Mahosot budget proposal 2005 - Tropical House Design by Vincent

Lao People’s Democratic Republic
Peace, Independence, Democracy, Unity, Prosperity.

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Ministry of Health - Mahosot Hosp
Pheivat Road, Vientiane, Lao P.D.R.

Project for the Provision of Plastic Surgery for Patients with
Cleft Lip–Palate in Provincial Hospitals of the Lao P.D.R.

1. Localization of the project:
Nation-wide, eventually to cover all provinces of the Lao P.D.R .

2 .Context of the project:
The public health system in Laos is still facing enormous challenges in order to provide accessibility of health care to its population, the lack of basic preventive health care in remote areas where the population is exposed to unexplored war devices (UXO)

Infant mortality in Lao P.D.R is at approximately 80 deaths per 1000 live births 5 years ago. Most of the health problems in Lao P.D.R are linked to diseases that could be intervened in terms of prevention of diseases.

The provision of surgical services for children with cleft lip- palates started in 1993-1994 in Lao P.D.R .The provision of these services was done on a yearly base since then by German surgery team.

Then in 1995 Australian team “Interplast” took over. This included not only the services in itself, but also training of a team of Lao plastic surgeons, anesthetists and operation theatre nurses.

This training resulted in a qualified team of Lao counter parts able to perform most of the surgical cases (cleft lip – palate mainly)

Since 1999, the Lao team did organize outreach sessions to provincial hospitals in order to decrease the prevalence of this affection. This resulted in an average of 200 operations at least per year.

In 2002, this project was managed by Handicap International (with funding from AusAID, SMILE TRAIN, AMADE and WIGV). It included training for provincial surgeons, training for the Mahosot Hospital team as well as operating during the year.This ensured that the cleft lip – palate prevalence could decrease in Lao P.D.R as well as taking care of other needs for plastic surgery.

3. Identified problems:
Cleft Lip – Palate can already be operated independently now. Throughout the practice in the provinces and at Mahosot hospital since 1995 until now, congenital deformities are also referred for surgery. These infirmities inhibit strongly the normal development for children which affects them psychologically .The main reason that these persons continue to suffer from these deformities are of economic nature (poverty).

4. Objectives of the overall project:

A. General objectives

To increase the capacity of the surgical team to be able to respond to the needs of facial and general plastic surgery at Mahosot Hospital and by training surgeons in the provinces.

To provide managerial support to surgeons through training in order to continue fundraising and to provide access for persons in need.

To search for partnerships (technical and financial) to enable the health system to extend services for persons with crania-deformities (increased interdisciplinary care).

B. Specific objectives for this project period

To operate a number of cases in order to reduce the prevalence of facial
deformities, and other plastic surgery needs.
The staff of the visited hospitals should also be seen as a beneficiary
here in terms of training. The expertise of the team is transmitted at least
on an informal basis first (local surgeons observe all operations and local
nurses are informed about their duties during anesthesia and after).

5. Beneficiaries:
Types of Lao patients treated by the project.

Despite the fact that many patients were operated in many provinces and also in the hospital in Vientiane every year since 1995 there are still many left because 70-80% of these patients are poor and live in remote areas without access to the public health care system. The causes of these infirmities can be related to:

a. Diseases contracted or because of inappropriate medication taken by the mother
during pregnancy: 40 %

b. Congenital cause: 30 %

c. Environmental causes: poison, chemical agents taken up in
the organism: 10%

d. Unknown 20 %

6. Partnerships and support:

In 1999 Save the Children Australia (S.C.A) in Vientiane funded 5,000 US$ for cleft lip reconstruction surgery.
Province: Sayabouly
Cases treated : 35
Trained : 1 surgeon, 1 anesthetist, 1 scrub nurse, 1 recovery nurse
Project Summary; it was a first time for Lao team to operate in the province to reduce the cleft lip-palate patients in the remote area, better for the patients who have no opportunity to pay by themselves

In October 2000, 22,000 US$ (US$ 5,500 per province) funded by AusAID
Provinces: Houaphan, Xieng Kouang, Luang Namtha, Bokeo)
Cases treated: 205
Trained: 4 surgeons, 4 anesthetists, 4 scrub nurses, 4 recovery nurses .
Project Summary: the budget was direct to Lao plastic team at Mahosot Hospital. We operated not only for the cleft lips-palates but also for burns, reconstructive patients .

In January 2002, AusAID with Handicap International funding has made it possible to set up and implement this project on a long-term basis. Their support enabled to address the cleft lip – palate surgery issue in Lao PDR as a challenge that can be solved by Lao surgeons.
Provinces: Champasack,Oudomxay, Phongsali, Khammouane, Attapeu.
Cases treated: 305
Trained: 5 surgeons, 7 anesthetists, 7 scrub nurses, 5 recovery nurses
Funding: US$ 32.500(US$ 6,500 per province)
Project Summary: the partnership was Handicap International, they organized the funding and Mahosot Hospital plastic team carried out the project

Since June 2002 Woman International Group of Vientiane (WIGV) has been an interested partner for supporting medical costs for children with clefts lips

The Smile Train grant of US$ 21,000, provided in October 2002, has been used for equipment purchase and patient support. In 2004 part of that grant was spent for training at Khon Khaen University Cleft Lip Center.

December 2002, AusAID together with Handicap International provided funds for the Lao team to carry out 105 operations of cleft lips in southern Laos.

Since 2002 AMADE association from Monaco supporting children in need under the representation of Dr. Christian-C Dupuis could gather around 2000 US$ for organizing the training of provincial surgeons by Lao team at Mahosot Hospital, every year until 2010.

The links with the Centre for Facial Surgery in Ho Chi Minh City since August 2002 resulted in the participation of Lao team in a seminar organized by Operation Smile in October 2003 at Pon Hong hospital (Maria Teresa hospital), 48 patients received care. (training and sharing surgery know-how)

Khon Khaen University contacts have resulted in exchanges of technicians,
know how and observation of activities on both sides.

Participation by the Mahosot team in the international congress on cleft lip care in December 2003 at Khon Khaen University was a real highlight.

In January 2004, further training at Khon Khaen University Hospital was provided for the Lao plastic surgery team.

In October-November 2005, with the initiative and funding of US$ 2,000 from Smile Train to Mahosot Hospital, 25 patients were operated. This was a warm visit strengthening the collaboration of KKU, the Smile Train representatives and Mahosot surgical team.

Several events and occasions organized by embassies and initiatives by individuals have also contributed in providing access to care and financial help for patients in need.

7. Summary: Year 1999 - 2005

Total cases treated: about 620
Total doctors trained: 18
Total anesthetists trained: 12
Total nurses and scrub nurses trained: 22

8. Human resources and materials:

The resources for this project consist of:

1. The plastic surgery team at Mahosot is multidisciplinary and made up of four core members plus their assistants; when performing operations in a provincial hospital, an additional staff of seven members is needed to assure the appropriate quality of service: 1 assistant surgeon, 1 assistant anesthetist, 2 scrub nurses, 1 recovery nurse, 1 social worker,1 speech therapist; this number could vary if needed.

2. A fee system is ruled for the services provided for all these persons.

3. Consumables include anesthetist medication, sutures, dressing material and disinfectants. A unit cost is provided per case. (Vary for difficult or simple cases for cleft-lip)

4. The transport cost of the project is covered through a vehicle: fuel expenses will be requested for calculation of rates based on the Mahosot hospital logistics procedures.

5. A transport allowance for the patient is calculated according to distance from the village to the hospital, food is also provided.

6. The amount for total expenses is about 125 US$ per case in Vientiane, more so up-country depending on the logistics

9. Monitoring and evaluation:

Mahosot plastic team and Director Board of the hospital in terms of the financial management will audit the project. This is in line with Mahosot hospital guidelines on all its programs: accountancy registration of expense and control of spending.

A set of guidelines for the activities has been written and applied by the management of the project. It includes:

- Practical advice on how to refer cases
- Registration system for patients
- Safety guidelines for anesthesia
- System of indemnities for personnel related to the activity in the hospitals
- Cost calculation system assuring access to the care
- Reporting procedure after each session of activity

10. Financial provisional matrix:

Transport cost is averages: in provincial travel in Lao they range between 6 US$ to 24 US$ per roundtrip. This cost will likely be less as most patients will come from the villages to the provincial hospital.

Medical exam costs, registration cost and medical treatments are fixed and have few fluctuations.

Family support and food have been calculated largely in order to address the highest needs

Personnel support staff cost is the average spent on per diem fees according responsibility and number of operations performed. This staff is necessary in order to assure safe practice and avoid “pressure “on patients. If it is found out that additional money is asked to patients, the Mahosot hospital program will see to it that the hospital direction is informed and action is taken accordingly. Mahosot hospital will reserve anyway its right to continue per diem to individual who has been identified by the Mahosot hospital program as not being reliable.

11. Summary of the project:

This project is presented by the Mahosot team to further the treatment of cleft lip and palate children in the provinces and towards the training of provincial surgeons in the field. If this can be continued it will be an important step towards the Laotian team self reliance without having to resort any more to substitution by foreign team.

Mahosot Hospital Vientiane , 22 July 2006
Dr.Bounthaphany BOUNXOUEI Mobile: 856-20-5509961
bounthaphany@yahoo.com Fax: 856-21-214020

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