Quarterly Review 2nd – 2019
Hep C: Our cooperation with MSF France on screening among diabetic members of MoPoTsyo, and treatment continues since May 2018. Over 12 months we screened a total of 2,558 Diabetics since the start. Among them, 122 Diabetics were found Hep C positive with Bioline rapid test (80 urban, 42 rural). The PCR results indicating high viral load required that among them 75 needed treatment to cure their Hep C. Among those 75 a total of 55 Diabetics have received the free Hep C treatment from MSF France in Phnom Penh at the National Hospital Preah Kossamak. In June 2019 MSF France moved out of Kossamak and set up the same Hep C service at Phnom Penh Municipal Hospital. We have to adapt our consent forms and explanations to the new location. In early 2019, screening encountered problems with cold chain for a brief period resulting in a drop in the detection rate. The start of problems coincided with the moment we began to screen in rural areas. MSF and MoPoTsyo have been trying to identify the precise cause with temperature controllers, and by managing a stricter transport-delivery systems. Problems happened during transportation of the blood.
Expansion into 3 new service locations:
1) Posenchey OD and HC Samaki signed the cooperation agreements. Then in May the medical consultation and the RDF became operational at Samaki Health Center. The OD Director had asked for a few weeks more time to adapt his building a bit. For the first time, medical consultation sessions were done at Samaki Health Center (annexed to Operational District office) in Posenchey OD. Also the Revolving Drug Fund was installed there. This extra location inside Posenchey OD is going to help reduce the enormous patient load at Pochentong Referral Hospital because all the patients from that part of the OD can now get services including their routine medication. The PE from another area came to help the inexperienced new local PE. In a few months, we use this experience to copy this model to Kambol HC in the same OD and even further away.
2) The second new service location is Daung Health Center in Stoong OD in Kampong Thom province. There we have put only the Revolving Drug Fund for the moment because there is no doctor there. It will attract patients from north eastern part of the OD plus more: Stoong Referral Hospital is peculiar because patients MUST pay userfee just to get refill of their prescription medication, whereas in other OD’s this is not always needed. There refills are allowed using the same prescription for a couple of times.
3) The 3rd location is going to be at Roka Khnong Health Center in Daunkeo OD in Takeo province. We used to work there in the past. Now the OD and PHD have asked us to re-open the service there. The contracts have been signed. Next step is Doctor training at Center of Hope.
Logistics: Airfreight with blood glucose strips arrived on 22 April 2019 at Pochentong. Also, a sea-freight container with medicines left Rotterdam by ship and arrived end of May at Sihanoukville. However we had some problems with damaged container door, and 6 boxes not for us which were destined for Canadian Red Cross in Mali in Africa. Our cargo was complete. We had run out of Atenolol 1 week ago, but we could avoid problems by buying it locally and supplying it in blisters to the contracted pharmacies so the patients did not experience a shortage.
Camcontrol and Camsab have been abolished for seafreight, while for airfreight there is no longer Camcontrol. This saves cost. However, now all import documents must pass through CDC for the permission: Steps: 1. MoH then 2. CDC then 3. Customs-Excise & 4. Tax authority. Our Blood Glucose Strips remained stuck at the airport since 22 april for 39 days till 31 May as the new custom clearance process took longer than before.
Impurities in Losartan: The worldwide impurities scandal involving impurities in ARB such as Losartan made the MoH issue official communication about Singapore FDA’s recall of Indian Losartan. The MoH mentions in its warning that that Indian Losartan is not available in Cambodia. Some of our patients expressed their worries, so MoPoTsyo also made a public statement to tell patients that our losartan is ok and that they should not worry. Our products are not object of a recall.
MoPoTsyo Research Plans:
- With University of Washington (Seattle), we prepare research about association between hyperglycemia, hypertension and Cognitive Decline: We signed a letter of intent to support a grant application by UW. The cognitive decline in about 1000 MoPoTsyo members will be assessed by psychologists of RUPP and by MRI at Calmette. MoPoTsyo will store the data. Patients benefit from this research by medical exam, laboratory tests, MRI and medicine discounts. MoPoTsyo benefits through some funding.
- ITM’s Prof Wim van Damme has been discussing with NIPH to research the use of pesticides, in particular by those who spray. Perhaps we can compare diabetics who spray and not spray pesticides?
Official Meetings, conferences, workshops:
- Pro-TWG Meeting in Phnom Penh: MoPoTsyo staff gave a presentation at Phnom Penh Municipal Health Department.
- Pro-TWG Meeting in Takeo: On 20 June MoPoTsyo presented its 12-year program at PHD Takeo. We invited OD authorities and PHD to discuss on the future of its peer educator networks after 2020, when our MoU with MoH will end. The OD’s and PHD welcome MoPoTsyo assistance and want to work towards a uniform model in the province. Due to hand-over of Kirivong and Ang Roka, split of Kirivong, hand-over of PreyKabas, lack of laboratory program, lack of medical consultation sessions, the implementation models in the 6 OD’s are all different. They have in common that from our data they all seem to perform less well than in other provinces where we run our peer educator networks in good cooperation with public service. So we will begin to discuss with each OD and then hold a final conclusive meeting at PHD about the future adaptations that we all want and can realize. It was a meeting in positive atmosphere.
- MoH meeting in SIem Reap about “modelling”: I joined a 2-day Workshop in Siem Reap organized by MoH, with technical assistance from NUS Singapore on 29th and 30th of April, in order to help identify barriers and obstacles to good care for Diabetes and Hypertension by Health Centers.
- MoH-Preventive Medicine Dpt kicks off a new project: A stakeholder workshop was held on 21 May 2019 to kick off “Project For Early Detection and Management of Diabetes in Primary Care”, MoH managed with technical advice from WHO. The issue of lack of medicines was raised by implementing provinces. MoPoTsyo is involved as adviser to this 3-year project financed by KfW and WDF. In order to get paid, the project must reach benchmarks. In Kampot our own OD Angkor Chey is included. The ambitious 3 objectives are: By December 2021, MoH Standard Operating Procedure for Diabetes and Hypertension Management in Primary Care (SOP) is fully implemented at 50% of HCs in all ODs in Kampot and Battambang Provinces. 2. By December 2020, sustainable models for providing community-based patient support, education, and information are integrated into preventive health services provided by at least 50% of HCs where staff have been trained to implement the SOP. 3. By December 2019, develop and enhance health information systems that can monitor national NCD program implementation and trends in disease.
- For SCUBY Cambodia (see https://www.scuby.eu/cambodia) 4 NIPH researchers came to interview me on 21 June about our suggestions experiences and ideas for scale up of diabetes and hypertension care.
- Technical Working Group Meeting for Environment & Health: On June 6th, H.E. Ung Phirun chaired the inter-ministerial meeting with large number of stakeholders to review progress of implementation of the National Multi-sectorial Action Plan for the Prevention and Control of NCD 2018-2027.
Maurits van Pelt