ANnual 2010 report - Prupet

Technical advisors. Nurse care. Eloïse Despond, Gaëlle. Tonnaire, Nathalie ... before start. All are recruited by. PRUPET for their specific competences.
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Dear, As usual, we are proud to present this annual report of our NGO. We expect that you could find in this document many reasons to pursue or to begin collaboration with PRUPET. We have also the pleasure to introduce a new communication tool between us and all our partners and friends: the newsletter of our association. It will be published every 3 months and will be distributed by email to all our contacts.

It

will

also

be

available

on

our

institutional

website

(www.prupet.org). We take this time to thanks all our staff; our Cambodian representative, Dr Sophors Chan; all Preah Kossamak staff and especially Dr Sokhoeun and M. Sathya for their fantastic motivation beyond all difficulties. Let’s go ahead together! Sincerely yours.

Sébastien Couraud, MD Founder, President

Céline Guichon Founder, Former president

PRUPET is French NGO. We undersigned MOU with Cambodian ministry of health and Preah Kossamak hospital in 2009.

Executive board

Executive president Sébastien Couraud, MD Treasurer Céline Guichon

General secretary Virginie Avrillon, MD

Head of Cambodia office Sophors Chan, MD Webmaster Christophe Legras

Technical advisors Nurse care Eloïse Despond, Gaëlle Tonnaire, Nathalie Kazmareck Epidemiology José Guerra General assembly 25 members

Management Marc Vandenbrouck Medical information Christian Vandenbusche, MD

Main aim of PRUPET is to share competences. Consequently, our NGO rely on several professional who bring their time and knowledge to their Cambodian colleagues. This year, 7 permanents staff and 4 volunteers have succeeded in Phnom Penh’s PRUPET office.

Permanents staff April 2010  November 2010 M. Sophors Chan Pulmonologist, Phnom Penh, Cambodia

Ms Gaëlle Tonnaire Nurse, Lyon, France.

He is our permanent representative and head of Cambodia office.

She pursued general hygien project and developed many care protocols (bandage, urinary catheter…)

Permanents staff November 2009  April 2010

Mr Raphaël Lachaux Health manager, Limoge, France.

Ms Thida Kol General practician, Bordeaux, France.

In management ward, he helps Cambodian team to improve its works.

Mission reports of all our staff are available on our internet website (French only). Please, visit www.prupet.org

Permanent staff benefits of a grant from PRUPET for their mission. Each had a special training in France and then in Cambodia, before start. All are recruited by PRUPET for their specific competences.

Affected in gynecologic ward, she worked especially on cervix cancer prevention.

Volunteers Year 2010

Ms Virginie Avrillon Pulmonologist, Lyon, France. Affected in pulmonology unit, mainly studied acute pneumonia.

she

Ms Eloïse Despond Nurse, Lyon, France. Affected to general hygien ward, she developed waste management and hydro-alcoolic use.

Ms Clémence Arvin-Berod Pharmacy student, Lille, France. She worked 1 month in pharmacy ward in order to better understand drug circuit in hospital (under authority of Ms Gaëlle Tonnaire).

Ms Anne Marie Repzka Surgery specialized nurse, Arras, France She assessed hygien in operating room: instruments, laundry, sterilization…

Lyse CATHELAIN Emmanuel KNOACKERT Nurse student, Arras, France During their 6 weeks training course, they developed care protocols in traumatology ward (under authorithy of Ms. Eloïse Despond).

As previous years, 2010 showed balanced accounts, exclusively dedicated to our work in Preah Kossamak hospital.

1%

2%

17%

Expenditures - 2010 Type Amount (€) Operating costs 375,39 € Incentive for staff 19 695,03 € Grants for projects 4 020,40 € Derivatives 129,83 € TOTAL 2010 24 220,65 €

80%

Operating costs

Incentive for staff

Grants for projects

Derivatives

1% 22% Incomes - 2010 Type Amount (€) Income from derivatives 185,00 € Donations 19 390,00 € Membership fees 700,00 € 2009 budget surplus 5 611,68 € TOTAL 2010 25 886,68 €

0% Income from derivatives

77%

Donations

Membership fees

2009 budget surplus

In Cambodia, PRUPET acts through the unit for International Affair of Preah Kossamak hospital. This department is fully supported by our NGO and is the coordinator of all projects supported by international partners. We also developed our proper projects; always on ask of hospital direction. Theses projects are those which are reported in this document.

I – General hygiene WHO home-made hydro-alcohol solution In 2010 we ensure that this project was durable. We developed nurse training in each hospital unit for better use of this hand washing solution. As efficiency indicator, we follow monthly the consumption (cf. Fig.1).

Waste management As asked by Cambodian MOH, we help the Kossamak hygiene ward to set up the waste management protocol in the whole hospital. Our nurse created special training and posters (see Fig.2). We are assessing efficiency by follow up of safety box and garbage bags monthly consumption (data not yet available).

Fig. 1 - Monthly consumption of hydro-alcohol solution 45 40 35

Liter

30 25 20 15 10 5

Au g0 Se 9 p0 O 9 ct -0 N 9 ov -0 D 9 ec -0 Ja 9 n1 Fe 0 b1 M 0 ar -1 Ap 0 r1 M 0 ay -1 Ju 0 n10 Ju lAu 10 g1 Se 0 p1 O 0 ct -1 N 0 ov -1 0

0

Stairs for family As pilot program, we financed stairs for each bedroom in traumatology unit. These stairs are aimed to collect all personal belonging (food, water, laundry…) of patients and visitors so that they are not more on the ground. This small program contributes to enhance floor hygiene in the unit. We aim to extend it in 2011 for the whole hospital.

Fig. 2 – Waste management poster.

II- Hospital assessment Cambodian ministry of health (MOH) developed an assessment tool. Under authority of direction, we decided to conduct a step by step program for apply all items of this official document in hospital. So, our staff develops many training and meeting to diffuse all these recommendation. Then, as expected, a self-evaluating was conducted by hospital staff under supervision of our staff. Results were compared to previous one (conducted in 2008 by MOH). They show a real improvement since last assessment (see Fig. 3).

80%

% conformity

70% 60%

79.2%

50% 40%

55%

30% 20% 10% 0% 2008

2010

Fig. 3- Assessment results for step 1 (Hygiene, equipment, organization)

In 2011 we aims to conducts another self-evaluating on step 1 (Hygiene, equipment and organization) and to expand it to step 2 (quality of documentation and procedure and patient verification).

III- Care protocol In 2010 we developed many care protocols in order to enhance quality and security of care in Preah Kossamak Hospital: Operating room hygiene, Laying of urinary catheter, Laying of periphery venous catheter, Bandage, intramuscular injection, Instrument sterilization.

Fig. 4 – Protocol for intramuscular injection.

IV – Enhance hospital care offer

V- NGO coordination

In respiratory disease unit, we created monthly video-assisted medical meeting for counseling physicians about difficult diagnosis or decision (cf. Fig. 5). This project permits better quality of care in this ward. Moreover, all cases discussed are summarized in a dedicated report archived in medical file of the patient. Furthermore, this is one of the first steps before development of oncology care in Kossamak (expected in 2011).

Last but not least, PRUPET, under authority of Kossamak direction, acts as coordinator of all missions of international NGO in the hospital. This years, our staff coordinated more than 10 “short” mission (2 weeks each usually). We also supervise reception of 2 containers.

12 10 8 6 4 2 0 Oncology

Infectious disease

Other

Fig. 5 – Number and theme of cases discussed.

Fig. 6 – A container opening in November 2010

VI- Koh Pich Drama During this drama in November 2010, PRUPET staff helps hospital management in care organization and in grants management.

We have many projects for 2011. Some are old projects for which we still need grants and some are new one.

I- Extend cares provided by Preah Kossamak hospital Lab We want to enhance performance of hospital’s lab. For this project, we currently explore several grants possibility such as Fondation Merieux. As a first step, we will soon conduct a first global expertise of the lab and develop quality control inside. Oncology Ward / Cytotoxic unit We aim to implant cancer chemotherapy in the hospital. This very complex project covers many fields and need a careful step by step procedure and lots of competences. Sleep disorders investigation After bronchoscopy and non-invasive ventilation, we will send to pulmonolgy ward some equipment for investigation of sleep disorders (polygraphy, night oxymetry). A dedicated training will occur in the same year. Double CT scan reporting In June 2011, Preah Kossamak should acquire a CT scan. In order to improve quality of radiologist analysis and reports, CT scan will be also interpreted by a French team (twinning between the two units). Biomedical unit This old project should be finally concretized this year. It aim to create a biomedical unit in Kossamak, to furnish special equipment and to train the staff. Moreover, we want to develop a dedicated formation on this field in Phnom Penh. Family House. This another old project is lacking of grants. This year, we recruit a volunteer specialized in fund research, especially for this project.

II- Continue our programs for nurse training and global hygiene

Vital signs Our nurse, will develop the monitoring of vital signs by nurse through dedicated training course. This item is part of MOH assessment and should be easy to assess later. Hygiene of surface (binch, floor) Surfanios© is a specified disinfectant for ground. Currently, it is used in operating room and ICU and we aim to extend it to the whole hospital.

III- Care assessment The NOSOKOS Study We establish an epidemiologic study about frequencies nosocomial surgical site infections. This study should begin in March and will recruit about 255 patients. MOH Assessment As 2010, we want to continue MOH assessment preparation. In 2011, we want to perform step 3 (Management assessment) and to perform step 1 again.

In 2010 PRUPET developed its scientific activities. Through several original works, our NGO proves its efficiency and contributes to train Cambodian doctors to evidence based medicine. Original article submitted Couraud S. Chan S, Guichon C, Horn K, Try S, Mafuna N, Avrillon V, Gérinière L, Perrot E, Souquet PJ, Ny C. How international guidelines can be applied in poor countries? Example from creation of a new flexible bronchoscopy unit in Cambodia. Open Respir Med J, 2010 (submit). Short publication submitted Couraud S, Chan S, Avrillon V, Guichon C, Duret E, Guerra J, Souquet PJ, Ny C. Monthly video assisted web meeting between French and Cambodian team in order to improve management of difficult cases: retrospective review of one year exercise. J R Soc Med. 2010 (submit). Medical doctor thesis Ny Chanty. Adult bacterial pneumonia: clinical and microbiological aspects – About 141 cases in Preah Kossamak Respiratory disease unit, from January st th 1 2009 to July 31 2010. Th Med, Cambodia, #698, 2011.

Drs Ny Chanty and Chan Sophors receiving their diploma from the hands of Pr KA Sunbaunat, Doyen of Cambodian medical university

Chan Sophors. Study of surgered patients for Non-Small Cell Lung Cancer in Lyon university hospital (France) from 1998 to 2002: patients’ characteristics and survival factors. Th Med, Cambodia, #699, 2011. Avrillon Virginie. Acute pneumonia: are French recommendations applicable to Cambodia. Th Med, France, 2010.

In 2011 we expect enhance this activity by publishing other articles about Home-made hydro-alcoolic solution, pneumonia in Cambodia, and our study about nosocomial surgical site infections.

PRUPET’s partners