4th Quarter: OCTOBER through December 2017:

14 November World Diabetes Day saw the appearance of an article about diabetes in the Cambodian press please read : http://www.khmertimeskh.com/5090467/sweet-silent-killer/

 

Local Doctors replaced Hired Doctors from Phnom Penh: We can say now that the transfer of responsibility to the local Doctors has been successful.  But we have re-negotiated the financing and the organisation of Medical Consultation sessions in the following OD’s: Kampong Speu, Kong Pisey, Baray Santuk, Stoong, Thmar Pouk and Svay Chek. Other OD’s will be visited this month too to complete the review of our relationship with OD’s about organizing the sessions.  The cooperation with the OD’s is very good and friendly. The main progress that we can see this year is that nowadays almost everywhere the Hospital Doctors themselves are doing the consultations but with full respect of the chronic care system that we have put in place, so without loss of data on prescription and with full involvement of the peer educator networks for the organization of the medical consultation sessions. It is a real pity, that in the OD’s that were handed over to the Ministry of Health the peer educator network system has basically become dysfunctional since we handed them over in March 2016, mainly due to a lack of detailed policy on how peer educators must function in primary care. Neglect is the result…

 

Ministry of Health:

For the first time in 12 years, the MoH-Department of International Relations voiced concerns about the legality of me representing MoPoTsyo when we were about to sign for the new Memorandum of Understanding (2018-2020).  MoH asked me to produce a written proof that MoI recognizes the Board’s delegation to me. However, when I wanted to submit an official request for such recognition, the MoI told me that the our Articles of Association and the delegation letter signed by our Board President are sufficient to prove the delegation is legal and recognized. Besides, earlier this year, the MoI had accepted a letter signed by me, to submit the new Articles of Association of MoPoTsyo, which is also an indication that MoI has never had any problems with this. So MoPoTsyo ends the year in bureaucratic limbo, caught between two ministries on which it depends.

 

New MoU with MoH?  MoPoTsyo had received good and timely support letters from 7 Provincial Health Directors but had to wait much too long for the support letter from Municipal Health Department Phnom Penh. The technical director, who is vice director of MHD, simply did not honor our request for a support letter. The consequence of the delay was that the MoH could not yet sign a new MoU with MoPoTsyo until I solved the problem. I had to resubmit the same request again to the Director himself. He decided immediately and positively on that 2nd request. The delay had already forced me to leave Cambodia on 30 November 2017 to make a “visa run” because my 2-year B-visa – expiring on 30 November 2017 – could not be renewed. I returned on December 1st receiving a business E-visa for 1 month as if I am really looking for business…?  Hopefully we can sign a new MoU with MoH in early 2018. This is important because we have an airfreight with medicines arriving in January. Also we are about to order a container (seafreight) and we must have the new MoU (2018-2020) to import the medicines. It makes me wonder if I am not welcome anymore and if MoH in fact wants me to stop helping organize chronic care for 17,000 patients in 20 operational districts together with the local government counterparts in a financially sustainable way measuring effectiveness based on health outcomes?

 

Research – ongoing Randomized Control Trial – University of Washington (Seattle – USA)

HEANG Hen and I went to USA for 1 week from 3 to 10 november. First we flew via Tokyo to Washington DC to join a conference on Mobile Health at the National Institute for Health (NIH). Then we flew to Atlanta (Georgia) to join at the APHA conference, a conference on public health where we joined the researcher Lesley Steinman of UW to present results of the focus group discussions which had been held in 2016 in different districts in Cambodia with patients and peer educators of MoPoTsyo in order to prepare the content of Voice Messages for the 6 months research that is ongoing at the moment since August 2017. The presentation by the 3 of us went well and we got some questions. The audience appeared to appreciate it. The time spent in Atlanta was short. On Wednesday early morning we had to leave Atlanta. Then we flew back to Cambodia .

The research itself: We have improved the internet for the 50 PE who are using the 12-Inch tablet and retrained the PE in entering data. We extracted preliminary data per 31 December 2017 and shared with Dr Mayuree Rao (UW). She is from University of Washington has arrived in Phnom Penh and is working with us to analyse the database to study adherence to medication based on the data in our database for a publication. Her visit will last from 25 December until 12 January. She visits peer educator groups, medical consultations and will interview other stakeholders. Her focus is mostly quantitative analysis.

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