbA1c superior to 10 %).
In 2009, this ratio decreased to reach 34%.
In 2007, the HbA1c average was 10, 6%.
In 2009, the HbA1c average was 9, 3 %.
This evolution shows that the advice delivered to the patients spreads widely among them and that many people benefit from it which is increasing the impact strikingly.
For several months, we have noticed a clear improvement with fewer and fewer patients with serious imbalance.
This is the same regarding the weight : during their first visit in 2007, 58 % had a BMI superior to 23, against 47 % in 2009.
More than 10 % already knew the noxious effect of being overweight and had taken it into account.
But after 5 or 6 consultations, this number of patients being overweight did not decrease.
The patients informed have already made some efforts and do not seem to maintain these efforts on a longer time, waiting for the results of the treatments.
Responding to our questionnaires, patients said that they have passed the information and the advice received at least to 10 or 15 persons of their environment.
It means that more than 50.000 persons have been reached and explains that more than 50 % of the patients come from all the provinces of the country.
This mode of communication is undoubtedly, the one that reaches better the Khmer population. Messages from the authorities are often perceived as propaganda and few people read the press, even more within the population from modest condition.
This regular increase in the number of patients coming allows us to note that this program responds to a real need and gives satisfaction to the patients.
MicaDO performed 30 missions for the program ; each trainer MD or nurse worked one month with the local actors
In January 2005 Kossamak Hospital did not beneficiated of diabetes department; After solicitation from Ministry and Hospital Direction we signed partnership agreement and we began training ( 6 hours/day, 30 days by 2 specialists MicaDO MD ) for the future specialised staffs : 2 MD ( Dr.Serey and Dr.Khun ) and 4 nurses ; we organise the department in the available area, we give some equipments and consumables and in February the DS department opened and the first patients was coming for detection and consultations (file and booklet , weight, height, pressure, blood glucose test, medical examine, medical prescriptions, giving drugs)
In December 2005 the data was : 1000 consultations, 600 new patients, 400 with regular follow up .
The changes over the course of the project period was :
Training to 2 more MD working in the department ( Dr.Chey Sokha and Dr.Sok Bunna, DU Diabetes students in the Faculty of Health) and 10 others DU students working in others hospitals
Project impact : (State actual impact in diabetes care)
The diabetic people feel the need of specialized consultations and well trained medical staff
The general population is better informed and broadcast their knowledge
The Health authorities and the Ministry consider the doctors trained as experts and allow them to participate in the decisions.
The study on rice IG in relation to local cooking modalities has improved the nutritional advice
key changes observed arising from project activities,
The number of consultants coming from provinces is regularly increasing.
The slow but significant decrease in the obesities and overweight of the patients coming for the first consultation
The very big imbalance among these same first consultants is decreasing.
Two points less over the HbA1c averages among patients after 4 or 5 consultations allows to expect a decrease in the complications of at least 25 % in the target population of diabetics. But we didn’t have enough time to study and to give evidence of it.
During the 7 first months before the partnership with WDF, 600 new patients came and 400 of them followed up regularly.
Now, at end of our project, the service had 5000 new patients (75 % regularly followed) and 22.000 consultations have been done
Rapport final septembre 2009
Les rapports bi-annuels de nos activités 2007 - 2008 - 2009
juillet 2007 - décembre 2007
juin 2008 - décembre 2008
Programme Santé et Nutrition à Kompong Speu
Ce programme s’est étendu à 4 villages de la province de Kompong Speu
Les membres des centres de santé ont été formés et une consultation avancée spécialisée de diabétologie se fait une fois par semaine depuis 1 an
Les 500 enfants de 4 villages, de 8 mois à 10 ans, consomment la pâte nutritive pendant un mois et sont ensuite bénéficiaires de l’éducation nutritionnelle délivrée aux parents et de l’appui aux familles.
Au 12° mois 45% des enfants ont amélioré leurs courbes de poids et taille (au-delà de +1 déviation-standard)
Formation du staff : les 2 médecins et les auxiliaires de santé en charge du programme
Les enfants du village de Trapaing Peuk consomment la bouillie nutritive quotidienne.
Par la suite, toutes les familles ont reçu l'éducation nutritionnelle destinée à améliorer régulièrement les apports.
L’évaluation au terme des 2 années du programme montre une amélioration staturo-pondérale de plus de 2 Déviations Standard chez 50% des enfants inclus
Actuellement les familles bénéficiaires mettent en pratique les conseils nutritionnels et les agents de santé formés continuent le suivi des enfants
L’acquis d’un bénéfice pour la moitié des enfants sera pérennisé.
Nous avons tenté de créer des partenariats avec des organisations agissant dans le domaine agricole et sanitaire afin d’aider les familles à accéder à la diversité alimentaire et à des activités génératrices de revenus. Cette complémentarité des compétences aurait permis d’améliorer les résultats.
Des projets ont été élaborés avec AGRICAM, HEIFER, Heath Unlimited. Les accords de partenariat n’ont pas pu être signés.
Le programme médical « Nutrition Cambodge » est terminé.