Quarterly Review 1st – 2019
New Evidence found of effectiveness of peer educators: Dr Mayuree Rao, University of Washington epidemiologist, used logistic regression to analyze large amounts of data over multiple years from our database: the medical consultations, the pharmacy invoice, the follow-up records from the Peer Educators and the laboratory profiles. Analyses show that MoPoTsyo patients who visit their peer educators 12 or more times per year have about a 30% higher odds of having good glycemic control relative to MoPoTsyo participants who visit their peer educators 4 or fewer times per year. This effect was found even after adjusting for consult visits and medication adherence. This result demonstrates a positive impact of peer educators on glycemic control that is independent of and incremental to other standard components of diabetes treatment. Participating in MoPoTsyo’s laboratory service also raises the odds of good glycemic control by about 30%, again after adjustment. Now we must help write an article for publication a peer reviewed journal.
Expansion to more Health Centers: The new guideline for primary care for diabetes and hypertension allows Health Centers to play a role in chronic care. Health authorities in Kampong Thom (OD Stong) and Phnom Penh (OD Posenchey) and Takeo (OD Daunkeo) want to expand to health center level. Without PE it cannot start. On 26th february, the recently created model Health Center Champey in OD Angkor Chey got some visitors: the OD Director Daunkeo and the Vice-Director in charge of NCD at the Provincial Health Department of Takeo came to see it in action as example of what can be done at Health Center level in their own OD’s. Director of Daung HC and Stoong OD Director from Kampong Thom were also visiting for the same purpose. The Doctor of Champey HC is also its Director. The visitors saw the local Director of Champey Health Center very busy with a large number of local diabetic patients, one of them a new insulin user, and all helped by peer educators and HC staff. The visitors also saw the Revolving Drug Fund in action. The result of the visit is that OD Directors and the PHD Vice-Director support the idea of expansion to the health center level. Medical Doctor who normally does consultations at Angkor Chey RH also joined because he had been training-on-the-job the Doctor of Champey HC.
Our prices: Because we bought the HbA1c machine, instead of continuing to lease it, MoPoTsyo reduced its price for HbA1c test from 30,000 riels per test to 20,000 riels. Lower price became effective on 1st February 2019. We have printed new posters with our fixed fees to distribute widely at community level.
Hep C: During Q1 we started to screen for Hep among Diabetics in Kampong Speu province and Kampong Thom province. Those who have high viral load can receive free treatment at Kossamak Hospital in Phnom Penh from MSF France.
MoH Guideline: The new Primary care guideline for Diabetes and Hypertension is ready.
Urine Glucose Strip Distribution: We have begun the distribution of urine glucose strips in Samaki HC in Posenchey OD. This is to identify patients and raise awareness. A special leaflet to connect the activity with the Health Center was created.
Training of candidate Peer Educators: training of 7 candidate peer educators was completed: 1 from Baray Santuk, 1 from Stoong, 1 from OD Kampong Speu, and 3 from Phnom Penh and one who will be program officer at our office.
WING Payroll: we pay our peer educators through the service of WING Payroll, switched from USD to Riels.
Losartan impurities: In many countries, impurities (3 types: NDEA, NDMA, NMBA) have been found in Losartan formed in the production process of many types of ARB’s (Angiotensin Receptor Blockers). It is also on Facebook in Cambodia. MoPoTsyo buys Losartan 50mg that is on Dutch market after control by the Dutch Health Inspection Authorities. In many countries all over the world including in the Netherlands lots have been recalled, but NOT our lots. In the USA, FDA has raised the upper limits for these impurities 10x! to avoid shortages of these ARB’s. Our worry is that Facebook scares our patients, making them stop Losartan without adequate replacement. I follow the situation as it develops further. It is good they the inspections test for impurities but the media should not hype these findings because there is no urgency to stop. But media love scandals because that is how they make money.
During March 2019 there were several official events in which MoPoTsyo participated or played a role:
- On March 18th National Institute of Public Health (NIPH) launched its SCUBY initiative for Cambodia, see https://www.scuby.eu/countries, and introduced more concretely a project called “BIOS”, a EU funded research project on Wearable Health Monitors (WHM), for example a wrist watch that measures blood pressure, physical activity, pulse, and even Electrocardiogram type of information (e.g. arrhythmia). London School of Hygiene and Tropical Medicine (LSHTM)’s Dpt of Global Health Associate Prof Marco Liverani, lecturer at Mahidol, NIPH staff) and Dr Josefien van Olmen on behalf of Antwerp Tropical Institute had come to Cambodia for the launch. Secretary of State H.E. Prof Eng Huot opened the event at Himawari Hotel. I was member of the expert-panel, facilitated by Dr Ir Por.
- On March 21st MoH Minister H.E. Mam Bun Heng launched an initiative called “Changing Diabetes in Children and Changing Diabetes in Adults” in front of representatives from MoH, GIZ, Novo Nordisk and Danish Embassy at Cambodiana Hotel. It will support existing Diabetes Clinics nationalwide and invest in training, providing equipment and in finding/supporting Children with Type 1. The children initiative will be located at National Pediatric Hospital, Cambodia Chinese Friendship Preah Kossamak Hospital, and Kuntha Bopha. The project aims to help 800 children under 18 with type 1 Diabetes, but to find them may be a challenge. We are a supporting partner.
- On March 26th the WHO launched its Hearts Software during a meeting with stakeholders at Sunway Hotel. WHO showed a map with only MoH Diabetes clinics and UN agencies, leaving out the work done by non-government partners such as MoPoTsyo. After the presentation, I commented that the map doesn’t reflect the reality and many others joined in with more examples. WHO has been developing HEARTS software, which stands for Healthy Lifestyle, Evidence based medicine, Access to essential medicines, Risk-based management, Team-care and Task sharing, Systems for monitoring, indeed all issues that must be strengthened to deliver chronic care successfully. The regional WHO representative proposed that Cambodian adopt 10 additional indicators to monitor CVD, but MoH just approved the new Primary Care Guideline for Diabetes and Hypertension which has its own indicators in there already.
- On March 28th the Cambodian NCD Alliance was officially launched by H.E. Or Vandine with support from WHO and organisations including MoPoTsyo, with funding coming for P4H and GIZ. I gave a presentation on the additional effects of peer educators on good glycemic control. Also, we had invited some patients with diabetes who spoke about how it is to live and cope with Diabetes: 2 of them had done this in 2012 during the Health Financing Conference at Phnom Penh Hotel. At that time it was our Board President MEN Cheanrithy who facilitated the interviewing on stage. Now it was Dr Te Vannarath, of ITM- NIPH. See article in Khmer Times https://www.khmertimeskh.com/50591597/majority-of-deaths-in-kingdom-caused-by-ncds/
Maurits van Pelt